Once again, it’s influenza season. The vaccine clinics are open, and the hysterical posts about the vaccine’s danger are appearing in social media. There’s familiarity to all of this, but also a big new change – at least in Canada, where I am. Pharmacists can now administer the vaccine. And it’s completely free to anyone in Ontario (where I am), so the barriers to obtaining the vaccine are pretty much eliminated. There’s no longer a need to drag your kids to their family doctor or line up at a public health clinic. Anyone can walk into a pharmacy, show their health card, and walk out minutes later, vaccinated. It’s another enabling change that may help improve immunization rates, as uptake rates in the population remain modest.
This year’s flu season is (as of week 47) fairly quiet. Google Flu trends suggests a fairly typical picture, nothing like what we saw in 2009/10, the year of H1N1. My city’s influenza tracker reports only a dozen cases so far this season. Many of us will get our flu shot, continue with our lives, and not think about the flu until next season’s announcements. That’s the hope, anyway. Influenza can kill, and in its more virulent forms, is devastatingly deadly. The worst case scenario (so far) is almost unimaginable today. In 1918/19 an influenza pandemic killed 50 million people worldwide (5% of the population). So among public health professionals, that worry about the next wave is always present. Much has been written at this blog <plug>nicely compiled in the SBM ebook,</plug> on the efficacy and safety of the flu vaccine. In short, the vaccine is effective for both individual and population-level protection, but only modestly so, and its effectiveness varies based on its match with circulating strains. And despite widespread use for decades, there are frustrating limitations with the current vaccine beyond efficacy, including the need to repeat the shot annually. Someone said something about “going to battle with the army you have”. (I thought it was Crislip but he was quoting Rumsfeld.) The quote is apt. It’s not a perfect vaccine, but it does offer protection – if not directly to you, then indirectly to those at greater risk of infection. Hospitals and health facilities have been criticized for demanding health professionals either get the vaccine or wear a mask – and the arguments against vaccination are losing. But even the strongest advocates of influenza vaccine will acknowledge its limitations, which perhaps contributes to the understandable perception that there is more that could be done- beyond reasonable and effective precautions like handwashing and hygiene. (more…)
Over my blogging “career,” which now stretches back nearly nine years, and my hobby before that of engaging in online “debates” on Usenet newsgroups back before 2004, I developed an interest in the antivaccine movement. Antivaccinationism, “antivax,” or whatever you want to call it, represents a particularly insidious and dangerous form of quackery because it doesn’t just endanger the children whose parents don’t vaccinate them. It also endangers children who are vaccinated, because vaccines are not 100% effective. The best vaccines have effectiveness rates in the 90%-plus range, but that still leaves somewhere up to 10% of children unprotected. Worse, because herd immunity requires in general approximately 90% of the population and above to be vaccinated against a vaccine-preventable disease to put the damper on outbreaks, it doesn’t take much of a degradation of vaccination rates to put a population in danger of outbreaks. That’s why, even though overall vaccine uptake is high in the US, we still see outbreaks, because there are areas with pockets of nonvaccinators and antivaccinationists who drive vaccine uptake down to dangerous levels. We’ve seen this in California and elsewhere. Other countries have observed even more dramatic examples, the most well-known being the way that fear of the MMR vaccine stoked by Andrew Wakefield’s bad science and the fear mongering of the British press led MMR uptake to plummet. The result? Measles came roaring back in the UK and Europe, from having been considered under control in the 1990s to being endemic again by 2008.
As much as I get chastised by concern trolls for saying this, to antivaccinationists it really is all about the vaccines. Always. They blame autism, other neurodevelopmental conditions, and a wide variety of chronic diseases on vaccines, without evidence that there is even a correlation. They even falsely blame sudden infant death syndrome (SIDS) on vaccines, even though there is no evidence of an association and, indeed, existing evidence suggests that vaccines likely have a protective effect against SIDS more than anything else. No matter what happens, no matter what the evidence says, antivaccinationists will always find a way to blame bad things on vaccines, even going so far as to claim at times that shaken baby syndrome is a misdiagnosis for vaccine injury.
