Posts Tagged Vaccines

The price of opposing medical pseudoscience

EDITOR’S NOTE: This post is a followup to a post from two weeks ago entitled In which Dr. Gorski once again finds himself a target of the “pharma shill” gambit. If you haven’t read that post before, you might want to go back and read it now before proceeding with this post. Please also note the disclaimer.

I want to beg your indulgence this week, hoping that my history as a blogger here on SBM and then as managing editor allows me that. Today’s post will be a little different because last week was really, really, hectic. First and foremost, I was busy writing a preapplication for a Susan J. Komen Foundation grant for a deadline of last Friday. The Komen Foundation, it turns out, has changed its procedures this year so that the preapplication is now evaluated much more rigorously. It’s no longer looked at just to make sure that the proposed project matches the subject matter and criteria for the request for applications (RFA). This year, the preapplication actually matters! Moreover, it’s so long that writing it is practically like writing the entire grant, other than the budget. But I got it done, and it looks pretty good, if I do say so myself. None of that is any guarantee that Komen will invite us to submit a full application, but I’m hopeful because if it does we should have a good shot at the grant.

Then, this weekend I had to pivot on a dime and return to writing the R01 I had been working on with my collaborator. To make the July resubmission deadline, it has to be done, in the can, and submitted by this Friday. In any case, these are the reasons why this post is likely to be uncharacteristically personal in nature.

Oh, those reasons plus a little bit of character assassination launched at me on Monday by Jake Crosby over at the Age of Autism, entitled David Gorski’s Financial Pharma Ties: What He Didn’t Tell You.

Posted in: Medical Academia, Neuroscience/Mental Health, Vaccines

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In which Dr. Gorski once again finds himself a target of the “pharma shill” gambit

EDITOR’S NOTICE: NOTE THE DISCLAIMER. Also note that there is a followup to this post entitled The price of opposing medical pseudoscience that is highly recommended after you read this post.

The “pharma shill gambit”: The quack’s favorite flavor of ad hominem argument

One of the very favorite and most commonly used tactics to attack criticism in the armamentarium of pseudoscientists, cranks, and quacks (not to mention politicians) is the ad hominem fallacy. In this fallacy, rather than addressing the actual evidence and science that demonstrate their favorite brand of woo to be nothing more than fairy dust, the idea is to preemptively attack and discredit the person. The ad hominem is not just insults or concluding that someone is ignorant because, well, they say ignorant things and make stupid arguments (in which case calling someone stupid or ignorant might just be drawing a valid, albeit impolitic, conclusion from observations of that person’s behavior), but rather arguing or insinuating that you shouldn’t accept someone’s arguments not because their arguments are weak but because they have this personal characteristic or that or belong to this group or that. Truly, the ad hominem is right up there with demanding public “debates” with skeptics as a favored defense strategy of cranks of all stripes.

Among the very favorite flavors of ad hominem attack used by quacks, cranks, and pseudoscientists is the fallacy of poisoning the well. This particular fallacy alludes to the medieval European myth that the Black Plague was caused by Jews poisoning town wells. Not surprisingly, this myth was used as a justification for pogroms and the persecution of the Jews. The idea is to poison how others view your opponent by preemptively attacking them. Well do I know this fallacy, having been at the receiving end of it many times! Basically, it involves invoking something bad or biased about a person’s situation or personality and then using a phrase something like, “Of course he (or she) would say that” to dismiss a person’s arguments, the implication being that the person receives such benefits from holding the position being attacked or has such a personality that he couldn’t argue otherwise regardless of the evidence. In my admittedly anecdotal experience, far and away the most common use of the ad hominem from quacks and pseudoscientists is what I once described as “the pharma shill gambit.” The idea behind this gambit when it comes to attacking those of us who promote science-based medicine is to tar one’s opponent as being a “shill” for big pharma or claiming that we have a conflict of interest so blatant that “of course we would say that.” In most cases, the bogey man is big pharma, in whose pockets we SBM bloggers are supposed to be safely (and profitably) ensconced, blogging away in our underwear for big bucks and, following the orders of our supposed paymasters, attacking anything that has even a whiff of being “alternative” or that “questions” the safety and/or efficacy of vaccines.

