Respectful Insolence

Mark Crislip versus Doug Bremner.

Dr. Crislip calmly explains the evidence regarding flu vaccination and why it’s safe and effective. Perhaps the most important point there is this:

So it’s a suboptimal vaccine. And that’s a problem. One, because it will make it more difficult to prove efficacy in clinical studies and two, there is a sub group of anti vaccine goofs who seem to require that vaccines either be perfect, with 100% efficacy and 100% safe, or they are not worth taking.

The influenza vaccine is not 100% efficacious in preventing disease, but it is as close to 100% safe, and much safer than the disease.

One of the biggest bits of nonsense about the flu vaccine (and, come to think of it, most vaccines) that the anti-vaccine movement promulgates is that if it isn’t 100% safe and 100% effective, then it’s crap. Unfortunately, virtually nothing in medicine is 100% effective or safe, but vaccines come pretty darned close to 100% safe.

It also appears that Dr. Bremner is spouting some real nonsense about Gardasil. It’s really pathetic in that he’s actually using a talking point straight from the anti-vaccine movement; specifically, the infamous “Freedom of Information” request that shows so many adverse events from the VAERS database, the same sort of deceptive misinformation that the anti-vaccine crank blog Age of Autism was trumpeting over a year ago. I’ve dealt with the issue before here and here. I’ve also pointed out how easily the VAERS database is manipulated by anti-vaccine litigants and, and distorted by, well, just about any bit of information that hits the zeitgeist. I’ve expressed my misgivings about the promotion of the HPV vaccine before (at the same time pointing why correlation does not necessarily equal causation), but Bremner’s arguments against it are nothing more than the recycled nonsense that the anti-vaccine movement has been cranking out.

As David Colquhoun said in a comment:

Although a pharmacologist, I’m very opposed to over medication, especially by psychiatrists who appear to be one of the groups that have acquiesced to bribery by Big Pharma, to prescribe marginally effective drugs. But this post cames dangerously close to endorsing the anti-vax conspiratorialists.

There’s no “dangerously close” about it. Bremner did endorse the misinformation about the HPV vaccine being spread far and wide by anti-vaccine conspiratorialists. He clearly has no clue about how the VAERS database actually works, and that’s how he fell for anti-vaccine propaganda. In my mind, with that post, Bremner has stepped out of the realm of reasonable skepticism and into the realm of flirting openly with the anti-vaccine movement. There’s room for reasonable skepticism about the HPV vaccine and its promotion, but what Bremner wrote in no way resembled reasonable skepticism. It was far more akin to a screed posted on anti-vaccine websites like Generation Rescue or the NVIC or on anti-vaccine blogs like Age of Autism.

Comments

  1. #1 Amy R.
    October 10, 2009

    On a related note:

    There is actually a pro-vax article in HuffPo, regarding the H1N1 vaccine. Holy crap!

    http://www.huffingtonpost.com/linda-bergthold/im-calling-bill-maher-out_b_316192.html

  2. #2 Richt Ofen
    October 10, 2009

    I’d like Orac to admit that he is no more of an expert on health than the alternative medicine people he ridicules. Orac is like the scientists in the story below. He claims he knows what is right, but when it comes down to real testing……

    “Flopdown: Moon collision fizzles

    Nasa’s hope of filming a spectacular crash on the moon was dashed satellite and telescope imagery failed to record the enormous plume of rock and dust that scientists had predicted.

    The US space agency steered two parts of a spacecraft, called LCROSS, into the moon at more than 5,600 miles per hour, in the final act of a hunt for signs of water.

    Nasa scientists had anticipated that the impact would throw up a six-mile-high cloud of lunar dust and rock which could be scanned for evidence of frozen water. But after the collision at 12.31pm today, no sign of the plume was spotted, even from the second stage, which crashed nearby four minutes later.”

  3. #3 Joseph C.
    October 10, 2009

    @Richt,

    That’s a pretty nice non sequitur. Do you care to get more specific? Or are you just another lame drive-by troll?

