Right now, I'm looking out my window to see the spreading pall of burning stupid rising over Channel 7's tower in Southfield. And the stupid isn't just for Steve Wilson anymore. What reporter Carolyn Clifford lacks in adiposity, she easily makes up for in credulity. Her "investigative report" tonight on the HPV vaccine Gardasil is another example of embarrassingly bad health reporting.
A few preliminaries:
Feel free to read my previous posts on Gardasil for some background, but just to catch you up, almost all of the 11,000 yearly cervical cancers are caused by a series of biological events that begins with an infection caused by human papilloma virus (HPV), and four subtypes are responsible for most of these cancers. The way we have approached this problem over the last several decades is by the use of the yearly Pap smear. This test looks at cells taken from the cervix to see if precancerous changes are taking place. If they are, and they do not resolve spontaneously, various surgeries are undertaken to remove cervical tissue. If it's too late even for that, well, you're in big trouble.
So a vaccine against the most dangerous strains of HPV seems like a good idea---stop the cancer at the earliest possible stage, not when it's already there.
Several advocacy groups, mostly antivax cultists, far right Christian cults, and libertarians have been fighting against this vaccine.
And in steps our intrepid reporter. In some of the laziest journalism I've ever seen, she finds an individual who believes she is suffering from a bad reaction to the vaccine. She then uses this anecdote to create a piece of sensationalist "journalism" that does little to educate the public.
So Carolyn went and found D. Ms D., who appears on visual inspection to fall outside of the recommended group for the vaccine (being too old) goes and gets one reportedly on the advice of her doctor. Then she has a "reaction".
She reports that she went to the ER and was told she was likely having a stroke, and was sent home to return if it got worse. Now, I realize we're getting third-hand information, but a reporter is supposed to clarify this. No one who goes to the hospital with a "stroke" is sent home to see if it gets worse. A good reporter would have spoken to some more folks here.
Ms D. was eventually diagnosed with Guillain-Barre syndrome, which "has been linked to vaccines in the past." What vaccines? Gardasil? Others? Linked how? In the same way the absence of one-armed pirates is linked to an increase in automobile accidents? She says:
The Centers for Disease Control has received 31 reports of Guillain Barre Syndrome following Gardasil vaccinations in the U-S. Of the seven confirmed cases...six patients were vaccinated with a meningitis vaccine at the same time. Deborah received only Gardasil.
What does the CDC really say?
Because GBS occurs at a rate of 1 to 2 per 100,000 person-years during the second decade of life, it is likely that some cases occur after vaccination by chance alone and are not caused by vaccination. Among 9 to 26 year-olds, the number of reports of GBS received by VAERS are within the range that could be expected to occur by chance alone after a vaccination.
This execrable job of "investigation" was nothing more than an anecdote of a patient who used a vaccine off label, experienced an illness at some point afterward, and now blames the vaccine. Where is the science? Where is the two minute trip to the CDCs website to check facts? Where is a background interview with the patient's doctor?
Hey, I'm just a doctor; I'm not a reporter.
Apparently, Carolyn isn't either.
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There is a typo in the title. "contuines" should be "Continues"
How...ironic.
Just to be annoying, I shall present another point of view from a family doc:
http://dinosaurmusings.blogspot.com/2008/07/is-70-good-enough.html
(note that some of the commenters do not agree)
Now for another anecdote of similar weight (none, it's an anecdote, which should not be confused with data)... my daughter has had all three of the series of shots. Absolutely no problems (I can't count the fact that she is keeping vampire hours, that is something that happens in summer to young teenagers who are too young for a summer job). A few months ago when I picked her up from school to get her to the doctor's office for the vaccine one of her friends said "Oh, no... that scary", daughter replied "Ah, it is nothing. It is just a little shot. Who cares? It beats getting the disease!"
By the way, just like your daughter... mine is the smartest in the world. ;-)
Sadly, my own mother almost succumbed to some of the right-wing opposition to the vaccine for my younger sister. She, like many of the religious cultists, for some reason thought that it would give my sister the idea that she could just go out and have all the sex she wanted. Luckily our family doc was able to convince her (not to mention my sister and I giving her some of the facts about it) that it was a good idea and my sister got the vaccination.
Score one here in lovely NY.
OK, I've seen the opposition from the anti-vaxers and the sex-phobic, but what the heck have the libertarians got against it?
I suspect it's something along the lines of 'how dare the big statist government force people to have chemicals injected into their bodies! People should be free to choose to get cervical cancer if they want!'
...or something. ;-)
Um, Michael, your comments pretty much speak for themselves, but could you try to maybe think of everything at once and not make the comment server cranky?
Oh, and you might want to visit this site: http://www.timecube.com/
Hmmm, on second thought, now that I see you're a 911 wacko and an antisemite, I think it's time to banninate you.