While I realize that there is such a thing as an “astroturf” campaign, in the vast majority of cases, the pharma shill gambit is nothing more than the variant of the ad hominem fallacy known as poisoning the well. I also realize that conflicts of interest (COIs) matter, particularly undisclosed COIs. Indeed, I wrote a rather lengthy post (I know, I know, do I write any other length of post?) about 8 months ago laying out my views regarding COIs in science-based medicine. The short version is that we all have COIs of some sort or another, be they financial, belief-based, or emotional, and more disclosure is usually better, to let the reader decide for himself. As far as COIs related to big pharma or finances, I think Mark Crislip put it quite well in his most recent Quackcast when he said that if a study is funded by big pharma, he decreases the strength of the evidence in his mind by a set amount. However, evidence is evidence, and, although it is reasonable to increase one’s level of skepticism if there is a major COI involving the authors, be it big pharma or otherwise, it is not reasonable to use that COI as the sole reason for rejecting its findings out of hand. That’s just an intellectually lazy excuse to dismiss the study, nothing more. Indeed, one prominent difference between a scientist and a pseudoscientist or quack is that in general scientists understand this and struggle to assign the correct degree of skepticism due to a COI when analyzing scientific studies, while quacks and pseudoscientists do not. It’s far easier for them just to put their fingers in their ears and scream “Conflict of interest! Conflict of interest!” and then use that to dismiss completely their opponent’s argument. It’s simple, neat, and it doesn’t require all that nasty thinking and weighing of evidence..

Posted in: Medical Ethics, Neuroscience/Mental Health, Public Health, Vaccines

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Nine differences between “us and them,” nine straw men burning

I’ll start this post by admitting right up front: I blatantly stole the idea for the title of this post from Mark Crislip’s most excellently infamous post Nine questions, nine answers. Why? Because I really liked that post and felt like it. Also, there seems to be something about the number nine among anti-vaccine zealots: Nine “questions.” Nine circles of hell.

Nine straw men.

I’m referring to an amazing post that appeared on the anti-vaccine crank blog Age of Autism over the weekend by contributing editor Julie Obradovic entitled The Difference Between You and Me. In this post, Julie describes not one difference, but nine differences, that she perceives between herself (and, apparently, by generalization other parents who have become believers in the myth that vaccines cause autism) and people like SBM contributors and (I hope) the vast majority of our readers, who support science-based medicine, understanding that correlation does not necessarily equal causation and that, most importantly, science not only does not support the belief that vaccines cause autism but provides us with copious evidence that there almost certainly no link between the two. Actually, there are more than nine differences, as Ms. Obradovic packs multiple apparently related differences around each of her nine “differences” and then complains that Alison Singer and, apparently by generalization the rest of us who support SBM and oppose the anti-vaccine movement, misrepresent the reasons why she and her merry band of anti-vaccine activists reject the science that has failed spectacularly to validate their deeply held belief that vaccines cause autism and all sorts of other health consequences. Her post ends up being a collection of straw men constructed to Burning Man size, each of which she then applies a flamethrower of burning nonsense to with self-righteous gusto.

Posted in: Public Health, Science and the Media, Vaccines

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Andrew Wakefield Fights Back

Dr. Andrew Wakefield was almost single-handedly responsible for frightening the public about a possible association between autism and the MMR vaccine. His alarmist recommendations directly led to lower vaccination rates and a resurgence of measles to endemic levels in the UK. The MMR/autism interpretation of his 1998 article in The Lancet was retracted by 10 of his 12 co-authors. The article itself was “fully retracted from the public record” by The Lancet. And now Wakefield has lost his license to practice medicine after the General Medical Council’s exhaustive 2½-year review of his ethical conduct.

