Effect Measure

The Atlantic article: sur rebuttal

On Saturday we posted our take on The Atlantic magazine article by Shannon Brownlee and Jeanne Lenzer. It’s a major story in the November issue, a banner across the top of the cover page reading: Swine flu: Does the vaccine really work? We tried to ignore it. People kept asking us to comment on it, but we didn’t want to get entangled in vaccine controversies. As Orac warned me, it’s a game of Whac-A-Mole. But we got fed up and posted our global response, not a point by point refutation, since that wasn’t what the issue was. Our main point was that it was a straw man argument built around the narrative device of the brave, mavericky truth teller who is shunned by colleagues and has to eat alone at conferences. A scientific Enemy of the People. Not unexpectedly it drew a sharp response from the authors here and elsewhere. So like the worker who gets his sleeve caught in the machine, we are being drawn inexorably into the gears of the vaccine controversy. Sigh. We should have known better. But what’s done is done, so we will add this to our initial immediate reply to the authors.

Brownlee/Lenzer title their response to us, “Faith-based science not methodolatry is the problem.” This is apparently a reference to our use of the neologism methodolatry to describe what we see as Dr. Jefferson’s overweaning fealty to the randomized trial as the only reliable knowledge. It was actually a rather minor point, but not to hear the authors tell it:

Blogger Revere describes our article, published in The Atlantic, ?Does the Vaccine Matter?? as an instance of ?methodolatry.? Revere and his followers, are so enamored with their new-found term that they fail to examine, using facts rather than insinuation and emotion, whether this article was worthy of that term – a term that is useful and could be used to describe a very real problem.

Leaving aside the issue of using “blogger” as an epithet (something they also do with Dr. Gorski), they apparently can’t separate their role as journalists from the role of Dr. Jefferson as the person we accused of methodolatry. We did not refer to their article as methodolatry because, as far as we know, the article had no formal study design. It is a magazine article meant for popular consumption and is clearly rhetorical in nature, where we use the word rhetorical in the sense of being an example of the art of persuasion. That’s the problem. It attempted to persuade people there is a real question about the usefulness of influenza vaccine during a pandemic, a time when the public is trying to understand what to do. It confused pretty much everyone who read it on that score. That might be acceptable if there were grounds for being confused. But the article doesn’t present any. It talks about a long standing controversy regarding the efficacy of influenza vaccination among the elderly, which for seasonal flu make up 90% of the fatalities, not the accepted efficacy (accepted even by Dr. Jefferson) of well matched influenza vaccine in the younger age groups that are the main target of a pandemic virus, including this one.

In a response to us over at the Knight Science Journalism Tracker (KSJ Tracker won’t accept our direct response because we use a pseudonym, although they have offered to let a colleague post under his or her own name), Brownlee and Lenzer try to dial back the their argument to reach safer ground:

We?re simply saying that the nation?s seasonal flu strategy, which is to vaccinate the elderly and other vulnerable populations, may not be working as well as has been claimed. If we rely on vaccine during a major, deadly pandemic (which thus far this one does not appear to be, but things could change), the public may not be as well protected as we might hope or believe. We don?t say flu vaccine is worthless, we simply say nobody really knows how much protection it might offer. Better studies would help define what vaccine can and can?t do – and help us prepare for the really nasty pandemic that many experts believe is only a matter of time. (Knight Science Journalism Tracker)

I don’t know many people (in fact I don’t know anyone) who took away from their article that it was a simple question about the nation’s seasonal flu strategy, which targets the elderly. That’s something we’ve done ourselves, for some of the reasons Brownlee and Lenzer cite. Go to the KSJ Tracker site and take a look at the cover of The Atlantic: Swine flu: Does the vaccine really work? That’s not about seasonal flu strategy. And that’s the nub of the issue.