  4. #4 Skeptico
    October 10, 2009

    NASA failed to film something therefore vaccines don’t work. Impeccable logic.

  5. #5 Kismet
    October 10, 2009

    Richtofen=Happ*h? Maybe too lucid, though.

    BTW, could someone point me to a good rebuttal of the study showing increased rates of H1N1 infection in those who vaccinated last year? I know the shortcomings of such research (ie. observational studies), but I’m wondering if there are any more concrete talking points.

    http://science.slashdot.org/article.pl?sid=09/10/04/1344259
    http://www.reutershealth.com/archive/2009/09/24/eline/links/20090924elin014.html

  6. #6 Rjaye
    October 10, 2009

    Yup, good post, especially regarding the VAERS “data.” I can’t believe people point to VAERS reports and treat them as scientific information. Since anti-vaxxers have completely poisoned that well, any possible lead on side effects will be even more suspect, making the search for real information harder.

    And where is that sack…

  7. #7 Chris
    October 10, 2009

    The lame drive by troll looks Happehish.

  8. #8 Dave
    October 10, 2009

    Unfortunately, virtually nothing in medicine is 100% effective or safe, but vaccines come pretty darned close to 100% safe.

    For that matter, nothing in life is 100% effective or safe. Yet I’m sure the anti-vax nitwits do not make this stringent requirement of other aspects of their existence. I’ve noticed, for example, that intercessory prayer is not 100% effective.

  9. #9 Sid Offit
    October 10, 2009

    Since anti-vaxxers have completely poisoned that well, any possible lead on side effects will be even more suspect, making the search for real information harder.
    ———————–
    So basically the post-licensure safety monitoring system is worthless? And even if there were adverse events, we’d have a hard time fining them? Damn those anti-vaxxer conspiratorialists

  10. #10 Prometheus
    October 10, 2009

    In reference to:

    “…the infamous “Freedom of Information” request that shows so many adverse events from the VAERS database.”

    You don’t need a “Freedom of Information Act” (FOIA) request to get the raw data from the VAERS database – you can simply go to their website and download it.

    http://vaers.hhs.gov/data/index

    Anyone who needs to file an FOIA request to get this data is either too lazy (or too technologically-challenged) to get it themselves or is trying to imply a “conspiracy of secrecy” that doesn’t exist.

    After all, I could file an FOIA request to find out the names of the US President and Vice President, which would “force” the White House to “reveal” their identities. Or I could simply read it in the newspaper.

    In reality, FOIA requests are routinely denied for information that is truly “secret”, “sensitive”, “confidential” or otherwise restricted from release.

    Prometheus

  11. #11 JakeS
    October 10, 2009

    Have your techs been playing with the site software recently? The layout has gone completely haywire when I view it in Opera, but it looks fine in Internet Explorer (both my browsers are reasonably up to date).

    - Jake

  12. #12 Uncle Dave
    October 10, 2009

    @Richt Ofen,

    The NASA experimentation in your example (moon impact example) is a perfectly good example of research in action and some in the public taking some of the hipe information about the research project and assigning value to it.
    For many amateur astronomers who got up early to watch the crashes through telescopes or on NASA TV, the crashes were a bit anticlimactic. The fact that it did not throw tons of debris into the atmosphere has nothing to do with mission success.

    The LCROSS mission is a search for water on the moon, not an attempt to make cool explosions for the public. The LCROSS mission did this by sending a rocket crashing into the moon causing a big impact and creating a crater. This impact will release materials from the lunar surface that will be analyzed for the presence of hydrated minerals which would tell researchers if water is there or not. The two main components of the LCROSS mission are the Shepherding Spacecraft (S-S/C) and the Centaur upper stage rocket. The Shepherding Spacecraft guides the rocket to a site selected on the moon that has a high probability of containing water. Because they have only one chance with this mission in finding water, the researchers have to be very precise where they program the Shepherding Spacecraft to guide the rocket.