His career was in shreds and there was only one way left for him to fight back: to write a book. Callous Disregard: Autism and Vaccines — The Truth Behind a Tragedy has just been published. I tried hard to read it with an open mind and to understand his point of view. He did make some points that I will accept as valid unless they can be refuted by the others involved. Some of what he said and did was apparently misinterpreted and distorted by his critics. But the book did not convince me that he was an ethical, rigorous scientist or that MMR is linked to autism or to bowel disease. In my opinion the book does nothing to scientifically validate his beliefs or to excuse his behavior, but rather boils down to self-serving apologetics and misleading rhetoric. It also undermines his claim that he is a good scientist by showing that he values anecdotal evidence (“listening to the parents”) over experimental evidence. (more…)

Posted in: Book & movie reviews, Vaccines

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Stand up for science-based medicine against anti-vaccine fear mongering in Chicago today

As I’ve pointed out numerous times this week, anti-vaccine loons, led Generation Rescue and a “health freedom” group, have organized an anti-vaccine rally in Grant Park in Chicago from 3 PM to 5 PM CDT. Andrew Wakefield himself will be the keynote speaker, and there will even be some very bad music promoting the anti-vaccine message. The rally, with its wonderfully Orwellian title, The American Rally for Personal Rights, will be pure anti-vaccine activism in support of pseudoscience on display.

Those supporting science-based medicine plan, led by Skepchick Elyse Anders, to be there to promote science over the conspiracy theories and fear mongering that the anti-vaccine movement uses to frighten parents out of vaccinating their children. I realize it’s short notice. I realize that you very likely will be outnumbered, given the combination of short notice and the fact that the anti-vaccine zealots have been organizing and promoting this rally for weeks, if not months. Nonetheless, you’ll be doing me a particular solid if you can show up there. Details are here. There are also going to be satellite rallies in New Jersey, Washington, and New York. They look as though they’ll be much smaller; so, as P.Z. Myers points out, even if a couple of people can go it could have an effect.

Oh, and if you see J.B. Handley, Jenny McCarthy (I don’t know if she’ll be there or not but thought I’d mention her anyway), Andrew Wakefield, Kim Stagliano, or any other prominent anti-vaccine loon with whom I’ve tussled from time to time here and elsewhere, please tap him or her on the shoulder, smile broadly, and tell ‘em Dr. Gorski says hi.

Particularly J.B. Handley, for at least three reasons1,2,3.

Posted in: Neuroscience/Mental Health, Vaccines

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Autism One: The yearly antivaccine autism “biomed” quackfest begins

In the world of the anti-vaccine underground, there is one time of the year that looms large. Over the last few years, this time has generally come right around the end of May, usually coinciding with the Memorial Day weekend and the unofficial beginning of the summer vacation season here in the U.S. I’m referring, of course, to Autism One, which blights one of my favorite cities in the world, Chicago, every year about this time. True, of late Autism One has been metastasizing, most recently to blight the city of Toronto and the very grounds of the University of Toronto itself. As you may recall, last fall, when Autism One descended upon Toronto, I described it as “a conference of believers in two things: (1) that vaccines cause autism and (2) that ‘biomedical’ and CAM/IM therapies can treat and even reverse autism,” and it’s true, but Autism One is more than that. It’s a combination of a networking meeting for the anti-vaccine set, a revival meeting for the cult of anti-vaccinationism and autism “biomedical” therapy, and a trade show for “biomed” treatments for autism, all dressed up to appear to be a legitimate scientific conference.

Of all the fake scientific conferences out there, Autism One in Chicago, which begins today, far eclipses all the others, including even Barbara Loe Fisher’s National Vaccine Information Center (NVIC) conference. Closely aligned with the anti-vaccine propaganda group Generation Rescue and its outlet in the blogosphere Age of Autism (both of which, not surprisingly, have been promoting the conference incessantly), Autism One is the granddaddy of fake academic autism conferences, where anyone who’s anyone in the anti-vaccine “autism biomed” underground goes to see and be seen. It even has a keynote address by anti-vaccine celebrity spokesmodel Jenny McCarthy herself this year, just like the previous two years. This year, however, Autism One has expanded from three or four days to a full week, and it has taken on a note of political activism that was generally lacking in previous conferences. In previous years, Autism One pretty much stayed localized to a hotel near O’Hare, far from the center of the city. This time around it’s still at a hotel near O’Hare, but its organizers plan an anti-vaccine protest rally right smack dab in the middle of Grant Park on Wednesday afternoon. All of this leads me to conclud that this year Autism One’s organizers appear to be cementing the relationship between the autism “biomed” movement, the anti-vaccine movement, and the “health freedom” movement.