Bye
Ugh.
That was painful to watch. Who on earth is in charge of science reporting at WXYZ?
But but but... according to the WXYZ piece on their web site, the problems with the vaccine have been discovered using research, see? The HPV vaccine Gardasil is proven to help prevent the virus that's a factor in most cervical cancers, but new research is showing that the vaccine may be causing health problems itself.
And of course, there's a long list of citations and references... oh wait, sorry - there's an interview with one anonymous woman. Well, that'll have to do, because we have to fill up the time with something, and we're on a tight schedule here. And besides, this will be good for ratings.
Well, one thing I used to rely on Channel 7 for, when I lived 60 miles south several decades ago, was great sci-fi and horror flicks on the Friday night late show. Maybe the sci-fi tradition continues in a different time-slot.
Or maybe they didn't realize it was sci-fi!
What about the nearly 9,000 complaints received regarding Gardasil. Just because the pharmacuticals say it is safe doesn't mean that it is. It appears if even if you disagree with that number (of complaints) you are willing to throw some under the bridge so that others will be saved. I know you play god in real life but you are not God. Finally, what are the long term effects of Gardasil? The short term effects have left some in dire straights.
Anonymous, how about some citations?
Anonymouse doesn't *HAVE* any citations. It's not really about the citations or the science. It's all about casting doubt on the science. The denialist doesn't savvy statistical analysis, cost/benefit analysis, or any of that "Sciencey" stuff. "Oh Noes! Some peepul hav bad reaktshuns! Vaxeenz bad!"
When asked for evidence?
*crickets*
@anonymous
I can't answer for PalMD, or anyone else for that matter, but... I'm not willing to throw anyone under the bridge, but I am willing to throw them off the bridge, and under the bus. 9000 complaints over a few years for mostly minor crap that is mostly attributable to random chance vs. the lowering of the number of deaths from cervical cancer seems more than equitable. Before you ask, yes, I am willing to take those chances with my life, and with those of my loved ones.
@anonymous:
I want to thank you for reminding me to call up my daughter this morning and remind her to get her shots. Since she's no longer on my health insurance, I transferred the money to her account to make sure she can afford it.
I don't know if that answers your question, but then I suspect it wasn't really a question either.
Okay, this is something I'm concerned about. My daughter is 5, so there's time to find out any problems with the vaccine before she's ready for it. My prob is with the pharm companies, who pushed really hard in my state to have mandatory vaccination passed by the legislature last year. I just can't help doubting these companies. Any advice?
BTW, I carry the HPV and have had pre-cancerous cells removed, so I fully support the idea of the vaccine. I'm just cynical about big-business motives v. my daughter's health.
You should be cynical. Merck's campaign has been horrible, unethical (IMO), and has set back the cause of disease prevention. Their aggressive marketing of the vaccine and lobbying of lawmakers muddies the issue and detracts from establishing real, evidence-based guidelines.
One thing I've learned from Reading-About-The-News-Reports rather than watching the news reports themselves is that there's very little fact checking. It's something that used to annoy me so much in los angeles that i finally broke down and got rid of all tvs i owned. (3, to be exact).
Even now hearing "coming up at 5, a breaking story" still makes me have a conniption fit. :-(
PalMD; i trust you've been well, sir? I haven't been able to read your words for quite some time now!
I was looking at the timecube site that palmd linked... i defy anyone to prove it was written by a human from beginning to end. It looks like that post on PZ's comment section.
Furthermore, i got through to the bottom of the page, saw "Next Page" link, and contemplated suicide.
Why on earth would you link that? hehehe
I am repeating myself here. I do not believe that the government should dictate what vaccines one takes or not. I believe that it is up to those science minded to educate. We seem to be doing a bad job of it. We seem to be passing laws that require what ever vaccines which lead to consperousy theories, etc. This leads to BigPharm being big bad (Buffy reference), etc. I am not anti-vaccine. My child has all that he is suppose to. But having government dictate simply pisses a lot of people off. As with all vaccines we (science minded) need to stress to important of the HPV vaccine without forcing it. All force will receive resistance. How is it that we fail to educated or communicate with the public? Is that not what public health is about?
Vaccines cannot be voluntary. We have many compulsory activities in society---education, speed limits, etc. Vaccination doesn't work unless it is made mandatory and we reach herd immunity levels.
That being said, which vaccines are mandatory is an important discussion.
Japan made measles vaccination voluntary about a decade ago, and what they got was a resurgence of measles which killed several people and required several of their college campuses to be closed:
http://www.ncbi.nlm.nih.gov/pubmed/18357755?
Also the embarrassment of being the source of several measles outbreaks in other countries:
http://www.ncbi.nlm.nih.gov/pubmed/18346240?