And when it comes to pandemic flu, exactly how do they expect to demonstrate the vaccine works against a novel strain? Let a couple of waves of roll over us while they perform a randomized clinical trial? If you don’t use antibody titers as a surrogate for protection (again, a problematic subject we’ve highlighted here numerous times) then you are stuck. Being stuck doesn’t seem to be a problem for them. It is a real problem for people who have to make decisions in public health. None of Brownlee, Lenzer or Jefferson are in that category.

In their response here, Brownlee and Lenzer accuse us of disregarding “data or even basic facts,” which data and facts they go on to list, numbered 1 to 7. Numbers 1 to 6 are just a rehash of the seasonal flu controversy. Number 7 has this remarkable form:

7. Claims of ?benefit? from vaccine are often based on the ability to generate antibodies – yet the very people who generate antibodies, young healthy people, almost never develop complications from flu – raising the conundrum: Does it work in those for whom it?s necessary and is it necessary for those in whom it works?

This isn’t data or fact. It’s handwaving. Moreover there is a literature of randomized trials in this age group that show the vaccine works. That’s the data and basic facts authors Brownlee and Lenzer ignored. We didn’t discuss the whole controversy in our response but we did provide links to the places we discussed them in the past several years. That’s the beauty of the web versus their magazine. On the web we have these things called hyperlinks that can lead interested readers to the back-up details. But the main reason we didn’t address them — although the authors appear to be surprised we didn’t — is that they were not relevant to the issue at hand, whether vaccination is well-founded as a way to deal with pandemic flu.

What does well founded mean? For Dr. Jefferson and other randomized trial zealots it means only one thing: a double blind randomized clinical trial (RCT). That’s what we referred to as methodolatry. A demand for RCTs for swine flu vaccination before employing it in a pandemic defies the imagination. The existing data indicate that vaccines work for younger people. Using current standards it would be unethical to intentionally withhold them. You’d have to regress to a time before there was this thing called the Nuremberg Code, or if you prefer something closer to home, the Tuskegee syphilis study. But if you insisted, picture this. Those long lines of anxious pregnant women and families with small children lining up for blocks to get the flu vaccine arrive at the head of the line and are handed an informed consent form saying that half of them won’t get a real vaccine but only a dummy shot with buffer and they won’t know which ones they got. I’d nominate the authors or Dr. Jefferson to be in charge of getting the consent forms signed, but I’m not sure they could be there. Most of us live on planet earth but only someone living on a planet orbiting slightly past Pluto would think a randomized double blind trial could be done with swine flu vaccination (I know Pluto is no longer a planet; so sue me).

Here’s more of the Brownlee/Lenzer EM response:

Revere declines to give a data- or fact-based challenge to any of Jefferson?s findings; instead he calls Jefferson a ?martyr,? a ?crank? and a ?contrarian.? OK, now that Revere smeared him – did he offer a challenge to a single one of Jefferson?s findings? Did Revere provide any evidence that Jefferson was wrong in his assessments of the data or the shoddiness of the studies? The answer is no.

Finally, Revere says we ?rely on and romanticize? Jefferson. This is simply not the case. We presented the work of several other researchers – mainstream and highly respected researchers including Lone Simonsen, Lisa Jackson and Sumit Majumdar -each of whom raises similar questions about the validity of the assumptions made about flu vaccine. It is interesting that Revere never once mentions any of these researchers and their findings, instead he attacks the person he appears to see as the weak link, Jefferson. The degree to which we did raise some points about the way Jefferson is treated was not to ?romanticize? him but to point out that emotion rather than clear-headed, sober, discussion of data and facts seem to be the way that purportedly dispassionate scientists are responding to the challenge to widely held assumptions. That is troubling.

