Three years ago, the influenza season was a really big deal. The reason, of course, is that the 2009-2010 flu season was dominated by fears of the H1N1 strain, so much so that it was a rare flu season that there were two recommended vaccines, one for the originally expected strains of flu and one for the H1N1 strain. Fortunately for all of us, the H1N1 fear mostly fizzled, but public health officials were in a bad place. Under-react, and if the pandemic turned out to be as bad as the worst case scenarios predicted before the pandemic, and they’d be crucified for not having done everything they could to prevent it and mitigate its effects. Over-react, and they’d be blamed for frightening the public unnecessarily and wasting resources. In the end, with the perfect hindsight of the retrospectoscope, we now know that the pandemic was not bad as anticipated, but there was no way to know that prospectively going in.
During the entire pandemic, not surprisingly there were a lot of articles about the flu in general and the H1N1 strain in particular. It was during that time that I came across an article published in The Atlantic by Shannon Brownlee and Jeanne Lenzer entitled Does the Vaccine Matter? The title referred, of course, to the flu vaccine. I was, to put it mildly, completely underwhelmed by Brownlee and Lenzer’s arguments that the flu vaccine was basically worthless. So were revere (who, I wish, were still blogging) and Mark Crislip, who has written multiple posts on the efficacy of flu vaccines, one of them basically a rebuke to the article in The Atlantic to go with his most excellent direct rebuttal to the article. The reason I bring all this up is because it was during that time that I first encountered (well, not encountered, more like “paid attention to”) a man named Tom Jefferson of the Cochrane Collaborative, who was the “star” of Brownlee and Lenzer’s article. Indeed, Jefferson was portrayed as the brave maverick scientist speaking truth to power and, in essence, supporting Lenzer and Brownlee’s thesis that the flu vaccine was, well, worthless. He is also the man whose example revere used to teach me a new word, “methodolatry,” defined as “the profane worship of the randomized clinical trial as the only valid method of investigation.” I love that word because it also nicely points out the blind spot of evidence-based medicine that allows quackademic medicine to take root.
Now, it would appear, Jefferson has revealed either his utter cluelessness or his true colors. Take your pick. Why do I say this? Because a couple of weeks ago, he appeared on the Gary Null Show. Mark Crislip is all over it, in particular regarding the issue of this year’s flu season, which appears to have hit earlier and harder than average. His deconstruction is quite detailed and long even Orac-ian standards.
None of that will, of course, stop me from taking my own swipe at Jefferson because I find it very disturbing that the head of the Cochrane Collaborative in charge of doing Cochrane systematic reviews and meta-analyses of flu vaccine efficacy and safety would agree to be interviewed by a quack much of whose quackery involves pure antivaccine nonsense. I suppose it’s possible that Jefferson didn’t know who Null was when he agreed to be interviewed, but come on! A quick Google search brings up the infamous documentary that Null made called Vaccine Nation and what Null says on his website about it:
At the end of the eighteenth century, British physician Edward Jenner, with highly questionable medical credentials, initiated the theory and practice of live virus immunization that continues to serve as the scientific basis for the ever increasing vaccination of the world’s citizens. With the number of vaccinations given to infants and children rising, kids are receiving doses of toxic mercury and other heavy metals well above environmental safety levels.
Yet the medical evidence is clear. Mercury, known as thimerosal, and other heavy metal additives are highly toxic and threaten children with neurological damage. The long-term efficacy of global vaccination remains controversial, inconclusive and is suspect in light of the powerful corporate interests, lobbying efforts, and profits associated with a multi-billion dollar vaccine industry..
In his documentary film Vaccine Nation, award-winning investigative film director Dr. Gary Null challenges the basic health claims by government health agencies and pharmaceutical firms that vaccines are perfectly safe.