Oh, and withdrawing the Japanese version of the MMR (it was different than the USA version because of a different mumps strain) did not reduce autism:
http://www.ncbi.nlm.nih.gov/pubmed/16865547?
and
http://www.ncbi.nlm.nih.gov/pubmed/15877763?
9,000 complaints of what appear to be about very, very mild side effects that happen with just about any drug including aspirin
vs.
11,000 women who contract cervical cancer (not abnormal Paps, but actual malignant cervical cancer) per year
Sure, cervical cancer is quite curable IF you get Paps regularly and IF you catch it early and IF you are not a DES daughter (although there aren't many DES daughters anymore, so that's probably moot). It's curable IF you get a good surgeon and IF you don't get some woo-meister like Dr. Herb Green (http://www.womens-health.org.nz/cartwright/unfortunate.htm) or his ilk.
I had cervical cancer, thankyouverymuch. And while my surgeon was awesome and I remain cancer-free six years later, I'm here to tell you that it was still pretty awful, and definitely not an experience I would want to repeat. The horrible endocervical position of the tumor meant I felt nauseated and on the edge of fainting, all the time. Post-surgery, the resulting scar tissue hurt something fierce, and my stomach did not tolerate pain meds all that well--I puked every hour, on the hour, and no amount of anti-nausea drugs helped. My husband was extremely supportive, but it took several months for our love life to get back to something resembling normality. Menstruation, ugh ugh ugh. I could still have children IF I wanted to stay on bed rest with cerclage for four or five months, but it ain't happening. Plus, due to the general suckitude of my job at that time, I was out of work for a week, unpaid. And my boss wasn't too thrilled about me taking hourly bathroom breaks, either.
And then I had to fire two OB/GYNs who told me that they couldn't discuss treatment options, answer my questions, discuss pathology reports or schedule surgery in a timely fashion because they were too busy to treat their non-OB patients. At one point, with a serious infection at a biopsy site, the ER attending doc called one such GYN and told her that her patient was in the ER unable to walk due to her negligence, and was also told by her nurse, "there's no such thing as a non-OB emergency." Any gynecologic oncologist, let alone a good one, is damn near impossible to find, and you're often stuck with an OB/GYN who will get a bigger and better reimbursement delivering babies.
What the heck kind of parent wishes that experience on their kid? I ask the anti-vaxers, you would really wish that on your kid? Because that's what happens if you're unfortunate enough to have been born too early, before a vaccine exists. I've heard the antivaxers state that they would rather deal with the disease, but I am telling you: NO YOU WOULDN'T.
Anonymous says, What about the nearly 9,000 complaints received regarding Gardasil.
When you go to the VAERS site, you see this: When evaluating data from VAERS, it is important to note that for any reported event, no cause and effect relationship has been established. VAERS is interested in all potential associations between vaccines and adverse events. Therefore, VAERS collects data on any adverse event following vaccination, be it coincidental or truly caused by a vaccine. The report of an adverse event to VAERS is not documentation that a vaccine caused the event.
The bulk of the reports are of "arm pain" and "fainting". Fainting is a common reaction - and more so when girls of that age start telling each other horror stories of how bad it's going to be and get themselves worked up to a high state of anxiety.
Anyone can file a VAERS report ... they are seldom high quality. I have the 58MB, 8,000+ page report from a wingnut site, and as I read I am seeing multiple reports of the same complaint (even to the misspellings), and some that are so vague there is no way to investigate them.
Here's an example: "Information has been received from a physician concerning a pt who on an unspecified date was vaccinated with HPV rL1 6 11 16 18 VLP vaccine yeast. Subsequently the pt experienced hives. No further details were provided, and at the time of this report, the outcome of the event was unknown. Additional information has been requested.
And another: Information has been received from a physician concerning a female (age not reported) who on an unspecified date was vaccinated intramuscularly with the first dose of 0.5 ml of HPV rLi 6 11 16 18 VLP vaccine (yeast). On an unspecified date, the patient developed "burning at the injection site". It was reported that the event improved after medical attention. It was reported that the event improved after "stopping therapy". At the time of this report, the outcome of the event was unknown. Additional information has been requested.
And one of my absolute favorites: Information has been received from a female consumer via a letter concerning a female (age unknown) who, on an unspecified date, was vaccinated with a dose of Gardasil. According to the reporting consumer, on an unspecified date, the patient "nearly died," At the time of this report, the patient's outcome was unknown. Upon internal review, "nearly died" was considered to be an other important medical event. This is a hearsay report in the absence of an identifiable patient. Attempts are being made to verify the existence of a patient. No further information is available.
Thanks, Tsu. Very educational and entertaining.
There are many more like that. One may be a typo, but it claims an adverse event that happened BEFORE the vaccine was given!
