And so it begins.
Well, it hasn't really just begun. In fact, it's been going on a long time. I'm talking about confusing correlation with causation when it comes to vaccines. For example, the "vaccines cause autism" variety of the anti-vaccine movement blatantly confuses the correlation with the beginning of the increase in autism diagnoses in the 1990s with the expansion of the vaccine schedule that occurred at roughly the same time. The same sort of thing is going on regarding the HPV vaccine. It began first with the credulous referring to reports of reactions to the Vaccine Adverse Events Reporting System (VAERS) database. Yet, as we have seen before, anyone can report anything to this database, whether it's plausibly related to vaccines or not, and activist groups and lawyers have manipulated the database by encouraging reports of vaccines causing autism. Similarly, there have been a lot of reports of reactions to the VAERS database for the HPV vaccine, but a careful examination shows reports of these reactions to be no more than would be expected by random chance alone
Then there was this story three days ago:
In urgent investigation has been launched after a 14-year-old girl died shortly after receiving a cervical cancer vaccination at her school.Natalie Morton was a pupil at the Blue Coat Church of England School in Coventry, where she was given the human papilloma virus (HPV) jab yesterday. She was taken to Coventry University hospital, where she died at lunchtime.
A letter to parents posted on the school's website by the headteacher, Dr Julie Roberts, said a girl had suffered a "rare but extreme reaction" after being given the vaccine. The precise cause of her death remains unknown.
Three other girls from the school are reported to have experienced possible side effects of dizziness and nausea after receiving the Cervarix jab, which was given to female pupils as part of a national immunisation programme against HPV. Their symptoms were described as mild and none was taken to hospital.
Sounds really scary, doesn't it? If you were the parents of this girl, you'd think for all the world that her tragic death was due to the vaccine. At the level of the individual, correlation sure does look like causation. After all, this was a 14-year-old girl, and children that young rarely just drop over and die. Imagine the shock and horror it caused the parents. The loss of a child is one of the worse things that can possibly happen.
Two days later, however, another story arose:
Natalie Morton died from a large and previously undetected tumour in her chest that could have killed her at any moment and not from a cervical cancer jab, an inquest was told yesterday.
The 14-year-old girl collapsed suddenly on Monday shortly after being given the vaccine as part of a national immunisation campaign.
Caron Grainger, joint director of public health for NHS Coventry and the city's council, told Coventry Magistrates' Court: "The pathologist has confirmed at the opening of the inquest into the death of Natalie Morton that she died from a large malignant tumour of unknown origin in the heart and lungs.
"There is no indication that the HPV vaccine, which she had received shortly before her death, was a contributing factor to the death, which could have arisen at any point."
In the time between the story of this unfortunate girl's tragic death and the revelation that she had a large malignant tumor in her chest that could have killed her at any time, there was plenty of tabloid journalism. Just check out The Lay Scientist, which posted a photo of a really badly done story about this poor girl's death, in which the reporter spoke to Jabs, the U.K. anti-vaccine group. Meanwhile anti-vaccine groups had a field day with this tragedy.
In contrast to the bad journalism about Natalie Morton's death, there was recently actually some good journalism about the H1N1 vaccine and the enormous effort going into monitoring it for safety:
WASHINGTON -- More than 3,000 people a day have a heart attack. If you're one of them the day after your swine flu shot, will you worry the vaccine was to blame and not the more likely culprit, all those burgers and fries?
The government is starting an unprecedented system to track possible side effects as mass flu vaccinations begin next month. The idea is to detect any rare but real problems quickly, and explain the inevitable coincidences that are sure to cause some false alarms.
"Every day, bad things happen to people. When you vaccinate a lot of people in a short period of time, some of those things are going to happen to some people by chance alone," said Dr. Daniel Salmon, a vaccine safety specialist at the Department of Health and Human Services
Kudos to Laura Neergaard, the AP reporter who wrote this story! That's exactly the problem with relying on anecdotal evidence of "vaccine injury." Given that there are this number of people having heart attacks each and every day, during these few months when so many people are being vaccinated against H1N1, it is inevitable that there will dozens, if not hundreds of coincidences a day in which something bad happens to a person after having the H1N1 vaccine. If you're one of those people, it will seem all the world as though the vaccine caused the badness to happen. It's not because these people are stupid or ignorant; it's because, not knowing the expected rate of these coincidences, most people assume that the rate of coincidence is far lower than it truly is. They assume that the rate is close to zero, that such a coincidence would be rare.