Posted in: Neuroscience/Mental Health, Politics and Regulation, Vaccines

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The story of Andrew Wakefield in pictures

I’ve blogged a lot about anti-vaccine hero Andrew Wakefield over the years. The story has become long and convoluted, and to tell it takes a lot of verbiage, even by my standards (or those of Kimball Atwood). However, I’ve found a good resource that tells the tale of Andrew Wakefield and his misdeeds in a highly accessible form:


The question at the very end of the story is about as appropriate as it gets. Unfortunately, the answer to the question is: Yes.

Posted in: Vaccines

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Nine Questions, Nine Answers.

This is not an easy blog to write.  Doctors Novella and Gorski want the entries to be formal, academic, referenced, with a minimum of snark.
For the most part I comply. But sometimes. Sometimes. It is hard, so hard, to not spiral into sarcastic diatribes over the writings that pass for information on the interwebs. I wish, sometimes, that I could be an irascible computer as well.
What brings on this particular bit of angst is a bit of whimsy on the Internet called “9 Questions That Stump Every Pro-Vaccine Advocate and Their Claims.”  by David Mihalovic, ND. Mr. Mihalovic identifies himself as “a naturopathic medical doctor who specializes in vaccine research.” However, just where the research is published is uncertain as his name yields no publications on pubmed.  BTW. I am a beer researcher.
The nine questions show up frequently on the interwebs, similar to questions on is to ask when you want to stump an evolutionist.  Like the supposed stumpers for evolution, the vaccine questions are grounded in either misinformation or laziness. Let’s go through them one at a time.
1. Could you please provide one double-blind, placebo-controlled study that can prove the safety and effectiveness of vaccines?
One trial? It took me 55 seconds to find 20211953, and that includes time to boot the browser and mis-spell the search terms.  Vaccine efficacy randomized placebo control trial gives 416 pubmed results; add safety to the search term, you 126 returns. The are easily more than one.  Of course, to find them you have to look.
Of course, I am a highly educated adult who constantly searches the web for medical information.  For hoots and giggles, I asked my 12 year old son, whose passions are basketball and filming comedy videos, to find me a reference that met the same criteria and I timed him.
22 seconds to find Randomized, Placebo-Controlled Trial of Inactivated Poliovirus Vaccine in Cuba from the NEJM.
12 yo one,  Mihalovic 0.  Served.
As long as we are on the topic, since he evidently place great store in science, could Mihalovic please provide one double-blind, placebo-controlled study that can prove the safety and effectiveness of naturopathy?  I would be happy at this point to know you could do a pubmed search corruptly just to make me look the fool.
2. Could you please provide scientific evidence on ANY study which can confirm the long-term safety and effectiveness of vaccines?
Long term is vague. What is long term?  Smallpox disappeared in 1976 thanks to the vaccine.  I have not seem a case of smallpox in my medical career, which now on it’s 31st year. No reported long term toxicities and the eradication of smallpox seems to me reasonable evidence for long term effectiveness.
No vaccine is 100% in efficacy, and whether  infected naturally or by way of a vaccine, immunity wanes with time.  In  earlier times  people would be have their immunity boosted by exposure to disease and maintain their antibody levels.  It is not the initial infection that leads to better immunity from natural infections, as posited by some antivaccine people, but the the fact that people were constantly re-exposed to wild type disease.
It is interesting what is happening with shingles.  Everyone used to get chickenpox as a child, and then, as they raised their kids and grand kids, got re-exposed to the virus and boost their immunity. Currently, due to the chickenpox vaccine and a change in the way way children are raised, older adults are not getting exposed naturally to chickenpox, immunity is waning, and there is an increase in shingles in older adults.  Part of why they need the zoster vaccine.
Clever conspiracy, huh?
Unless exposed to new infection, immunity, as measured by antibody levels directed against the infecting agent, can wane over time. That is to be expected.  The nice thing about the immune system, unlike water, is that it remembers the infection. It is primed so that if exposed again at a later date, it can almost instantly produce large amounts of antibody to nip an infection in the bud. So rather than prevent infection, in some people far removed in time from the vaccine, may instead have a shorter, less severe illness and be infectious not as long, thereby decreasing spread.