I addressed the first issue already: Jefferson’s points were not germane to the swine flu problem. If he were summarizing studies of flu among the elderly and the question is about flu in younger age groups, why bother to discuss it beyond pointing the interested reader to what we’ve said about it in numerous other posts. Which we did. We did not criticize Lone Simonsen’s work on the same topic (work which we’ve posted about here and which we take seriously) because her work wasn’t at issue, Jefferson’s was. What we did do, though, is present the Conclusory statements from three papers Jefferson had his name on that made the case in a form considerably weaker than presented by the authors. Maybe the way the authors presented Jefferson’s views distorted them, although I am giving them the benefit of the doubt (to Jefferson’s disadvantage). To say that describing the way Jefferson alleges he has been treated was purely factual or based only on his scientific views is disingenuous. The rhetorical use of this image in the article is plain to us but we invite any reader to make their own judgment. Here’s a link to The Atlantic article.

More:

Revere writes: ?There is nothing judicious about Jefferson? and ?he is extreme in his views, looking at Jefferson’s own recent papers in the literature show conclusions much weaker than the picture painted in this article:?

B&L respond: It is interesting that when Jefferson writes in a manner that is neither injudicious nor extreme, that Revere, instead of acknowledging his work as nuanced or careful, then calls his writings ?much weaker? – much weaker than what? The most extreme thing Jefferson suggested in interviews with us was that scientists don?t have all the answers to the flu vaccine story and that some RCTs are in order. That hardly seems injudicious or extreme.

His published statements, which we displayed, present weaker views than the authors portrayed. See previous point. We find non credible on its face the idea that the article only intended to convey that Jefferson was merely suggesting “scientists don?t have all the answers to the flu vaccine story and that some RCTs are in order. That hardly seems injudicious or extreme.” Nor would it have made much of a magazine article. “Does the vaccine really work?” based on your reporting of Jefferson’s views goes way beyond that. Way, way beyond that. And mind you the “answers” Jefferson was asking for had to do with the efficacy of the vaccine in the elderly, something not germane to the pandemic setting.

Still more:

B&L respond: Once again, Revere reverts to emotional suasion rather than fact to argue his case. We raised point by point concerns that researchers have had about the flu vaccine narrative. We demonstrated that those who raise questions about vaccine efficacy are sometimes subjected to faith-based, emotional attacks rather than sober discussion. The last part of Revere?s sentence is particularly troubling. He writes, ?…this was a particularly irresponsible time to pull this stunt.? The implication is that during this time of the 2009 H1N1 flu our article will be responsible for the loss of lives if people decline the flu vaccine. We?ve heard that argument before. When we challenged widely held beliefs about various interventions, including cancer screening campaigns, we were told that we were causing the deaths of untold numbers of people because of our articles. Years later, we are now joined by many top experts and professional organizations, such as the American Cancer Society, who now agree that the early voices were right. We could just as easily charge those whose work we criticize are causing the deaths of untold numbers of patients for publishing their work. But such emotional appeals have no place in science. We suggest that for those concerned about this issue, there is no better book to read than Arrowsmith.

Once again, we’ll leave it to readers to decide whether Brownlee and Lenzer rely on appeals to emotion, or if their device of calling our take “faith-based” is fact based. Next they’ll be telling me atheism is a religion. I didn’t accuse them of endangering lives. I accused them of spreading doubt and confusion at a time when there is already too much doubt and confusion. And why drag cancer screening into it? Is the straw man style just too irresistible?

Dr. Gorski has ably defended his statement here and written further here, so I’ll leave it at that.

Finally, we brought up the unsupported claim that hand washing will protect against flu. The authors apparently concede the point but go on to say it’s a sensible thing to do that will have other demonstrated benefits. We couldn’t agree more. Wash your hands. It will help prevent respiratory diseases (maybe even flu, although that is less clear) and intestinal ailments. But my point was not what they claim. I don’t demand high quality randomized trials of handwashing before recommending it. That’s a good example of methodolatry. And to prove that irony isn’t dead, they specifically use the word “ironically” to misunderstand an attempt at irony on our part:

Ironically, Revere’s argument about hand washing is precisely the same as Jefferson’s (and our) argument about vaccine: mortality reduction needs further direct testing in high quality research. The irony appears to be lost on Revere, however, who then goes on to say, “They [physical interventions] are still good things to do, although if Dr. Jefferson decides to review the literature, I wouldn’t count on him finding any support for them.” Actually, Jefferson wrote the Cochrane review on hand washing and other physical interventions, and indeed, he found support.