Consider another example. In 2007, there were 41,059 highway fatalities overall. That's 112 deaths per day on average. We can expect that there will be a at least few people nearly every day who receive the vaccine and then die in a traffic accident; yet no one's going to say that the H1N1 vaccine causes traffic fatalities. The lesson is that large numbers make coincidences, if not exactly common then not rare either. That's why the government is going to incredible lengths in its post-marketing safety surveillance for the H1N1 vaccine:
On top of routine vaccine tracking, there are these government-sponsored projects:
- Harvard Medical School scientists are linking large insurance databases that cover up to 50 million people with vaccination registries around the country for real-time checks of whether people see a doctor in the weeks after a flu shot and why. The huge numbers make it possible to quickly compare rates of complaints among the vaccinated and unvaccinated, said the project leader, Dr. Richard Platt, Harvard's population medicine chief.
- Johns Hopkins University will direct e-mails to at least 100,000 vaccine recipients to track how they're feeling, including the smaller complaints that wouldn't prompt a doctor visit. If anything seems connected, researchers can call to follow up with detailed questions.
- The Centers for Disease Control and Prevention is preparing take-home cards that tell vaccine recipients how to report any suspected side effects to the nation's Vaccine Adverse Event Reporting system.
What was that that anti-vaccine loons say about vaccines "not being tested" and not being monitored for safety? In actuality, the government goes to huge lengths to monitor vaccine safety. Even so, it's very likely that by random chance alone there will be lots of stories coming out of the H1N1 vaccination program of horrific "reactions" that are almost certainly coincidence. The problem will be to identify real problems that are occurring detectably more frequently after vaccination or in vaccinated people versus the unvaccinated.
Unfortunately, you know that the anti-vaccine movement will never accept this explanation. They refuse to accept it for the vaccine/autism myth. They're refusing to accept it for the death of Natalie Moore. Naturally (heh), Mike Adams at that repository of all things quacking, NaturalNews.com, is all over the case with some of his patented spectacularly full mental jacket conspiracy theories:
Today, the mainstream media is reporting an obviously-fabricated explanation for her death. A pathologist is declaring that Natalie died from a "malignant chest tumor" that just coincidentally and suddenly killed her within hours after she received the cervical cancer vaccine.
This explanation is obviously a cover story to protect the vaccine industry; and it's not even a convincing cover story at that. Natalie Morton had never been diagnosed with a chest tumor before, and she showed absolutely no symptoms of a cancer tumor. Chest tumors don't just "lash out" and attack their hosts all of a sudden, without warning. A typical death from a cancer tumor is more often a slow, painful wasting away that can take months or years. Natalie Morton was killed in hours, and the description of her symptoms exactly matches what might be expected from an inflammatory reaction to a chemical vaccine.
Um, no, Mike. You're an idiot. A flaming, moronic, credulously conspiratorial idiot. Cancer doctors know that it's amazing how large tumors can sometimes grow without causing much, if anything, in the way of symptoms. In sudden death cases like this, moreover, quite frequently in retrospect it is noted that there were symptoms before the death, often for weeks or months beforehand, symptoms such as easy fatigue, vague aches and pains, or other relatively nonspecific symptoms. (Pancreatic cancer is notorious for growing to a deadly extent while producing few, if any, symptoms.) While it is true that many advanced tumors do cause a slow wasting away, there are a number of complications from tumors in the chest that can cause rapid death. The most obvious example that comes to mind is for the tumor to erode into a major blood vessel, resulting in massive internal bleeding. Another mechanical effect that can result in cardiac failure and sudden death is pericardial tamponade, which is what occurs when the sack surrounding the heart fills with fluid and compresses the heart. This fluid can be serum (from a reaction due to the tumor) or blood (from a bleed). Because the pericardial sac is fairly stretchable, a tamponade can develop slowly but then, once the capacity of the pericardium to stretch is exceeded, quite rapidly result in critical right heart failure leading to death. Then there's the fact that the blood in cancer patients often clots too easily; i.e., it's hypercoagulable, due to factors secreted by the tumors That means cancer patients are prone to deep venous thromboses and, worse, to pulmonary embolus, large ones of which can quite easily cause sudden death. Also, large malignant tumors can also cause hypercalcemia (too much calcium) that can lead to cardiac arrhythmias, although the calcium level usually has to be quite high to result in bradyarrhythmias, bundle branch block, incomplete or complete atrioventricular block, asystole, and cardiac arrest, making this a less likely consideration, especially since it would be rare to have a calcium level that high without having some symptoms.
