I’m not really happy to have to write this post, but a blogger’s got to do what a blogger’s got to do. The reason is that Katie Couric has done something requires—nay, demands—a heapin’ helpin’ of Orac’s characteristic Respectful Insolence. Why should I give the proverbial rodent’s posterior about who gets the Insolence today? The reason is that, when it comes to medicine, Katie Couric has done a fair amount of good. After the tragic death of her husband at a young age from colon cancer, she became an activist and spokesperson for colorectal cancer awareness, even famously undergoing her very own on-air colonoscopy in 2000. Then, in 2005, as part of Breast Cancer Awareness Month, she similarly underwent mammography on the air on the Today Show. She was even one of the co-founders of Stand Up To Cancer (SU2C). Indeed, I saw her accept the AACR Award for Distinguished Public Service earlier this year. In brief, Katie Couric was supposed to be one of the good guys, and usually she is.
There is, however a somewhat darker side. Couric tolerated the notorious antivaccine reporter Sharyl Attkisson for years, even after Attkisson demonstrated that she was an Andrew Wakefield fangirl and dropped stinky bombs of burning stupid on the blogosphere about vaccines in the form of abusing the Hannah Poling case and promoting Helen Ratajczak’s mind-numbingly scientifically ignorant “review” of the evidence regarding vaccines and autism, among numerous other examples. She even once pulled the classic crank tactic of the “pharma shill gambit” on Paul Offit and “vaccine defenders” in a despicable journalistic hit piece called How Independent Are Vaccine Defenders? When pro-vaccine groups complained, someone at CBS News, likely Attkisson, passed the complaint along to the antivaccine cranks at AoA.
So, despite her good works on the cancer front, I wasn’t entirely surprised to see alarmed warnings that Katie Couric was going to do a segment on the vaccine against the human papilloma virus (HPV) from people like Seth Mnookin. The segment appears to be an installment of something Couric calls The Big Conversation, and the story was entitled The HPV Vaccine Controversy, and it contained segments like Is the HPV Vaccine Safe? Because I have a day job and can’t watch vapid daytime TV, I DVRed the episode and watched it, just so that I could report on it for you. The things I do for my readers! Then it popped up online, so that you, too, can share my pain.
It was even worse than I thought it was going to be, and I knew it was going to be bad when it was advertised as having a mother who thought that Gardasil killed her daughter. And so it did. What I didn’t realize is that Couric also had one of the founders of the anti-HPV vaccine crank blog SaneVax on her show, Rosemary Mathis, and her daughter Lauren. If you want to get an idea of just how much quackery and pseudoscience is promoted by SaneVax, just search this blog for the term. I’ll just give you two examples. First, SaneVax latched onto a dubious finding of trace amounts of HPV DNA in Gardasil to launch a fear mongering campaign of such monumental ignorance about molecular biology and science itself that it was breathtaking in its scope. Then about a year ago, SaneVax published a guide to blaming the deaths of children on Gardasil. I kid you not. The title of the despicable article was A Parent’s Guide: What to do if your child dies after vaccination. More recently, SaneVax published an article entitled Gardasil HPV: What to Do If You or Your Daughter Suspect Premature Ovarian Failure, another bogus claim made about Gardasil by antivaccinationists.
One of the founders of this group was one of the mothers Couric interviewed as an equal to a real pediatrician. Yes, the entire segment was structured as a “he said, she said” tour de force of false “balance.” On the one hand, we have two anti-HPV mothers, one who thinks that the HPV vaccine killed her daughter and the other who thinks it injured her and as a result helped form a website that spreads the vilest, most idiotic pseudoscientific fear mongering about HPV imaginable. On the other side, there was a lone pediatrician trying to promote science-based medicine and a mother who had her daughter vaccinated and didn’t regret it. Somewhere in the middle, but not really given what she says, is Diane Harper, represented as having been integral to the development of Gardasil. In reality, Harper is on the anti-HPV side and, being represented as the definitive Gardasil authority, weighs heavily on the message, even though she doesn’t get the last say.
The segment starts with Couric asking, “Have you all heard about the controversy surrounding the HPV vaccine?” I’m half tempted to answer here, “No.” The reason is that, scientifically speaking, there is no “controversy.” The HPV vaccine, be it Gardasil or Cervarix, is effective and incredibly safe. The whole “controversy” is not a controversy at all, but rather a manufactroversy, and Couric does her part in promoting that manufactroversy through the tried and not-so-true technique of false balance.