    Scientists say it could be days before data transmitted by LCROSS are fully analyzed. If no evidence for lunar water is found, that will be a significant finding in itself, Bicay of NASA’s Ames center said.

    It could mean water doesn’t exist on the moon or that there’s very little water or that it’s only patchy.

    “Like an old Texas wildcatter,” Bicay said, “we may have hit a dry hole.”

    Again, making a huge plume of dust or at least a much larger one then was actually anticipated was not the mission objective.

    You could have brought up the measurement conversion error on the Mars probe lander? However that would have just pointed out a failed attempt to collect data rather then some sort error in the scientific method.

  13. #13 Chris
    October 10, 2009

    Do not feed the off topic troll.

  14. #14 Science Mom
    October 10, 2009

    Since anti-vaxxers have completely poisoned that well, any possible lead on side effects will be even more suspect, making the search for real information harder.
    ———————–
    So basically the post-licensure safety monitoring system is worthless? And even if there were adverse events, we’d have a hard time fining them? Damn those anti-vaxxer conspiratorialists

    @Sid, how on earth did you make that leap from the previous commenter? Anti-vaxers use VAERs to astroturf, which dilutes signals that legitimate entries make. Each entry is not consistent and needs to be followed up on personally. Not to mention, some rather incompetent and nefarious ‘investigators’ attempt to use VAERS as a data source for prevalence estimates, which, of course, diminish the importance of such a surveillance system. So yes, damn those antivax morons.

  15. #15 Sid Offit
    October 10, 2009

    I was surprised to see what an investigation of a signal involved. This describes an investigation into SIDS reports. A letter and a phone call by “staff?” doesn’t seem all that thorough

    The FDA followed up all reports of death following immunization submitted to VAERS during the time period July 1, 1990, to September 30, 1991 Of 235 reports, 29 were duplicates, leaving 206 unduplicated reports. The submitted data were considered to be adequate for 78 of those reports. Complete follow-up was achieved for an additional 81 reports. Thus, the number of reports with completed assessments was 159. Follow-up was done by FDA staff. Most queries were by telephone, and a few were by mail. There were 3.5 calls per clarified report and 2.5 completed calls per clarified report. The typical succession of calls was first to the reporting physician’s office and then one or more referrals to the hospital medical records department, the coroner or medical examiner’s office, and occasionally, the county recorder or state public health vaccination department.

  16. #16 a-non
    October 10, 2009

    This describes an investigation into SIDS reports. A letter and a phone call by “staff?” doesn’t seem all that thorough

    What would you consider to be thorough, genius?

  17. #17 Leilah
    October 10, 2009

    If I can second Kisment’s comment, I’m hunting for info refuting that study as well – especially since Canada’s flu schedule this year has taken the study massively into account.

  18. #18 Kristinmh
    October 10, 2009

    Leilah, I’m guessing it’s because Canada strongly promotes flu vaccination to high-risk groups but not so much to the general population (I live in Toronto, and I know Ontario is starting to change this). Also it’s easy to vaccinate elderly people who live in nursing homes and/or frequently visit doctors. Same with small children – easy to add the flu vaccine to a routine visit. Harder to vaccinate healthy adults who may rarely if ever go to a doctor.

    Since the elderly and small children are more vulnerable to flu in general + more likely to get the flu vaccine, it might be a predictable statistical blip. Or, since I haven’t read the study and am basically talking out of my ass, there might be some weird medical reason for the effect.

  19. #19 tracy79
    October 11, 2009

    sometimes it’s more interesting to read the comments made by you guys than the article itself..

    http://www.craigspr.org

  20. #20 Chris
    October 11, 2009

    Dear craigspr spammer, this only shows you have not read the article.

  21. #21 Azkyroth
    October 11, 2009

    If we expand the definition of “not safe” to include all demonstrable negative physiological effects, coming down with the flu is nearly (hack, wheeze) 0% safe.

  22. #22 Michael Ralston
    October 11, 2009

    “Richt Ofen” and “tracy79″ are both spammers.
    Richt just remixed part of a H*appeh comment with something that looks to be from another blog entirely, and tracy just posted a generically-dull comment.