Not so minor point: they left off the final interrogatory: “So what?” Our point was this: whether there is RCT support or not for handwashing specifically in influenza (and that’s the subject, isn’t it? after all it is indisputable that polio vaccine works and that tetanus vaccine works, etc., but that’s not what we are talking about) or whether Dr. Jefferson finds papers he deems acceptable to that point or not, we wouldn’t or shouldn’t stop recommending people wash their hands unless there was a good reason, e.g., it was counterproductive.

OK. Enough. The gears of the machine are eating me alive.

Comments

  1. #1 nika
    October 27, 2009

    and my question is, are the B&Ls trained in science in any way? Are they epidemiologists?

    We mostly know they are insecure now.

  2. #2 g336
    October 27, 2009

    I read the article via a link on dKos. But I’ve been reading this blog and DemFromCT’s stuff for years, so I’m well-vaccinated (heh) against the anti-vax crowd.

    My reaction to it was: Whether or not what’s-his-name has a viable critique of vaccination, can be addressed in subsequent research, but not right in the middle of an emergency. The article changes nothing for me in a practical sense. I’m still going to get the shot at the first opportunity.

    However I can see that it could confuse and dissuade people who tend toward skepticism of “the establishment,” and that’s irresponsible journalism at this point in time.

    The worst of it is that The Atlantic has the image of responsible journalism rather than sensationalistic nonsense. Or rather, “has had.” No longer. This seriously undermines their credibility.

    Good for you taking them to task. The Atlantic needs to run an apology and a retraction.

  3. #3 Cassie
    October 27, 2009

    Brownlee and Lenzer co-authored an article in the Huffington Post “A New Year’s Resolution for the FDA: Kick the Drug (Company) Addiction” in January 2009

    “Jeanne Lenzer is a freelance medical investigative journalist and former Knight Science Journalism fellow. She is currently a stringer for the BMJ (formerly British Medical Journal). Her articles, reviews, and commentary have appeared in The New Republic, Discover, Slate, The American Prospect, The Scientist, The (London) Independent, USA Today, Newsweek Japan, and Mother Jones.

    Shannon Brownlee is a Schwartz Senior Fellow at the New America Foundation and author of Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer.”

    Read more at: http://www.huffingtonpost.com/jeanne-lenzer-and-shannon-brownlee/a-new-years-resolution-fo_b_156571.html

  4. #4 CPF
    October 27, 2009

    It would appear to me that the authors of the Atlantic “article” (quotes intentional, will explain below) did not do due diligence while framing their response to the reveres’ reaction to the piece – nothing in their response indicates that any of the links to previous posts were followed, for example. Instead, it appears that the authors reacted emotionally to a rebuttal of their work. Further, this reaction reminds me very much of an individual frantically attempting to defend his/her point of view in the face of reasonable argument.

    Hence the quotes above – the authors’ reaction leads me to believe that this “article” is an opinion piece posing as journalism – a most insiduous form of mass control. It reminds me too much of the Limbaughs, O’Reilly’s and (yes, even) Olbermanns of the world – the men and women who dictate how the majority of the country should think through clever sound bites and an “I’m right, they’re wrong, and you want to be right, right?” charisma.

    As the reveres have said, this is not an appropriate time for this type of rhetoric. Having had to field calls from a panicked public on H1N1, I know that the worst thing to do right now is to dole out pieces of “a little knowledge” – especially when those pieces are incomplete.

    Thank you, reveres. I offer your blog to friends, colleagues, acquaintances – even strangers – as a resource to counter-balance the herd mentality, and I pray to chance that people visit.