Somewhere in there might be the claim from a citizen of the UK that his daughter was turned into Wonder Woman:
http://leftbrainrightbrain.co.uk/?p=342
(does anyone really need to learn why a self-selected survey like VAERS is not of any statistical significance?)
PalMD wrote: "Vaccines cannot be voluntary." Here is where we agree to disagree. I still and will always think that it is up to public health to inform, enlighten, educate, etc. without becoming a nanny state.
I understand where you're coming from but there is always some element of "nanny state". Should education be mandatory? Should we be forced to pay taxes that provide us with clean water? How about an army? Should we be forced to have one? Sure, it's a volunteer army, but I didn't "volunteer" to pay for it; nevertheless, we have it, because it would be unsafe to NOT have it.
I also understand where you are coming from. We differ on how much government should be involved? I enjoy your writings and probably would not mind having you as my MD. I believe that we as science minded folks fail to communicate the need for vaccination. Then no laws would be necessary.
I'm a teenager that chooses not to get the vaccine. My mother is a pharmacist with a doctorates in organic chemistry and she thinks I'm making the right decision. After spending years working for pharmaceutical companies and seeing their testing methods for medications (not to mention corruption thanks to the large amount of money involved) she'd rather me wait at least five to ten years to make sure there are no long term side effects. The vaccine hasn't even been tested that long.
And I honestly feel that there are other ways of treating cervical cancer, which doesn't always arise from HPV. Precancerous legions don't always turn to cancer. This vaccine is not a cancer vaccine. And furthermore, it protects from only four out of at least thirty strands, many others which are dangerous. Studies have shown that these four are prevalent in indirectly causing cervical cancer because they fight several others that can do the same thing. When these four strains become obsolete, then there's a likelihood that several other dangerous ones will become more common, still keeping the cancer rates the same, if not higher.
ALSO, HPV is something that over ninety percent of people are able to fight off. Mandating the HPV vaccine is about as shitty as mandating the flu vaccine.
To answer your question about Guillain-Barre syndrome and other vaccines -- there was a marked increase in the number of GBS cases following vaccination against swine flu during an epidemic in the mid-1970s. Although no definitive link between vaccination and GBS was made, it brought an abrupt halt to the flu vaccination program and made President Ford look like a fool for supporting it (of course, if thousand had died of swine flu while Ford had done nothing, he would have looked bad as well).
"she'd rather me wait at least five to ten years to make sure there are no long term side effects."
Has your mom read the package insert? In five or ten years you will be too old to get the vaccine. Functionally, she's recommended that you not get it at all.
"Studies have shown that these four are prevalent in indirectly causing cervical cancer because they fight several others that can do the same thing."
Can you please cite the specific studies?
If I was young enough, I'd get Gardasil in a second. When I was about 16, I had an irregular Pap smear. The irregularity was "consistent with HPV". This event gave me the tiniest little taste of what people with problematic strains of HPV go through - 2 follow-up Pap smears and a coloscopy in the space of about 6 months. Even with insurance, this was pretty damn expensive for my parents. For me, it was a lot of doctor's appointments to go to on top of the stress of thinking I might have an incurable STD quite early n my life.
For me, everything worked out fine. But it doesn't for a lot of people. If I have kids, and any of them are girls, they'll definitely get the HPV vax.
This is what I call a "commitment check." Time was when I had young kids and the Company wanted me to work late, I asked them to foot the bill for the baby sitter. Not much -- basically minimum wage for a professional working OT -- but it's remarkable how often they decided that they didn't need the OT that badly after all.
Well, if herd immunity (which isn't of any direct benefit to the patient) is that valuable to society [1], then it would seem reasonable that society at least foot the bill for the shots. If nothing else, it's vastly more cost effective to have County Health buy the stuff in mass purchases than to have paediatricians do it retail.
Most of all, though, it's one less excuse to avoid vaccination.
In the meantime, the public has grounds to doubt how important a public good immunization is when the State doesn't consider it worth while.
[1] In economics this is called "externalization" and is a well-known cause of bad decision making.
Could someone please provide a scientific reference to determine what percent of the population must be immunized for each disease to reach "herd immunity" rather then the hyperbole of everyone.
This is done as much as possible in a non-single payer system.
For example: http://www.michigan.gov/mdch/0,1607,7-132-2942_4911_4914-124017--,00.ht…
Not only are most vaccines available at no cost, but we have a fund, if you'll recall, to compensate people for vaccine-related injury, or perceived vaccine-related injury.
Chuck, it appears to range from 75 to 94% by disease: http://en.wikipedia.org/wiki/Herd_immunity. The citation for the table is a CDC presentation (PDF): http://www.bt.cdc.gov/agent/smallpox/training/overview/pdf/eradicationh…