  23. #23 ekcol
    October 11, 2009

    “…there is a sub group of anti vaccine goofs who seem to require that vaccines either be perfect, with 100% efficacy and 100% safe, or they are not worth taking.”

    This leads to what is IMHO the most unpleasant part of some anti-vaccine parent’s logic. If they give their kid the vaccine, there’s a tiny chance they might get sick, a tiny tiny tiny chance they might die, and it would be their fault. When you point out there’s a much greater chance of their kid dying of the disease, it doesn’t matter, because that would just be random bad luck and not their fault.

    So they don’t care which option is more dangerous for their child, just about making sure they don’t feel guilty if the kid dies.

  24. #24 trrll
    October 11, 2009

    I was surprised to see what an investigation of a signal involved. This describes an investigation into SIDS reports. A letter and a phone call by “staff?” doesn’t seem all that thorough

    It sounds as if you are subject to confirmation bias regarding your own expectation that the investigation would be perfunctory. Read the material you quoted again, and try to understand it this time. Was it really just “a” letter and “a” phone call?

    Most queries were by telephone, and a few were by mail. There were 3.5 calls per clarified report and 2.5 completed calls per clarified report.

    So in fact, multiple sources were contacted to obtain the medical records required for evaluation:

    The typical succession of calls was first to the reporting physician’s office and then one or more referrals to the hospital medical records department, the coroner or medical examiner’s office, and occasionally, the county recorder or state public health vaccination department.

    And who would you expect to make calls and send the letters, if not FDA staff? Temps? And what data, other than the patient’s medical records, would you expect to be required for follow-up to clarify the diagnosis?

    Considering that you seemed unable to understand a single paragraph in plain language that you yourself selected to quote, it is not surprising that you are having so much difficulty comprehending the scientific data.

  25. #25 Joesph C
    October 11, 2009

    Another day, another medical screw up that kills a patient.

    Alternative medicine doesn’t kill people like this because they don’t believe a knife is a medical tool. A knife is for killing, not healing people.

    “Soldier dies after being given cancerous lungs in transplant operation

    Matthew Millington, 31, died at home in Brown Lees, near Stoke-on-Trent, after receiving the organs from a donor who is believed to have smoked between 30 and 50 roll-up cigarettes a day, an inquest heard.

    Following the death, an investigation at Papworth Hospital, in Cambridge, pinpointed a string of problems, including issues with communication, record-keeping and patient handover. It found that a radiographer had failed to highlight the growth of a cancerous tumour. “

  26. #26 Peeved
    October 11, 2009

    Alright, the comment spam is getting out of hand here…post #25 looks like H*ppehspam and is co-opting the name of “Joseph C”, a regular and a clear-thinker that wouldn’t post this tripe.

    Go away, comment spammer.

  27. #27 Orac
    October 11, 2009

    Yeah, it looks like Happ#h. More terms for the killfile. The bugger saw that I am out of town and not paying as close attention to the blog as I normally do and tried to take advantage.

  28. #28 mad the swine
    October 11, 2009

    Another day, another medical screw up that kills a patient.

    “Soldier dies after being given cancerous lungs in transplant operation.”

    Yeah, because the ‘incurable lung condition’ which the papers report he had would totally have been curable by broccoli enemas and magic diluted water.

    That being said, I’m not looking forward to Obamacare making these sorts of mistakes as routine in American medicine as they are in British government-run health care. Especially since they wouldn’t give the soldier a second lung transplant: with the way Britain rations treatment, cancer patients don’t get new organs.

    On topic: if a treatment is 100% safe, with no side effects whatsoever in anyone, that’s probably because it doesn’t actually do anything. To be honest, if parents want to keep their children away from HPV vaccines in order to keep the consequences of immoral behavior higher, that’s their prerogative, but Brenner’s fear-mongering is nothing but mathematically illiterate gibberish directed against people who don’t understand statistics.