But that's not the full extent of Adams' idiocy. Get a load of this:
But why would a pathologist cover up the true cause of Natalie Morton's death? It's simple: There are billions of dollars in profits at stake. Natalie's death threatened to put the entire first-world cervical vaccination program on hold. "News of Morton's death came shortly before U.S. health regulators again delayed a decision on whether to allow Glaxo to sell Cervarix in the United States where a panel of specialists has recommended its use," reports Reuters.
The continuation of global cervical cancer vaccination programs -- which generate billions in profits -- absolutely required blaming Natalie's death on something other than the vaccine. Blaming it on cancer is very easy to do, since every person living today has cancerous micro-tumors in their body right now. All the pathologist had to do was locate such a micro-tumor in Natalie's body, then dismiss the vaccine altogether.
Yes, indeed, it's those evil pharmaceutical companies and their blasted need for profits, no matter how many people they kill! Now, Adams' sheer insanity aside, I've said before that I'm not yet entirely sold on the HPV vaccine. I don't say that because I think the vaccine is dangerous or has killed anyone. I don't, and, as far as I can tell, it hasn't, Mike Adams' blather and all those reports to the VAERS database notwithstanding. Rather, I say this because the vaccine is very expensive compared to other vaccines. In developed nations vaccination against HPV provides probably only a modest benefit, given that most women undergo yearly Pap smears, which can achieve more or less the same end of decreasing death from cervical cancer. In other words, I think it's a worthwhile vaccine, but I'm not sure if it's yet a good idea to make it mandatory, given that it risks diverting resources from other vaccines that protect against highly infectious diseases now (such as MMR, Haemophilus influenzae B, etc.). However, those are, I think, reasonable quibbles with the vaccine. Nothing Adams says resembles anything close to rationality or reason. Indeed, I wonder how he thinks this stuff up.
He's also full of crap when he invokes the dreaded "microtumors" argument. In fact, that's such an obvious load of fetid dingo's kidneys, it leads me to think that Adams, besides being profoundly ignorant, is also profoundly cynical, viewing his readers as so incredibly stupid that it is a wonder that they can manage to breathe and walk at the same time. Let's see. What did the pathologist say? Oh, yes, he said that Natalie died of a "large malignant tumour of unknown origin in the heart and lungs." If any pathologist tried to attribute Natalie's death to "microtumors," he would have provoked quite justifiable skepticism not just from those who fear vaccines but from the medical community itself. But, hey, Adams can never let a few inconvenient facts get in the way of a good rant, and rant he does:
It takes a real cold-hearted CEO to watch your product potentially kill a 14-year-old girl in mere hours and then continue to recommend that same product to millions more.
This astonishing dismissal of concern about the vaccine's safety is indicative of the kind of quackery taking place today with vaccines and modern medicine. Notice how scientific thinking is replaced with blatant dogma...
You know, I think this is the time, as it was for Adam Dreamhealer, to reply to Adams with the immortal words of Inigo Montoya:
Mr. Adams, you keep using those terms "scientific thinking" and "dogma."I do not think they mean what you think they mean. (All right, I'll lay off that quote for a while.)
Unfortunately, as nutty as Mike Adams is, he's not alone. Check out this amazing piece of winguttery Meryl Dorey, who belongs to a group with the amazingly Orwellian name Australian Vaccination Network entitled Natalie Morton's death-convenient pre-existing condition or vaccine cover-up? Yes, to this loon, Morton's preexisting tumor is a "covenient" excuse:
Our buddies from the scumbags organisation (well, if Paul Keating can say it, I can too!) have been emailing me all morning to demand that I take down the article I posted a couple of days ago in which I stated that I didn't believe that Natalie's death was coincidental to the Cervarix vaccine.
I won't do that. Because I still don't believe in coincidence. Not when it comes to vaccines.
And that's the problem, isn't it? I bet she believes in coincidences when it comes to other issues. But not vaccines. Never vaccines. For vaccines, when bad things happen, it's never a coincidence; it's always the vaccine. I often think that, if a person were to be vaccinated, walk out of the doctor's office, and then be hit by a passing car, loons like Adams or Dorey would somehow find a way to blame the vaccination. Because to anti-vaccinationists, it is always, first and foremost, about the vaccines. For example, look at what the grand dame of the anti-vaccine movement, Barbara Loe Fisher, has to say about this:
Federal health officials are already pre-emptively warning Americans that most of the deaths and cases of brain inflammation, seizures, paralysis, multiple sclerosis, rheumatoid arthritis, lupus, strokes, heart attacks, miscarriages and other serious health problems that develop after swine flu vaccination will be considered a "coincidence" and not related in any way to the flu shots just given.