There is a nice review in the NEJM 1798383 on duration of immunity (first search in pubmed using duration of immunity vaccine, results in 17 seconds, including correcting typos.  Seriously, just how hard is it to find this information?  As would be expected, it depends on the disease and the vaccine (live better than killed). They estimated the half life for the varicella zoster virus immunity at 50 years, 200 years for measles and mumps, and 11 years for tetanus.  If you peruse the references, you can find other studies that show variable but sustained response to vaccines,  for example 90% maintain immunity to smallpox up to 75 years after vaccination. 12925846
Long term safety was more difficult, 5 years was the limit of time I could find safety studies, for the Hepatits B.  j med virol  65 2001Most vaccine toxicities are found in the first week after the inoculation and the studies follow most patients for a year.  Probably would not cut it as long term for Mihalovic.
BTW, could you please provide scientific evidence on ANY study which can confirm the long-term safety and effectiveness of naturopathy?
3.  Could you please provide scientific evidence which can prove that disease reduction in any part of the world, at any point in history was attributable to inoculation of populations?
Smallpox? Smallpox? Smallpox? Anyone? Smallpox? Buehler? Buehler?
Again I get back to the whole binary, black and white approach that characterizes many with whom we cross medical swords.  The decrease in infectious diseases has been multifactorial, due to improved nutrition, improved hygienic (lets hear it for the flush toilet) and understanding the epidemiology of diseases.  Knowing how a disease is spread has always been critical in decreasing its spread.  Note that none, none, none of the interventions that have decreased the spread of infections in the last 200 years or so have come from alt med tradition.
The teasing out the effects of vaccines on populations is always fraught with potential controversy. There are always multiple confounders.  The best example of the effects of vaccines was from JAMA
“Objective  To compare morbidity and mortality before and after widespread implementation of national vaccine recommendations for 13 vaccine-preventable diseases for which recommendations were in place prior to 2005.
Design, Setting, and Participants  For the United States, prevaccine baselines were assessed based on representative historical data from primary sources and were compared to the most recent morbidity (2006) and mortality (2004) data for diphtheria, pertussis, tetanus, poliomyelitis, measles, mumps, rubella (including congenital rubella syndrome), invasive Haemophilus influenzae type b (Hib), acute hepatitis B, hepatitis A, varicella, Streptococcus pneumoniae, and smallpox.
Main Outcome Measures  Number of cases, deaths, and hospitalizations for 13 vaccine-preventable diseases. Estimates of the percent reductions from baseline to recent were made without adjustment for factors that could affect vaccine-preventable disease morbidity, mortality, or reporting.
Results  A greater than 92% decline in cases and a 99% or greater decline in deaths due to diseases prevented by vaccines recommended before 1980 were shown for diphtheria, mumps, pertussis, and tetanus. Endemic transmission of poliovirus and measles and rubella viruses has been eliminated in the United States; smallpox has been eradicated worldwide. Declines were 80% or greater for cases and deaths of most vaccine-preventable diseases targeted since 1980 including hepatitis A, acute hepatitis B, Hib, and varicella. Declines in cases and deaths of invasive S pneumoniae were 34% and 25%, respectively.”
Milhalovic,  could you please provide scientific evidence which can prove that disease reduction in any part of the world, at any point in history was attributable to naturopathy?
4. Could you please explain how the safety and mechanism of vaccines in the human body are scientifically proven if their pharmacokinetics (the study of bodily absorption, distribution, metabolism and excretion of ingredients) are never examined or analyzed in any vaccine study?
There is, superficially, some truth in this statement.  Most pharmacokinetics are done prior to the clinical efficacy trials.  That is why there are phase 1 and phase 2 trials. The assumption being that if you exam influenza vaccine pharmacokinetic studies in one group it can be extrapolated to similar populations.  I think that is reasonable. So no, there are no pharmacokinetic studies in the clinical efficacy trials, those were done prior to the efficacy trials.  But it is not hard to find the phase 1 and 2 trials if you are so moved.
Milhalovic, could you please explain how the safety and mechanism of naturopathic nostrums in the human body are scientifically proven if their pharmacokinetics (the study of bodily absorption, distribution, metabolism and excretion of ingredients) are never examined or analyzed in any naturopathic nostrum study?  Is this getting old?  There is something to be said for repetition.
5. Could you please provide scientific justification as to how injecting a human being with a confirmed neurotoxin is beneficial to human health and prevents disease?