That balance starts out with an interview with an interview with Emily Tarsell, whose daughter Christina died unexpectedly at the age of 21. Tarsell has been telling the world that she thinks Gardasil killed her daughter for quite some time now, telling the Institute of Medicine, having her story featured on website of the the antivaccine group National Vaccine Information Center (NVIC). Couric begins, as is appropriate, by expressing sympathy for Tarsell’s loss. It’s always horrible when a parent loses a child. Even recognizing that, this interview was pretty pointless, consisting mainly of going on and on about how awesome Christina was and how awful it was that she died. Emily Tarsell did not present a single shred of evidence that Gardasil had anything to do with her death, and when Couric asked her what her daughter’s symptoms were, she demurred, refusing to answer, “Because we have a case pending, I cannot go into detail what happened each time,” referring to each dose of Gardasil. All we learn is that Emily died suddenly 18 days after receiving her third dose of Gardasil, and that the autopsy failed to find a cause of death. You can see it all here:
Of course, what isn’t mentioned is that Emily Tarsell is on the board of directors of the antivaccine political group known as the Canary Party, which was behind the effort to have a Congressional hearing in front of the House Committee on Oversight and Government Reform, chaired by Darrell Issa. Fortunately, it failed. This time. Of course, up until now, Tarsell has not been shy at all about telling her daughter’s story in detail. For example:
Here we learn that Tarsell didn’t think about Gardasil as the cause of her daughter’s death until weeks later, when a family member mentioned reports of Gardasil and that Tarsell remembered that her daughter had complained of not feeling well after the shot. What was wrong? She said she was tired and felt dizzy when she stood up.
Then there’s this video:
Here, we learn that a few days after the third Gardasil vaccine, Emily felt dizzy and complained of fatigue. These are very vague symptoms, and could be due to many things. As tragic as it is and as much sympathy as we all feel for Tarsell, her story is a perfect example of the post hoc ergo propter hoc fallacy. Just because Christina Tarsell received Gardasil before she died unexpectedly does not mean Gardasil caused her death. It doesn’t even mean that it caused her vague symptoms of fatigue. In fact, given the literature out there, it almost certainly didn’t.
Next up was Diane Harper. After seeing Harper in action on Katie Couric’s show, I now take back the benefit of the doubt that I gave her, particularly after her crack later in the show that pediatricians are “trained to give vaccines, not trained to do Pap smears.” Besides being wrong, it’s a quote so full of burning stupid—yes, I’m calling Harper out on that—that I change my mind. Harper has become a crank, and she does now hate Gardasil. In essence, her argument was that, because only 10% of women with HPV infection develop chronic infection, why vaccinate? She also points out that approximately 10% of girls acquire HPV before their 11th birthday, which is when the first dose of Gardasil is recommended to begin.
Her biggest trope, however, is that HPV vaccines “only” last five years. There is simply no reason to believe that is true. The reality is that HPV vaccines haven’t been licensed long enough to know how long vaccine-induced immunity persists. Even so, although we might not yet know how long HPV vaccine immunity will last, but we do know that the duration of vaccine coverage (95%) protection remains at least five years. Indeed, a recent analysis of nearly 5,000 women on Nordic countries found that Gardasil “is effective up to 6 years following vaccination with a trend of continuing protection up to 8 years following vaccination,” and Matthew Herper points out that an analysis by also indicates that people still have immune responses 8 years after getting the shot.
The rest of the time, Harper seems to have a magical faith in the ability of Pap smears to catch cervical lesions early enough to allow interventions that prevent progression to full-blown cancer. While this is true in a perfect world (i.e., where women receive their Pap smears according to recommendations), in the real world, efficacy isn’t as great, but there’s also a philosophical issue here: Isn’t it better to prevent cervical neoplasia that can lead to cervical cancer rather than treating it when we find it, particularly when it can be done so safely? Let’s just put it this way. As Tara Smith writes:
Dr. Harper believes the HPV vaccine is over-hyped, and that Pap screening is “100% accurate” so no HPV vaccine is really needed. This, frankly, is hogwash. Even with emphasis on screening, here in the U.S. we have 12,000 cases and 4,000 deaths from cervical cancer alone each year. (And in Mnookin’s post and in Matthew Herper’s Forbes post, both note that head and neck cancers can also be caused by HPV as well–but have no good screening process).