You can watch the whole thing here if you can stand it. It’s propaganda every bit as blatant and idiotic as that presented in the anti-vaccine magnum opus The Greater Good, so much so that I think someday I’ll have to subject myself to the movie and review it, because people do mention it from time to time, and antivaccinationists use it as “evidence” that vaccines are the root of all evil. Amusingly, on my search at least, a post I wrote about Gary Null shows up on the first page of search results, in which he accidentally poisoned himself with his own Power Meal supplements. I love it when my posts show up high in Google searches on quacks like Null because it doesn’t happen very often. Seriously, Dr. Jefferson? You couldn’t even Google Gary Null along with the word “vaccine” to see what his views were on the subject. I don’t know which is worse: If he didn’t bother to Google Gary Null and agreed to an interview or if he did.
Strike that. The latter would be infinitely worse. In the first case, Jefferson would just be clueless. In the second case, he’d be blatantly antivaccine. Crislip might say that he’s reluctant to judge a person by the company he keeps, but in this case I’m not. There’s no excuse for someone as prominent in the world of influenza vaccines as Tom Jefferson is step foot into Gary Null’s studio or allow Null to call him on the phone. To anyone who is a serious scientist studying vaccines, Null should be like Kryptonite to Superman.
Of course, the flu vaccine is an easy vaccine to attack because, although it is incredibly safe, it is not one of the best vaccines. Typical effectiveness varies from year to year because it depends on how well the flu experts who try to prognosticate every year about what strains of flu virus will be circulating many months in the future did in their prognostications. If they guess right and there’s a good match, the flu vaccine can be quite effective. If they guess wrong and the match between the circulating strains and the strains used to make the flu vaccine then it’s not a very effective vaccine. This year, according to Crislip, it appears that the flu vaccine should be around 60-70% effective. Antivaccinationists seem to think that if a vaccine isn’t 100% effective it’s crap.
So what sorts of things did Jefferson say on Gary Null’s show?
Null begins by peppering Jefferson with a bunch of questions, the most prominent of which is a question about whether pregnant women really need to get the flu vaccine:
Thank you very much for hosting me on your show Gary. You’ve asked me about 15 questions in one, so let me just start from the first one on pregnant women. When you are talking about pregnant women you are of course not just talking about pregnant women but you are talking about a pregnant woman and the fetus, the unborn baby. Now a pregnancy woman is a healthy adult despite desperate attempts at transforming pregnancy into a deadly disease. Pregnancy is part of… is a physiological state. It is the reason why our race is still on the planet. So there is nothing wrong with pregnancy. That is, it is normal. Pregnancy women therefore are healthy adults and we do know what the performance of the inactivated influenza vaccine is in healthy adults because there are quite a number of trials, clinical trials, that’s experiments, we summarize them, and to give you some idea, we need to vaccinate about 33 to 99 people to avoid one set of influenza symptoms.
Yes, pregnancy is a normal condition and not a disease, but that doesn’t mean it doesn’t carry risks. Women die in childbirth. They lose children. Health problems that pregnant women suffer during their pregnancy can have direct and permanent effects on their babies. More importantly, however, pregnant women who get the flu suffer more complications that the possibility of death, as Crislip points out. The are at a higher risk of miscarriage, developing respiratory complications such as pneumonia from the flu, and having low birth weight babies, for example, and there is evidence that the flu vaccine decreases the risk of these complications. Jefferson, consistent with his modus operandi, focuses on a narrow, limited set of complications in which, at least in part due to the complexities of doing the study, the benefits of the flu vaccine are harder to show (mortality, for instance) and ignores all the other ancillary benefits. He even pulls out the naturalistic fallacy at one point.