Uh, no. As the AP story quoted above shows, federal officials are putting quite a bit of money and effort to investigate scientifically and epidemiologically whether any adverse reactions reported after H1N1 flu vaccination are coincidence or could plausibly have been related to receiving the H1N1 vaccine. They're working very hard to distinguish correlation from probable causation. Nice misrepresentation, though!
But it's not just Barbara Loe Fisher. It's also all about the vaccines and nothing but the vaccines to Mike Adams; it's about the vaccines to Dorey at the Australian Vaccination Network; and it's about the vaccines to Generation Rescue, the National Vaccine Information Center, Jenny McCarthy, J.B. Handley, Jim Carrey, and all the other anti-vaccine loons out there. It always has been; it is now; and it always will be. To them, reason and science mean nothing except when they can be misused to try to "prove" that vaccines are deadly or cause autism.
Fear and loathing of vaccines are everything, damn the price.
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@Orac: Thanks for addressing these issues. I didn't know about the planned gov't followup of the flu vaccine. There are our tax dollars at work! And actually good work at that.
A real pity about the girl. Her parents must be devastated. I wonder if she had showed any symptoms from the cancer, like shortness of breath? The reputable reports I have seen haven't said, since they are waiting for the full autopsy report.
Re: the AVN. I believe the section you quoted was written by Meryl Dorey, the head of the AVN. She's a loony. She's also (according to posts by Peter Bowditch) claimed that flu vaccines are part of the world conspiracy to decrease the population, and contain contraceptives.
Of course not. As we learned in the previous post, traffic fatalities are caused by Mexican lemons.
Excellent post Orac, one I'll have to remember for future reference.
I have to say that one thing did annoy me while reading your post, every time I thought of something that I was going to mention in a comment you had to go and address it in the next paragraph. Leave something for your readers!
Sadly, even a flagship programme on BBC Radio 4 (transcript) gave air time to one of those "I'm not anti-vax, I'm really pro-vaccine, look at my commercial clinic and book if you don't believe me" types. Dr Richard Halvorsen was up against Prof Adam Finn - one of those is a vaccine dissenting GP (whatever his protestations), the other a professor of paediatrics and immunology.
One of those had more than double the airtime of the other - guess which way round that was. One of them said:
The other said:
But one of those obviously meant the news agenda of the presenter rather better than the other...
@MI Dawn
Not sure if it's still there, but either on her blog or on the AVN site, there was a link to a story that could eventually be traced back to David Icke that the H1N1 vaccine would contain nanotechnology to control the population and ultimately kill them off. It was also supposed to contain some agent that would activate a priming agent that was distributed by...contrails! All a part of the lizard illuminati overlords.
Or something like that. These conspiracy nuts are so loony, it's hard to remember the crazy details.
Give it a few days and the undetected tumor will be cited in Congress as evidence that "socialized medicine" will kill teenagers.
@ Todd W: I don't really like the lizard illuminati overlords. Can I choose my overlord? I'd rather have the one I can turn into calamari (if he doesn't turn me into lunch first...grin)
It may be possible that what I remember is just from the link to David Icke. But the fact she links and apparently agrees with him is scary.
@MI Dawn
Yeah. She's a bit loopy. And she's on record as stating she doesn't need education because she "has a brain". Or something to that effect. Dr. Rachie mentioned it at the Boston Skeptics in the Pub (a video of it is on the Boston Skeptics site).
To make sure my SO,who has asthma,gets his flu vaccine, I brought him a consent form (as a reminder) which -naturally enough- questions about allergies to:"Eggs,Gelatin,Gentimycin,Streptomycin,Neomycin,Thimerisol, Baker's Yeast".I'm just imagining how those indoctrinated by Idiot Adams (and others)will react to the questions on the form about allergies, previous "serious reactions" to vaccines,as well as illnesses or conditions a person might have. Woo-meisters are "teaching" the public to become *phobic*- maladaptively frightened and avoidant of something that is generally useful and safe.As much as I applaud efforts at public education, unfortunately I think that the stupid(and the crazy) has *already* gone viral.Re-education will be a massive effort(I know, I know, I shouldn't use the word,"re-education".)