Harper acts as if finding HPV via Pap smears is like rainbows and unicorns, but it too has a risk-benefit equation, and I’d so much rather have received a vaccination than to have gone through that. And, some women’s treatments for HPV infections and cervical abnormalities are even more extreme than mine was.
Indeed. An argument can be made that in developed countries Pap smears can produce results as good as the vaccine in terms of lowering death rates, but there are tradeoffs. Moreover, if HPV incidence is driven low enough by mass vaccination, Pap smears could be done less frequently or only targeted to high risk populations. If better HPV vaccines are developed to cover more types of HPV, this process could accelerate to the point where Pap smears are not even necessary any longer. Be that as it may, I’ve seen Harper make far more nuanced arguments, understanding that it’s not black and white. Her argument that Gardasil’s benefits are overhyped and that the cost-benefit ratio of the vaccine might not be worth making it part of the recommended vaccination schedule even had some resonance with me before. My thinking has evolved on the issue. Be that as it may, here, it’s very clear, despite her waffling, that Harper thinks Gardasil is a waste of time and that women should just get Pap smears.
Throughout the entire segment, what is most frustrating about Harper’s responses is that she sidesteps the answer to one question. She is asked on at least two occasions whether she thinks the benefits of HPV vaccines outweigh the risks. Both times, she answered another question, first dodging the question of whether she thought Tarsell’s blaming the HPV vaccine for her daughter’s death was plausible, and then near the end she waffles about if “you’re comfortable” with the risks and benefits of the HPV vaccine you should have it. She can’t, however, resist making the aforementioned crack about pediatricians being trained to give vaccines rather than Pap smears, adding that the best gift you could give your daughter would be a certificate for a pap smear at age 21.
As mentioned before, Couric also interviewed Rosemary and Lauren Mathis. Rosemary Mathis founded the antivaccine (specifically, anti-HPV vaccine) group SaneVax, and Lauren is her daughter. Her story is even less convincing than that of Emily Tarsell. It’s summarized in a news story from 2010, in which it is stated that Lauren was bedridden for 85 days.
Doctors diagnosed her with an enlarged liver and a nonfunctioning gallbladder.
“I was scared and for probably a year I slept beside her because I was afraid for her to go to sleep,” Mathis said.
After seeing other doctors and specialists across North Carolina for nearly a year, a doctor at Duke Medical Center confirmed that Lauren’s illness was directly related to a vaccine. Mathis said the only recent vaccine given to Lauren was Gardasil.
The story as shown on Katie Couric’s show is here:
In this, Lauren states that she felt sick after each vaccine and lost two years. Apparently Lauren developed some sort of chronic illness, leading her mother to take her from doctor to doctor, feeling as though she was being ignored. Finally, a doctor at Duke diagnosed her with “vaccine injury.” What type of vaccine injury, you ask? I can’t tell you because Rosemary Mathis doesn’t tell. She just says “vaccine injury.” She also doesn’t tell us how this doctor, whom she doesn’t name, came to the conclusion that Lauren had “vaccine injury.” This is a key component of Rosemary Mathis’ story, but I’ve as yet been unable to find anywhere where she revealed the identity of this doctor (or, as it is sometimes portrayed, “doctors”). In this post on the SaneVax website, Rosemary Mathis states:
She went from being an Academically Gifted student to one who struggled to complete her 8th grade year of school. She was placed on a modified school plan by her principal who fully backed her because she was an excellent student who had been in the North Carolina Academically Gifted Program since 2nd grade. Her life became an endless round of hospital and doctor visits with little resolution to the severe pain that she was experiencing. She was even sent for surgery on her gall bladder at Wake Forest Baptist Medical Center where a skilled surgeon recognized the symptoms were more than gall bladder dysfunction and thankfully did not operate. We have spent the past year researching this horrible vaccine and the side effects and treating her with vitamins and medicine. My daughter is currently being treated by Duke University’s Children’s Hospital and Wake Forest Baptist Medical Center’s Brenner’s Children’s Hospital and the bills are now in the tens of thousands of dollars. Thankfully, I am a manager for Lowe’s Home Improvement Warehouse in their Corporate Office and have a good insurance policy which has helped cover the costs associated with the effects of Gardasil.
Lauren’s dates of vaccinations were 2/4/08 (Lot #1448U); 4/16/08 (Lot #1757U); 8/18/08 ( Lot #0067X).