One thing, however, that is often forgotten, is that they also do their utmost to downplay the beneficial effects of vaccines. One such tactic is for antivaccinationists to claim that the pertussis vaccine doesn’t work because we are seeing resurgences of pertussis even in the face of high vaccine uptake. For example, another common trope is what I like to refer to as the “vaccines didn’t save us” or the “vaccines don’t work” gambit, in which it is pointed out that the introduction of vaccines doesn’t correlate tightly with drops in mortality from various diseases. Julian Whitaker even used this gambit when he debated Steve Novella. The fundamental flaw in this trope neglects the contribution of better medical care to the survival of more victims of disease, which decreased mortality. If you look at graphs of disease incidence you will see a profound and powerful effect of the introduction of vaccines on specific vaccine-preventable diseases. In other words, vaccines work. (more…)
We have evolved in order to survive reality, not to understand it. And it is a good thing that understanding and survival are not tightly linked as many people are apparently totally disconnected from the reality I inhabit, the one described by the natural sciences. When I started writing and podcasting about the SCAMverse I was under the impression that people who used SCAMs were simply misinformed. If people were made aware of the facts of the matter, they would see the error of their ways and put away their SCAMs as the childish thoughts they are.
Silly me. Reality, as I understand it, is often if little interest to proponents of SCAM. This was brought home by the Food Babe with an essay Should I get the Flu Shot? Spoiler alert. Her answer is “No, I’m not taking the Flu Shot. Ever.”
It is how she reaches that conclusion that is amazing. There are nouns and adjectives and adverbs and verbs and article and prepositions. They are strung together to form sentences and paragraphs, but somehow, though an almost magical alchemy, all that writing transmutes into content that is completely divorced from reality as I understand it. It is a tour de farce that reaches the definition of the Pauli Principle, where “It is not only not right, it is not even wrong.” (more…)
Integrative medicine combines the practice of medicine with alternative medicine. Proponents tend to take a paragraph or two to say this, but that is what remains when boiled down to its essence. By putting this more concise definition together with Tim Minchin’s often-quoted observation about alternative medicine, you get: integrative medicine is the practice of medicine combined with medicine that either has not been proved to work or proved not to work. If it is proved to work, it is medicine.
I couldn’t find an official start date for integrative medicine, but it seems to have been around for about 15-20 years. (Osher Center for Integrative Medicine at the University of California, San Francisco, an early adapter, opened in 1997.) Yet despite some lofty pronouncements about transforming patient care, there is still no good evidence that integrative medicine improves patient outcomes. It seems unlikely that such evidence is forthcoming. It is illogical to assume that adding therapies that do not work, or are proven not to work, would benefit a patient except by inducing the ethically problematic placebo response.
Whatever its goals initially, integrative medicine now appears to serve two purposes. First, it attracts funding from wealthy patrons (Samueli, Bravewell) and the government (the military, NCCAM). Second, it is a marketing device used by hospitals, academic medical centers and individual practitioners. As an added bonus, alternative medicine is usually fee-for-service because very little of it is covered by insurance. And whatever its charms as a money-making device, given the lack of proven health benefit it is fair to ask: is integrative medicine worth it? To answer that question, let us look at what might be called the supply side of integrative medicine practitioners’ delivery of alternative medicine. Here we run into some unpleasant facts proponents seem unwilling to acknowledge: integrative medicine’s collateral damage. (more…)
Do you hear me
Do you care
Do you hear me
Do you care
My lips are moving and the sound’s coming out
The words are audible but I have my doubts
That you realize what has been said
You look at me as if you’re in a daze
It’s like the feeling at the end of the page
When you realize you don’t know what you just read
What are words for when no one listens anymore
What are words for when no one listens
What are words for when no one listens it’s no use talking at all
I might as well go up and talk to a wall
‘Cause all the words are having no effect at all
Missing Persons on blogging. Or so I thought. I was surprised to learn the song was written by the brothers Gibb.
Words are important. I try and choose my words carefully when writing so that they accurately reflect not only my thoughts but reality. When I speak, not so much. My frontal lobe filters often fail if I think might I might get a laugh.
I tell housestaff, precision of writing reflects precision of thought. It is one of the reasons I write; the act of writing forces some coherence into what can be muddled and inchoate thoughts. Even though I have residents who write notes, I always write my own. Often I do not make a final decision as to a plan until I put pen to paper, or electrons to screen. Writing crystallizes thought.