  5. #5 Abel Pharmboy
    October 27, 2009

    I find it ironic that The Atlantic’s own David Shenk had a post last week on The New Pandemic of Vaccine Phobia.

  6. #6 Library Lady
    October 27, 2009

    Dear Revere,
    Please see an article in the New York Times, October 25, 2009, titled “Worst Case: Choosing who survives in a flu epidemic”, by Sherri Fink. It is time to address this again. Paiwan and Krueger, please read as well.
    Love,
    Library Lady

  7. #7 renee
    October 27, 2009

    I appreciate your demolition of the article. In addition to the article itself, The Atlantic seems to have a problem with its headlines, which mislead people whether or not they actually read the article. This also happened last year with Hannah Rosin’s essay, alarmingly titled “The Case Against Breastfeeding,” which of course was no such thing; it was a perfectly reasonable discussion of the difficult of isolating the effects of breast milk in the absence of RCTs, the need for support for breastfeeding in workplaces, and the perfectly ok-ness of formula. But boy, did that headline get attention. Likewise, there are people running around airports right now thinking hmm, maybe that H1N1 vaccine doesn’t work…

  8. #8 Tom DVM
    October 27, 2009

    Revere

    Based on your review of the literature, what percentage of those vaccinated would you expect to be protected against seasonal influenza?

    Thanks

  9. #9 revere
    October 27, 2009

    Tom DVM: Hard to say. I would put it at a minimum of 40% to 60% efficacy (that’s compared to the unvaccinated).

  10. #10 DrZZ
    October 27, 2009

    What does well founded mean? For Dr. Jefferson and other randomized trial zealots it means only one thing: a double blind randomized clinical trial (RCT).

    In other words after an outbreak they think it is much better to say “Studies show that we could have saved 9,372 lives if we had implemented a vaccine program” rather than “We estimate the vaccine program saved about 10,000 lives”.

  11. #11 Tom DVM
    October 27, 2009

    Thanks Revere.

    I just read the full article and it sure doesn’t seem to take much for you ‘human’ guys to start pissing on each other.

    If you took a sample of those at risk (seniors) as well as other age groups and took extensive histories, one question would be…would you like a free vaccine in exchange for a few blood samples…some would say no and some would say yes.

    Then you could analyze the histories putting equivalent groups in the treated and untreated groups by choice…then you would have double-blind quality research.

    You might even pick from the uninterviewed to get third (control) type grouping.

    If we are to accept that there is a significant percentage for which the vaccine produces a protective titre and an approx. equivalent group where the vaccine does not produce a protective titre…then we must also accept contemplate how the second grouping may be contributing to the apparent acceleration in evolution of all types of influenza, both avian (exotic) and seasonal, since 1999 towards human adaption and increased virulence…especially since these partially effective vaccines may have been given to poultry and pigs as well as humans.

    A vaccine for dog influenza (H3N8) is about to be released if it is not already on the market. The thought of vaccinated companion animals on the bed keeping a child sick with H1N1 company is very scary to me…especially since H1N1 is most evolved in the same area where canine flu is endemic.

    …and then there is the elephant in the corner (H5N1) and we will never know how many other animals in China may have been given H5N1 vaccine along with the factory poultry flocks. You can bet it has been given to valued fighting poultry and dogs.

    We might just win the battle with our 20th century advancement in influenza vaccine technology but we also might just lose the war.

  12. #12 Jimmy
    October 27, 2009

    Revere, I’m sure you realize the risk of feeding this fire. ‘Your’ anonymity may become worth unveiling to someone. Someone has already publicly called for just that. These days it may not be difficult for the motivated to succeed.

  13. #13 Ed Whitney
    October 27, 2009

    Jefferson does not seem to be that inappropriate in pointing out that observational studies often inflate effect sizes. People who get flu shots may differ from people who do not in a number of ways that are associated with better health status, just as it is well known that people in RCTs who comply with their placebo regimens fare better than placebo non-compliers.