I presume the issue is mercury. Maybe aluminum. The latter is not in most vaccines, although as been discussed at length on this blog, the amount of mercury and aluminum found in vaccines is minimal and, at the dosing and formulation, has never been demonstrated to cause neurotoxicity from vaccines.  Of course, I am old school and think there is a dose response, and that a greater amount leads to a greater response.  Most naturopaths receive extensive training in homeopathy, where the less the amount, the greater the response.  So I would presume arguments based on chemistry would have little meaning to an ND, although I would not want my appletini made by a practitioner of homeopathy.
Of course, it is not the ‘neurotoxin’ that is being used to prevent disease, but the antigens of the potential infection. That is assuming that the author of the nine questions does not consider the antigens to be neurotoxins, and to judge from his understanding of disease later in the post, I am notes certain he warrants the benefit of the doubt.
Could you please provide scientific justification as to how applying naturopathy to a human being is beneficial to human health and prevents disease?
6. Can you provide a risk/benefit profile on how the benefits of injecting a known neurotoxin exceeds its risks to human health for the intended goal of preventing disease?
Since there is no more mercury in most vaccines, I will assume, for the sake of argument, it is the aluminum.  Risk from aluminum in the H. influenza type b vaccine, where aluminium is used as a adjuvant: zero.
The benefit from the vaccine: “From eight trials, the protective efficacy of the Hib conjugate vaccine was 84% (OR 0.16; 95%CI 0.08-0.30) against invasive Hib disease, 75% (OR 0.25; 95%CI 0.08-0.84) against meningitis, and 69% (OR 0.31; 95%CI 0.10-0.97) against pneumonia. Serious adverse events were rare.” 16491301
Seems a good trade off. No risk from aluminum, significant decrease in morbidity and mortality.
7. Could you please provide scientific justification on how bypassing the respiratory tract (or mucous membrane) is advantageous and how directly injecting viruses into the bloodstream enhances immune functioning and prevents future infections?
Well, things really get off the rails here.  Vaccines are not injected into the blood stream, they are infected into the soft tissues.   At a simple level, an infection enters to body, the body makes a variety of antibodies to the constituent parts of the infecting organism and next time the patient is exposed, the pre-existing antibody can, if there is a match with new strain, inactivate the new infection.
It doesn’t matter how the antigen is presented to the immune system, the response is the same. Natural influenza, inhaled influenza vaccine, or injected influenza vaccine, the same antibody will be made.
He says later
“All promoters of vaccination fail to realize that the respiratory tract of humans (actually all mammals) contains antibodies which initiates natural immune responses within the respiratory tract mucosa. Bypassing this mucosal aspect of the immune system by directly injecting viruses into the bloodstream leads to a corruption in the immune system itself. As a result, the pathogenic viruses or bacteria cannot be eliminated by the immune system and remain in the body, where they will further grow and/or mutate as the individual is exposed to ever more antigens and toxins in the environment which continue to assault the immune system.”
This is what we call in the trade, gibberish. At least it makes no sense to me.  I will leave to the readers to search, Bible Code style, for truthiness in the above selection.
8. Could you please provide scientific justification on how a vaccine would prevent viruses from mutating?
That is actually a very interesting question. It has nothing to do with why we give vaccines and  I fear our intrepid ND does not have a firm grasp on what he is talking about as he says
“Despite the injection of any type of vaccine, viruses continue circulating through the body, mutating and transforming into other organisms. The ability of a vaccine manufacturer to target the exact viral strain without knowing its mutagenic properties is equivalent to shooting a gun at a fixed target that has already been moved from its location. You would be shooting at what was, not what is!”
Mutating and transforming into other organisms. Sigh.  Either the author is a sloppy writer  (sloppy writing reflects a sloppy mind) or his understanding of microbiology is so profoundly mistaken it boggles the mind that he takes care of patients.  And in Oregon he would allowed by the state to prescribe antibiotics.
If you have a population of viruses and a specific antibody against the virus, then those naturally occurring mutants that are not recognized by the antibody should have a replication advantage.  It is possible that the vaccine can help select for new strains of an infection, but not new organisms.
Vaccines selecting for new mutants has been looked at for the Hepatitis B vaccine, and found not to be a issue 20210630.
In HIV, there is an ongoing interaction between the immune response and the virus driving mutations that escape the immune system and, in some patients leads to a marked increase in HIV replication and a clinical decline decline (9143689). Oh wait, this is a natural infection. That shouldn’t happen.  It is the vaccines that do do this.