Not, evidently, for everyone, as 10 Facts About the Flu Vaccine and the Flu nicely demonstrates. (more…)
The Internet has produced a revolution with respect to information. Now, people anywhere, any time, can find almost any information that they want, as long as they have a connection to the global network and aren’t unfortunate enough to live in a country that heavily censors the Internet connections coming in. In addition, anyone any time can put his or her opinion out on the Internet and it might be read by people on the other side of the planet. For example, it continually amazes me that my blatherings here are read by people in Australia and New Zealand, as well as Europe and pretty much every other continent. Before the Internet, there was no way I would ever have achieved my current measure of minor celebrity status (and I do mean minor). Now, with enough good (I hope) writing and some links from some popular sources, and I can make my opinion known worldwide.
The dark side of this is that cranks can also make their opinions known worldwide, and, all too frequently, they are much better at it than skeptics are. For example, this very blog used a generic, vanilla WordPress template for the longest time, only updating it a few months ago. Meanwhile crank websites like NaturalNews.com are decked out in the latest, greatest web accoutrements, complete with video. One other problem with the democratization of information is that there now exist what I like to call “zombie memes.” In the world of quackery and pseudoscience, these are pseudoscientific claims on the Internet that never die, no matter how often they are refuted. Generally, such memes/claims pop up, make a fuss, are refuted, and then disappear. Then a few months (or even a year or two) later, something will happen to resurrect them. Maybe it’s a clueless mortician cremating the remains of such a zombie meme during a rainstorm and letting whatever it is that resurrected the dead meme in the first place permeate the soil of a graveyard of dead memes. Maybe it involved injecting a glowing fluid into the corpse of the meme. Who knows? Who cares that much? All I know is that these zombie memes keep popping up again and again as though they were new.
Now that the World Wide Web (at least as we know it, in its graphically browsable form) is approaching its twentieth birthday, we now have enough perspective to see these things. Steve Novella pointed out one zombie meme just the other day about the MMR, as did a certain person well known to this blog. Just yesterday I noticed another of these zombie memes arising from the dead yet again to feast on the brains of the living and thus make them cranks too. (At least, that is the goal of their continual resurrection.) This one popped up at that online repository of all things quackery, NaturalNews.com, in a post by Mike Adams himself entitled Merck vaccine developer admits vaccines routinely contain hidden cancer viruses derived from diseased monkeys. Other versions of this meme pop up from time to time with titles like CDC Admits 98 Million Americans Received Polio Vaccine In An 8-Year Span When It Was Contaminated With Cancer Virus.
Let’s dive in, shall we?
Reality is one honey badger. It don’t care. About you, about your thoughts, about your needs, about your beliefs. You can reject reality and substitute your own, but reality will roll on, eventually crushing you even as you refuse to dodge it. The best you can hope for is to play by reality’s rules and use them to your benefit. Combined with a little luck (nothing quite as beneficial as being a white, middle class male in the US) you might have a reasonably healthy health.
The most reliable way to understand reality is science and the scientific method. Used wisely you may have a shot at minimizing morbidity and mortality. Deny or ignore it and reality don’t care. Reality will get us all.
We all have our biases, recognized and unrecognized. I often see the world in terms of infectious diseases. When I read Team of Rivals: The Political Genius of Abraham Lincoln I enjoyed the politics and personalities but I was struck by how people constantly died young of infectious diseases. We don’t see mortality in the young anymore for a variety of reasons: better nutrition, an understanding of the pathogenesis of disease, clean water, flush toilets and vaccines.
One of the tactics of snake-oil salesmen is to fearmonger about mainstream medical practices so as to scare potential customers into their clutches. A common target of such fearmongering is vaccines. Vaccine are an easy target – they are generally required by the government to some degree, and involve sticking small children with needles and injecting them with a cocktail that parents often don’t understand in detail.
While vaccines are of clear benefit, no one argues that they are risk free. There are rare serious complications. For this reason the US established the NVIC – National Vaccine Injury Compensation program. This is funded by a small tax on each vaccine, and is designed to compensate families of children who have a possible reaction to vaccines, bypassing the slow and costly regular court system. The NVIC works well.
The goal of the NVIC is not to determine scientifically if there is a link between a particular vaccine and a particular side effect. That is determined by the scientific community. Rather, the NVIC’s charge is to determine if “compensation is appropriate” in specific cases. They also give the benefit of the doubt to the families.