    While antibody titers are a very reasonable surrogate measure of influenza protection, we must remember that premature ventricular contractions were a very reasonable surrogate measure of the effectiveness of encainide and flecainide prior to the Cardiac Arrhythmia Suppression Trial back in the early 1990s. There were people who opposed CAST as unethical to even conduct. The answer to antiarrhythmic drug therapy effectiveness was “known,” and conducting a clinical trial seemed to be a way of condemning people to an unnecessary risk of cardiac death. CAST remains a cautionary tale, and was a major spur to the EBM movement that took off in a big way about the same time as it was published.

    I know nothing personally about Tom Jefferson or what makes him tick. However, the issues about flu vaccine effectiveness are familiar in other areas of medicine. He may be wrong, but he does not seem to be irrational.

  14. #14 revere
    October 27, 2009

    Ed Whitney: Remember what this is about. It isn’t about the disparity between observational versus experimental data for influenza vaccination in the elderly, which is what that controversy is about. It is about sliding it over into the swine flu policy and not making it clear they are separate issues. As for antibody levels, yes, we all know that they are not the endpoint we want. But in dealing with the endpoint we want we can’t do that until the vaccine has been deployed with a novel virus. So calling for RCTs for pandemic vaccine is not an option.

  15. #15 titmouse
    October 27, 2009

    My advice to Shannon Brownlee and Jeanne Lenzer would be to say something like this:

    “We realize now that our article in The Atlantic confused important distictions between seasonal influenza and the present swine flu pandemic. For example, we presented concerns about the diminished antibody response among older individuals given the seasonal flu vaccine in a manner that seemed to challenge the CDC’s recommendations concerning the present pandemic.

    “Swine flu has been causing greater morbidity and mortality among pregnant women, children, and healthy adults than typically occurs with annual seasonal flu epidemics. Our failure to clarify the relevance of questions about seasonal flu vaccine efficacy in relation to the present H1N1 pandemic may have discouraged a number of people from getting the vaccine. That’s a mistake we’d like to correct now.

    “We urge our readers to check the CDC web site. There you will find honest, well considered information about the swine flu vaccine and who is most at risk for serious illness.”

    To err is human. To persist in error as a face saving measure –never mind the body count– is something else entirely.

  16. #16 Phila
    October 27, 2009

    Revere and his followers, are so enamored with their new-found term that they fail to examine, using facts rather than insinuation and emotion, whether this article was worthy of that term

    These are professional journalists?

    God help us.

  17. #17 Bigbruther
    October 27, 2009

    S-M-A-C-K-D-O-W-N

    Goodness, it’s nice to school sensationalists. I don’t agree with you all the time, Revere, but I strongly agreed with, and enjoyed, your piece.

  18. #18 Paula
    October 27, 2009

    Revere, nice job here. I hope these gears can be pulled away soon. Semi-relatedly–certainly related to more popular journalism–I agree with Library Lady, it would be good to address the concerns of New York Times article, October 25, 2009, “Worst Case: Choosing who survives in a flu epidemic”, by Sherri Fink. This is a brave article but there is far more to be said on the ethics involved, especially as such “choosing” is already happening, if more subtly, in choosing where (cf. Rebecca Ruiz’s article in today’s Forbes) and to whom (as I’ve brought up here perhaps too often, over-65s are “last in line” yet account so far for 7 percent–vs. children’s 9.5 percent–of fatalities from lab-confirmed 2009H1N1) vaccine is being allotted. Also, if we can climb out from the gears a moment, we see the simple fact in your/b&s controversy: the Atlantic article, however well meant, can lead to people skipping this vaccine and thus dying. Which leads one to wonder how many nonpublished pieces–on this flu, on single-payer, on social justice–would, if published, have saved lives.

  19. #19 downeast
    October 27, 2009

    Uhmm. Revere. Sorry to hang to the right and head down a narrow, side road, but another truly lay question for you: With the population slowly getting vaccinated, and with a 2-3 week kick-in rate for the body to build immunity, what happens to the virus? Does it still burn through populations, infecting people, or does it get discouraged and slow?