  29. #29 Joseph C.
    October 11, 2009

    I’m amused that Happ*h would attempt to use my name for one of his sock puppets. Even more so that he can’t even spell “Joseph”.

    Orac, go out and have some fun!

  30. #30 Ramel
    October 11, 2009

    Am I to assume that Mad the Swine has never been to the UK, knows nothing about the country, and is in fact talking out of his porcine posterior?

  31. #31 trrll
    October 11, 2009

    Alternative medicine doesn’t kill people like this because they don’t believe a knife is a medical tool. A knife is for killing, not healing people

    Sprinkling flower petals over people’s heads doesn’t kill people like this either. Of course, it also doesn’t heal them…

    As the saying goes, if it sounds too good to be true, then it probably is. So if somebody tells you that they have a treatment for serious disease that cannot possibly hurt you…

  32. #32 wackyvorlon
    October 12, 2009

    @Ramel, he’s completely out to lunch. It’s amazing the silliness that gets lobbed about.

  33. #33 Calli Arcale
    October 12, 2009

    Okay, I know LCROSS is off-topic, but I *have* to correct one serious mistaken assumption from our drive-by nonsequitor troll, and some minor ones:

    Nasa’s hope of filming a spectacular crash on the moon was dashed satellite and telescope imagery failed to record the enormous plume of rock and dust that scientists had predicted.

    The US space agency steered two parts of a spacecraft, called LCROSS, into the moon at more than 5,600 miles per hour, in the final act of a hunt for signs of water.

    Nasa scientists had anticipated that the impact would throw up a six-mile-high cloud of lunar dust and rock which could be scanned for evidence of frozen water. But after the collision at 12.31pm today, no sign of the plume was spotted, even from the second stage, which crashed nearby four minutes later.

    First, the major error:
    No visible-light plume was detected. This is not the same thing as no plume. In fact, the orbiting Lunar Reconnaissance Orbiter, which carries instruments far more powerful than those on the disposable LCROSS spacecraft, detected solid evidence of an actual plume. At this point, it is not clear why Earth-based observers did not detect a plume, and it is possible that orbiting assets (such as Hubble) will have the answer, as their data is not immediately available. Possibilities include the plume coming out a different angle than expected (since the crater is completely dark and not completely radar-mapped, the actual slope at the impact site isn’t known) and the plume being much darker than expected. If the ejected material is very dark, then that would be very surprising and quite possibly just as interesting as finding water there — dark material is usually high in carbon, which would be interesting indeed and potentially very useful for future lunar colonists.

    So it is actually false that no plume was detected. It just wasn’t visible from Earth as hoped. Indeed, the LCROSS spacecraft probably detected the plume as well; researchers have to sort through the huge volume of data it frantically pumped out during its suicide dive. So far, it looks promising — the researchers are actually seeing exactly the sort of data they expected to see, even with the plume not being visible from Earth. But they want to be sure before they go making any announcements.

    Now, for a quibble:
    The thing that actually struck the moon first was the second stage of the rocket, a cryogenic booster called a Centaur. It’s quite a venerable upper stage. It was spent boosting LRO to a translunar trajectory. After LRO separated, the LCROSS spacecraft remained attached to the Centaur, periodically firing its engines to control outgasing as the small amount of propellant boiled away, and to tweak the thing’s trajectory. Even empty, it’s not small. In the final phase, LCROSS separated from the Centaur and then fired its engines one last time to ensure it would land a bit later, giving it the chance to sniff any plume that was kicked up. The second stage of the rocket, the Centaur booster, smacked into the moon’s Cabeus crater. Five minutes later, the much smaller LCROSS spacecraft smacked into the moon somewhat downrange of Cabeus crater.

    Scientists don’t make pronouncements on the basis of whether or not pretty pictures are returned. They *love* pretty pictures, and they like big kabooms as much as anyone. But that’s not why they run a mission like this. Their life’s work is *science*, and they are now very busy applying science to the data they obtained last Friday. This doesn’t mean they’re clueless. It means they understand “real testing”, which I suspect is something beyond Richt Ofen.