With her second Gardasil vaccination, Lauren also received Varicella 165U and Menactra U2559AA. Symptoms over this past year and a half have included: enlarged liver, gall bladder attacks, severe nausea, chest pain, severe abdominal pain, severe headaches, brain freezes, stomach ulcer, sensitivity to light.
This all sounds like some sort of hepatitis, perhaps autoimmune. Or perhaps she had primary sclerosing cholangitis. One wonders if the doctor at Duke saw autoimmune hepatitis or cholangitis and decided Lauren had had vaccine injury. Certainly my speculation is no more ridiculous than coming up with a diagnosis of “vaccine injury” just by looking through medical records. I’d love to know on what basis the doctor in question, if he even exists, diagnosed Lauren with “vaccine injury,” because I am unaware of a mechanism by which vaccine injury could cause gallbladder dysfunction.
The segment concludes with Dr. Mallika Marshall, a pediatrician at Massachusetts General Hospital and “Katie” medical contributor, who explains why she recommends the HPV vaccine for both boys and girls.
Overall, Dr. Marshall does as good a job as any science-based contributor could be expected to do under the circumstances, pointing out that just because these girls received vaccines before getting sick doesn’t mean it was the vaccines that made them sick and trying to inject some common sense and science into the discussion. Unfortunately, it’s too little, too late. The issue had already been irrevocably and intentionally framed by two women who think that their daughters were either killed or horribly injured by HPV vaccines, another woman who barely disguises her contempt for the HPV vaccine and her belief that pap smears are better, and a script dripping with false balance and obvious sympathy for the viewpoint that HPV vaccines are dangerous. It’s a horrible, horrible piece, and tacking Dr. Marshall on at the end, as valiantly as she strives to fight the waves of pseudoscience engulfing the show without being too “harsh.” The producers should be ashamed, but they are clearly shameless if their response to criticism is any indication:
We reached out to Couric’s producers; a person close to the program defended the segment by observing that the show “regularly discusses important topics in the hope that people can make their own decisions.”
May I then assume that Katie will soon be airing “both sides” of claims that 9/11 was an “inside job”; evolution is a “theory in crisis”; the moon landing was a hoax; and the Holocaust never happened? If not, why not? What she has done with Gardasil is the equivalent: Examining an issue that does not have two sides and then applying liberal helpings of false balance. Worse, by framing this as a “debate” or a “he said, she said” format, Couric’s producers have falsely elevated complete loons like SaneVax founder Rosemary Mathis to the seeming level of real experts like Dr. Marshall. There are controversies about the HPV vaccine. Whether it is safe or not is not one of them, and giving the floor to the most committed antivaccine activists to appeal to emotion rather than science is not how to discuss them. Couric’s producers and Couric herself were far more interested in “human interest” and controversy than actual medical and scientific accuracy.
Worse, Couric promotes a viewpoint that has no evidence to support the risks she attributes to HPV vaccination. Indeed, the evidence is very much against the existence of such risks attributable to Gardasil. For example, recent large cohort study of nearly 1,000,000 girls between the ages of 10 and 17, 296,000 of whom had received at least one dose of the HPV vaccine and 160,000 of whom received all three doses failed to find any link to health problems, either long or short term. Nada. Zip. Gardasil is incredibly safe. It’s also effective. Earlier this year, a study by the CDC showed that the prevalence of the cancer-causing strains of HPV has dropped by half among teenage girls in recent years, evidence of major success of the HPV vaccine. This is good news, given that the risks of HPV infection are very real. Every year about 12,000 women develop cervical cancer, and HPV is by far the most common cause. Couric’s mothers and Diane Harper are simply wrong, wrong, wrong.
It’s amazing how, in one fell swoop, Couric has called into question her dedication to science-based medicine after having done yeoman work promoting it with respect to colon cancer and other cancers. When asked in the title whether Couric is antivaccine or irresponsible journalist, I didn’t actually think that Couric is antivaccine. However, she is irresponsible. By giving voice to the crankiest of the antivaccine cranks with such an obvious biasing of the segment towards them, Couric has demonstrated irresponsibility on a massive scale. For shame. I don’t think she’s becoming the next Jenny McCarthy (a tempting title for this post that briefly crossed my mind, but way too obvious and easy), but she has dropped a massive turd of antivaccine pseudoscience on national TV. Maybe she’s trying to emulate Dr. Oz, except that even Dr. Oz probably wouldn’t have touched this.
ADDENDUM: The ever-helpful antivaccine cranks at Age of Autism have provided an “unofficial” transcript of the show.