    In other words, does the virus still jump from host to host, seizing on a chance for replication within a host, while the vaccinated just have a better chance of fighting it, or does the ever-increased number of those vaccinated dampen the virus’ spread?

    I realize this may be a very elemental question, but am trying to understand bigger implications of inoculating populations against flu. And while on topic, why was smallpox eradicated so effectively and influenza not?

  20. #20 revere
    October 27, 2009

    downeast: No, a good question. The presence of some immune people will slow transmission. There is actually a formula to predict what percent of the population needs to be immune before the effective reproductive number gets small enough that spread peters out, but for flu it’s up in the 80% plus range as I recall. The lack of any immune people is what makes a pandemic strain spread so quickly (this went around the world in 6 weeks).

    Regarding smallpox, there is only one reservoir for smallpox (humans), it doesn’t mutate like flu and the vaccine is almost 100% effective and decades long in duration. A much nastier disease but much easier to eradicate (although that wasn’t at all easy).

  21. #21 Tom DVM
    October 27, 2009

    Revere.

    In Basta et al 2008, Estimating Influenza Vaccine Efficacy From Challenge and Community-based Study Data,there was a large percentage of asymptomatic shedders in the vaccinated groupings…so things may be a little complicated when it comes to community transmission.

  22. #22 Magpie
    October 28, 2009

    Once again, we’ll leave it to readers to decide whether Brownlee and Lenzer rely on appeals to emotion, or if their device of calling our take “faith-based” is fact based.

    This reader decided that they’re not terribly bright and woefully out of their depth. Their answers remind me of the saying “better to stay silent and appear a fool than speak and remove all doubt”.

    Basic reading comprehension FAIL. Not one, not twice, but multiple times.

  23. #23 Simon Rippon
    October 28, 2009

    Revere writes: “There is nothing judicious about Jefferson” and “he is extreme in his views, looking at Jefferson’s own recent papers in the literature show conclusions much weaker than the picture painted in this article:”

    B&L respond: It is interesting that when Jefferson writes in a manner that is neither injudicious nor extreme, that Revere, instead of acknowledging his work as nuanced or careful, then calls his writings “much weaker” – much weaker than what?

    His “conclusions are much weaker” is interpreted as “his writings are much weaker”???! This quote shows that, quite remarkably, these so-called “science journalists”, “health writers”, or whatever they are, don’t actually understand the meaning of the word “weaker” when applied to a scientific conclusion. That is such a basic and incredible misunderstanding that I believe you completely missed it, revere. Perhaps their opinions of science in general are to be explained by their astonishing ignorance of the meaning of its language.

  24. #24 alia
    October 28, 2009

    From here in rainy Queens, NYC, where we had many schools close for swine flu outbreaks in the spring: My older son’s pediatrician is out of regular flu vaccine, and has not yet received– nor do they know if they will receive– a swine flu vaccine.
    My baby’s doctor ran out of regular flu vaccine earlier this month, but has been resupplied, and has plenty of swine flu vaccine that parents are avoiding because they are more scared of the vaccine than the flu.

    I know fear sells papers, but I get angry when I see babies’ lives at risk because their parents don’t know what to do, and in the absence of clear and confident information think it is better to do nothing than get “taken in” by a drug company conspiracy. Cuz that’s what’s happening in my crowd of Moms.

  25. #25 Hank Roberts
    October 29, 2009

    Reveres, I got this in email from a family member who’s skeptical (you name it, he’s skeptical of it). Comment?

    > If this vaccine works like other flu vaccines (but
    > unlike smallpox and polio vaccines) then it will reduce
    > symptom duration in healthy people who weren’t at severe
    > risk anyway, but leave mortality untouched.