An antivaccine reporter strikes again
The damaged done by the antivaccine movement is primarily in how it frightens parents out of vaccinating using classic denialist tactics of spreading fear, uncertainty and doubt (FUD). Indeed, as has been pointed out many times before, antivaccinationists are often proud of their success in discouraging parents from vaccinating, with one leader of the antivaccine movement even going so far as to characterize his antivaccine “community, held together with duct tape and bailing wire,” as being in the “early to middle stages of bringing the U.S. vaccine program to its knees.” Meanwhile, just last week Anne Dachel, “media editor” for the antivaccine crank blog Age of Autism, gloated about basically the same thing, how although overall vaccination rates remain high, vaccine exemption rates are up in many areas of the country and how her movement has provided plenty of information to “scare [parents] out of vaccinating.”
And it is the very same antivaccine propaganda blog, Age of Autism, that is promoting a different, more insidious message, specifically how the brutal murder of an autistic teen nearly three months ago “illumines the autism nightmare.” What do I mean by “insidious message”? It’s the hijacking of the autism advocacy movement, which tries to advocate for more services for autistic children and adults and more awareness and understanding of autism, by the antivaccine message that autistic people are somehow “damaged,” be it by vaccines or unnamed “toxins,” that the “real child” has been “stolen” by autism, and that any manner of biomedical quackery to “recover” autistics is justified by the horror of autism. Although Attkisson, the reporter for the story discussed below, never specifically mentions vaccines, if you know the background of the case, that message is quite obvious and not very far under the surface of her report on the murder of Alex Spourdalakis:
Not surprisingly, this story was reported by Sharyl Attkisson, who is CBS News’ resident antivaccine reporter. I’ve known her to promote antivaccine views in a manner that gave Robert F. Kennedy, Jr. a run for his money as far back as 2007. Since then, she’s smeared Paul Offit as a “pharma shill,” very likely fed information to someone at AoA to help them portray Lisa Randall at Voices for Vaccines as an “industry group,” done a puff piece about antivaccine physician and hero to the antivaccine movement Andrew Wakefield, and misreported the significance of the Hannah Poling case (which was really just the rebranding of autism). Most recently, Attkisson promoted a truly execrable “review article” summarizing the evidence relating vaccines to autism. The review article, by Helen Ratajczak, cited lots of pseudoscience from antivaccine literature in the service of supporting a truly dumb hypothesis, namely that DNA from vaccines could recombine in the brains of children to result in autism. Attkisson was quite smitten with the idea. As you might imagine, I was not. Along the way, Attkisson also indulged in promoting breast cancer misinformation. No wonder she is the perfect reporter to do this story promoting the viewpoint that autism is so horrible and the system provides so little help that we should understand why a mother like Alex’s might become so desperate that she would poison her son and then, when that failed to kill him, try to slash his wrist, and then, when that failed, stab him in the heart with a kitchen knife.
Back in 2009 I wrote a story entitled, “The New Plague”, about my experiences as a pediatrician with the frightening trend of parental vaccine refusal in New York City. In that post I discussed some of the complex social factors contributing to this phenomenon, and some of the common vaccine myths to which many parents fall prey. I recommend that you read that post, as it is (unfortunately) as timely today as it was then. Now I’m a pediatrician in Amherst, Massachusetts, and I find it necessary to revisit this dangerous trend in parenting.
As I described in my previous post on the subject, my old practice was at an interesting crossroads of several communities that seemed to perfectly embody the socioeconomic and cultural characteristics commonly found in communities with high rates of parental vaccine refusal. Ironically, these tend to include people who are educated and socially privileged; those empowered to question authority. In 2010, I left New York City and moved to Western Massachusetts to take a job at Baystate Children’s Hospital in Springfield. There I was in charge of the teaching clinic where pediatric residents are trained in the outpatient care of children. The children we took care of in Springfield comprised a very high-risk, underprivileged population. Our patients were significantly below the poverty level, with high rates of developmental and educational disability, a high teen pregnancy rate, and high rates of domestic violence, drug use, and gang involvement. Children who were not up to date with their vaccinations were behind because of poor continuity of care, with many missed appointments and gaps in follow-up. I now work at a private practice further north in the Pioneer Valley of Central Massachusetts. Here, my experiences with vaccine lapses are starkly different. Now, when I encounter a child who is not fully vaccinated or is completely unvaccinated, it is the result of a parental decision. A very flawed, dangerous, and misinformed parental decision.