There is nothing unique about the vaccine response acting as environmental pressure on the evolution of infections; the response from the natural infections should be the same.  I would wonder, since the response to  a natural infection is broader, with antibodies made to numerous parts of the infection, rather than the few key antibodies provided by the response to the vaccine, whether a natural infection would lead to a faster mutation rate.  As a rule in the microbial world, the more intense the stress, the faster and more varied the mutations.  More antibiotics leads to faster development of resistance in E. coli, not its delay
9. Could you please provide scientific justification as to how a vaccination can target a virus in an infected individual who does not have the exact viral configuration or strain the vaccine was developed for?
Dr. Black and White.  Antibody response is not all or nothing, there is a gradient of response between the developed antibody and the site to which it is directed.  A good example is the H1N1 influenza.  People exposed to the strains from the first half f the century had antibody that was partially protective for the 2009 strain.  The reason
“The pandemic influenza virus (2009 H1N1) was recently introduced into the human population. The hemagglutinin (HA) gene of 2009 H1N1 is derived from “classical swine H1N1″ virus, which likely shares a common ancestor with the human H1N1 virus that caused the pandemic in 1918, whose descendant viruses are still circulating in the human population with highly altered antigenicity of HA. However, information on the structural basis to compare the HA antigenicity among 2009 H1N1, the 1918 pandemic, and seasonal human H1N1 viruses has been lacking. By homology modeling of the HA structure, here we show that HAs of 2009 H1N1 and the 1918 pandemic virus share a significant number of amino acid residues in known antigenic sites, suggesting the existence of common epitopes for neutralizing antibodies cross-reactive to both HAs. It was noted that the early human H1N1 viruses isolated in the 1930s-1940s still harbored some of the original epitopes that are also found in 2009 H1N1. Interestingly, while 2009 H1N1 HA lacks the multiple N-glycosylations that have been found to be associated with an antigenic change of the human H1N1 virus during the early epidemic of this virus, 2009 H1N1 HA still retains unique three-codon motifs, some of which became N-glycosylation sites via a single nucleotide mutation in the human H1N1 virus. We thus hypothesize that the 2009 H1N1 HA antigenic sites involving the conserved amino acids will soon be targeted by antibody-mediated selection pressure in humans. Indeed, amino acid substitutions predicted here are occurring in the recent 2009 H1N1 variants. The present study suggests that antibodies elicited by natural infection with the 1918 pandemic or its early descendant viruses play a role in specific immunity against 2009 H1N1, and provides an insight into future likely antigenic changes in the evolutionary process of 2009 H1N1 in the human population.”
Oops.  Not simple.
But the result?
” over 75% of confirmed cases of novel H1N1 occurred in persons < or = 30 years old, with peak incidence in the age range 10-19 years. Less than 3% of cases occurred in persons over 65, with a gradation in incidence between ages 20 and 60 years.The sequence data indicates that novel H1N1 is most similar to H1N1 viruses that circulated before 1943. Novel H1N1 lacks glycosylation sites on the globular head of hemagglutinin (HA1) near antigenic regions, a pattern shared with the 1918 pandemic strain and H1N1 viruses that circulated until the early 1940s. Later H1N1 viruses progressively added new glycosylation sites likely to shield antigenic epitopes, while T-cell epitopes were relatively unchanged.
CONCLUSIONS: In this evolutionary context, Original Antigenic Sin exposure should produce an immune response increasingly mismatched to novel H1N1 in progressively younger persons. We suggest that it is this mismatch that produces both the gradation in susceptibility and the unusual toxicity”
The better the antibdy fit for the epitope (where the antibody binds) the better the effect, but it doesn’t have to be all or nothing. He would probably ask, what good is half and eye, why have half a wing. Or had a brain.
He finishes
“I have never encountered one pro-vaccine advocate, whether medically or scientifically qualified, who could answer even 1 let alone all 9 of these questions. One or all of the following will happen when debating any of the above questions:
- They will concede defeat and admit they are stumped.
- They will attempt to discredit unrelated issues that do not pertain to the question.
- They will formulate their response and rebuttal based on historical arguments and scientific studies which have been disproved over and over again. Not one pro-vaccine advocate will ever directly address these questions in an open mainstream venue.”
I am neither stumped not defeated.
My response was not unrelated.
My arguments are bases on modern studies that a 12 year old can find in less than a minute.
SBM is an open mainstream venue.
I do feel like I just had a foot race with a sloth; where is the honor in that?
And people wonder why I question the wisdom of allowing naturopaths to function as primary care providers.