    No citation, none expected. Any idea what this comes from?
    I also got this:

    > all of the young people in [mountain west state] who have
    > died have had underlying medical conditions like weakened
    > immune systems. I haven’t been paying attention to the
    > nation, but healthy young people here tend to stay healthy
    > young people and unhealthy young people (especially really
    > young like infants) are at risk.

    I can refute that from

    http://www.newscientist.com/special/swine-flu-myths-that-could-endanger-your-life
    specifically
    http://www.newscientist.com/article/dn18057-swine-flu-myth-youre-safe-as-long-as-youre-healthy-only-sick-weak-people-get-really-ill.html
    which cites among other sources
    http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19309 “… A high proportion of young children (27% of the 0-9 year-olds) and young adults (22% of the 20-29 year-olds) had no documented underlying disease …”
    and
    http://content.nejm.org/cgi/content/full/NEJMoa0906695?query=TOC
    “… Of the 272 patients, 198 (73%) had an underlying medical condition, including 60% of children …” (that’s out of small samples, not out of the total number hospitalized)

  26. #26 Yeast Infection
    October 29, 2009

    I think it is irresponsible journalism at this time.

  27. #27 revere
    October 29, 2009

    Hank: There are numerous studies on vaccine efficacy using various endpoints that show they work to reduce the chance of infection in the relevant population for swine flu. So the first statement is without basis, as far as I can see. You have amply dealt with the second. Your relative is misinformed.

  28. #28 Marc Lipsitch
    October 29, 2009

    The Atlantic authors reply on the KSJ Tracker Website:

    We’re simply saying that the nation’s seasonal flu strategy, which is to vaccinate the elderly and other vulnerable populations, may not be working as well as has been claimed. If we rely on vaccine during a major, deadly pandemic (which thus far this one does not appear to be, but things could change), the public may not be as well protected as we might hope or believe.

    thereby nicely encapsulating the non sequitur that is the thesis of their entire article.

    Like Revere, I am sympathetic to Jackson and Simonsen’s argument about seasonal flu vaccine in the elderly, and in fact have a paper coming out in the journal Epidemiology that discusses in a very positive fashion Lisa Jackson’s original study indicating that the protection for the elderly has been overestimated. But like Revere and the others upset by this article, I can’t see how Brownlee and Lenzer move from the premise in the first sentence above, to the conclusion in the second. Rhetoric and “maverick scientist” tropes notwithstanding, their argument makes no sense.

  29. #29 Monado, FCD
    October 29, 2009

    After the highly publicized death of a young, healthy athlete in the Greater Toronto Area after a very brief bout of swine flu, hundreds of people were lined up for the first public clinics today (free, of course) and the opposition party is calling for them to be open 24/7.

  30. #30 Hank Roberts
    October 30, 2009

    From Janet Raloff, a consistently excellent science writer:

    http://www.sciencenews.org/view/generic/id/48926/title/Science_%2B_the_Public__Mice_Seasonal_flu_vaccine_ups_risk_of_pandemic_flu October 29th, 2009

    “… The authors of this rodent study now ask whether there are lessons in their data for parents. Such as whether to ignore recommendations that youngsters get seasonal-flu shots during years when pandemic flu is raging.

    In a commentary accompanying this paper in Lancet Infectious Diseases (published online Oct. 30), researchers in Finland conclude the Dutch hypothesis, though interesting, is essentially bunk (although they do use a more academically respectful phrase).”

    As always, full citations and links are with the article.

  31. #31 Laura
    October 30, 2009

    Revere,

    Maybe a bit off subject, but is there any danger of getting the H1N1 vaccine after you already had swine flu but just did not know it? I think I had it but not sure, and doctor still wants me to be vaccinated for H1N1 due to my cancer history. But, I don’t want take any vaccine risks if I already had it. But I will never know. But would side effects and the risk of gullian barre be almost non-existant if I already had the strain and then was vaccinated against it? My thought was my body would not react at all because I am already immune to it. Should I still get the shot? thoughts?

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