I don’t want to respond point-by-point to everything that Jefferson has said. After all, Mark has done a fine job of that. What I do want to do is to take the view from five miles up and wonder what the hell Jefferson thinks he’s doing. It’s clear that he’s skeptical of the benefits of the flu vaccine. That isn’t what bothers me. What bothers me is how he insinuates that the flu vaccine doesn’t work while never actually saying that you shouldn’t get it. He maintains plausible deniability, while trashing the vaccine left and right. What he says in public also differs from what he says in his Cochrane reviews, as I’ve pointed out before. For his reviews, he has to stick to the evidence, and peer reviewers have to be satisfied. When he’s talking to journalists, he can let his freak flag fly higher and, as I put it, go full mental negative on the flu vaccine. Why he does it is anyone’s guess, but what is undeniable is that he can. He’s also become known as a “brave maverick,” which can be very seductive. To get an idea of how Tom Jefferson was portrayed and quoted, let’s go back to Brownlee and Lenzer’s article from 2009:
The most vocal–and undoubtedly most vexing–critic of the gospel of flu vaccine is the Cochrane Collaboration’s Jefferson, who’s also an epidemiologist trained at the famed London School of Tropical Hygiene, and who, in Lisa Jackson’s view, makes other skeptics seem “moderate by comparison.” Among his fellow flu researchers, Jefferson’s outspokenness has made him something of a pariah. At a 2007 meeting on pandemic preparedness at a hotel in Bethesda, Maryland, Jefferson, who’d been invited to speak at the conference, was not greeted by any of the colleagues milling about the lobby. He ate his meals in the hotel restaurant alone, surrounded by scientists chatting amiably at other tables. He shrugs off such treatment. As a medical officer working for the United Nations in 1992, during the siege of Sarajevo, he and other peacekeepers were captured and held for more than a month by militiamen brandishing AK-47s and reeking of alcohol. Professional shunning seems trivial by comparison, he says.
See? Not only is Jefferson a Brave Maverick Scientist, but he’s such a Brave Maverick Scientist that his fellow scientists don’t want to hang out with him. Either that, or he’s a very boring dinner companion, which is something I rather suspect after having listened to his conversation with Gary Null. Or maybe he’s just shy. I’ve sat alone to eat meals at many a conference, particularly when I’m in a strange city where I don’t know anyone or at a conference where friends that I usually hang out with decided not to attend. I’m a little shy in person myself; I’ve never been the sort just to step up to a group of people whom I don’t know well and ask if they mind if I join them. In other words, It does not follow from Tom Jefferson’s tendency to eat meals alone at scientific conferences that his fellow epidemiologists must be shunning him. I’ve met plenty of surgeons and scientists with—shall we say?—”outside the mainstream” opinions about various scientific issues who are quite gregarious and sometimes even the center of attention. Be that as it may, bucking the establishment is something the media loves. Being an “iconoclast” or a “maverick” can be very rewarding. It brings attention and fame. In recent years, Dr. Jefferson has become the go-to vaccine scientist for the “skeptical view” on the flu vaccine whenever a journalist is doing a story. I never thought he’d actually willingly appear on a show like Gary Null’s. What’s next? Alex Jones? At this point, it wouldn’t surprise me.
Three years ago, I was willing to give Tom Jefferson the benefit of the doubt. I thought he was just suffering from serious methodolatry, in which randomized clinical trials are the be-all and end-all of evidence (and not even all of them). The problem, of course, is that a lot of the evidence is epidemiological, as the questions being examined don’t always lend themselves to ethical randomized clinical trials. Jefferson typically fails to consider the totality of evidence into context and draw conclusions based on more than a very narrow set of observations. Whether he is antivaccine or not in his heart of hearts, I don’t know. What I do know is that his behavior certainly flirts with it, just as he did when he let an antivaccine quack like Gary Null interview him. There’s an old saying that if you lie down with dogs you’ll get fleas (although, quite frankly, I love dogs and don’t like to insult such noble creatures by making an analogy comparing Gary Null to them). Jefferson should be getting a bit itchy right about now.
Maybe Barbara Loe Fisher’s National Vaccine Information Center got it right when she wanted to award him the NVIC Visionary Award. Back then, Jefferson, after initially accepting it, ultimately decided to do the right thing and decline it before what was in essence the antivaccine awards ceremony, apparently finally figuring out that the NVIC is an antivaccine organization. After listening to him on Gary Null’s show, I can’t help but conclude that, if the NVIC were to offer the award to him today, I’m not sure he’d still the good sense to turn it down. On the other hand, maybe he’s finally learned his lesson, tweaked by a bit of itchiness.
I wouldn’t count on it, though.