This is not an easy blog to write.  Doctors Novella and Gorski want the entries to be formal, academic, referenced, with a minimum of snark.

For the most part I comply. But sometimes. Sometimes. It is hard, so hard,  not to spiral into sarcastic diatribes over the writings that pass for information on the interwebs. How should one respond to profound ignorance and misinformation?  I wish, sometimes, that I could be an irascible computer as well.

What brings on this particular bit of angst is a bit of whimsy on the Internet called “9 Questions That Stump Every Pro-Vaccine Advocate and Their Claims.”  by David Mihalovic, ND. Mr. Mihalovic identifies himself as “a naturopathic medical doctor who specializes in vaccine research.” However, just where the research is published is uncertain as his name yields no publications on Pubmed.  BTW. I specialize in  beer research.  Same credentials.


Posted in: Vaccines

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The Vaccine War

On Tuesday night PBS FRONTLINE aired an episode about the anti-vaccine movement entitled The Vaccine War (which, by the time you read this, should be available for online viewing in case you missed it). When I first heard that this show was going to air, I was a bit concerned. My concern, of course is what I’m always concerned about when journalists do a story about pseudoscience, be it the anti-vaccine movement, “intelligent design” creationism, various “alternative medicine” modalities, or whatever. We’ve written about such things right here on SBM on more than one occasion, be it Dr. Jay Gordon on The Doctors or Andrew Wakefield being interviewed by Matt Lauer. Although FRONTLINE has done a pretty good, science-based job on controversial topics, I felt some trepidation, particularly after seeing some of the promos for the show, even though it featured Dr. Paul Offit, and other physicians and scientists.

Fortunately, I needn’t have worried. The Vaccine War is not perfect. There are some definite flaws, but by and large it is a rare thing on TV: A science-based discussion of a pseudoscientific movement. True, the opening montage did bring back a bit of that anxiety that this was going to be a “tell both sides” bit of false balance in that it included J.B. Handley blathering and Jenny McCarthy spewing her same false dilemma of measles versus autism. (She’d choose the measles, of course.) I was able to forgive that, because it’s very clear that the producers were just setting up the story. The show then launched straight into a birth and a list of the vaccines that children get, with Melinda Wharton of the CDC and Paul Offit pointing out how much good vaccines do, how we no longer see diseases that once killed thousands or even milions.

Posted in: Science and the Media, Vaccines

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