"Mad Mike" Adams sez: "But why would a pathologist cover up the true cause of Natalie Morton's death? It's simple: There are billions of dollars in profits at stake."
It really ticks me off. This pathologist probably got millions in payoffs from Big PharmaVax for covering up the cause of death, at least in Mad Mike's fantasy world. Meanwhile I toil in obscurity, doing the occasional autopsy for comparative pennies, praising immunization and otherwise doing the bidding of my corporate masters, and where are those giant checks?
Maybe I could name my next Labrador puppy Cervarix for a suitable fee. There's gotta be money in this.
Well of course, didn't you know the the vengeful spirit of the aborted fetus used to make the vaccine will use mind control to make you throw yourself under a passing car?
/crazy
"...an obvious load of fetid dingo's kidneys..."
I heart Orac.
Yet you generalize about 'Mad Mike Adams' and reports of H1N1 being unproven with irregularities in production and approval as fantasizing. I'll take that with a bag of salt - not a grain. 'What's sauce for the goose is sauce for the gander.'
Offtopic but just saw this story on Slashdot:Diabetes Medication May Get New Life as Cancer Treatment
Some of the things people around the 'net are saying about this are just beyond insane. Example:
[quote]The girl's "tumor" was doing just fine until she had an immediate vax reaction[/quote]
Orac, thanks for posting links to "The Princess Bride." I'd forgotten how much I love watching those scenes.
Is there a detailed medical news story about this tragedy? I've only seen the broad strokes and I'm naturally as suspicious about a pathologist who would make this public "massive tumor" announcement as you would have been about a "definitive" public diagnosis of vaccine-caused death.
Bacon! You have lab puppies? I knew we had a more convivial connection somewhere. Black, chocolate or yellow? Getting a puppy myself very soon. My good old 16 year old lab will love the playful companionship. Maybe she won't . . .
Best,
Jay
i agree that when vaccines are concerned there is NO COINCIDENCE!!! correlation IS CAUSATION. i just had the flu vaccine last week. since then i have had no strokes, cancer, heart attacks, ebola, brain damage, food poisoning, paralysis, colds, broken bones or anything of negative health consequence!! i haven't even been hit by an asteroid or fried by a gamma ray burst!!!! the vaccine actually prevented all of these things! the flu vaccine must be a wonder drug!! it keeps you in perfect health!! fends off interplanetary disaster!!! although, i note, i did not win the lottery. the vaccine seems to have the negative side effect of preventing you from winning the lottery. DANG!!! since i want to win the lottery, you can be sure that next year i WONT be getting the flu vaccine!!!!
In developed nations vaccination against HPV provides probably only a modest benefit, given that most women undergo yearly Pap smears, which can achieve more or less the same end of decreasing death from cervical cancer.
Orac, where do you get the statistic that most women undergo annual Pap smears? I'd be willing to wager that a high percentage of women (more than 33%) do NOT get them annually, at least not in the United States. I bet that number is even higher among women rarely counted by surveyors (the poor, the uninsured, the immigrants).
Annual Pap smears are not even recommended for women over 30 who've had three normal smears (every two or three years is the guideline, according to my doc).
Does the vac cost more than a Pap smear (for the entire doc visit, not just the lab test)?
Ah, but aren't the very girls who are most likely to undergo regular Pap smears (annual, every other year, or whatever, depending on how many normal ones they've had in a row) exactly the population whose parents are most likely to give them the HPV vaccine? You know, children with good insurance who end up having good insurance when they're adults?
Man, you are a dingbat, aren't you?
Sorry Orac, but just because one has good health insurance as a child doesn't necessarily mean they will have good insurance as an adult. My daughter finished her round of the HPV vaccine when she was 10 because I knew there would be a few years where she would probably go without insurance once she's no longer eligible to be on her father's health plan unless universal health care finally becomes a reality. Paying for pap tests out of pocket are expensive and most young women starting out on their own have more dire expenses than health insurance. Food, rent, and birth control come to mind.
Pablo nailed it, you're really clueless. The pathologist was asked his opinion under oath at an official inquest. Do you know what it's called when you don't answer questions in court?
Pablo, thank you for always having something valuable to contribute to the conversation.
Orac, I'm sure that I too often confuse correlation and causation and always appreciate your reminders.
And, yes, the group of women who get the best medical care are the least likely to benefit from this vaccine. Implying that the HPV shot is a big "life saver" is a misrepresentation of the science at hand.
Brest,
Jay
Noadi, not answering questions in court when a medical authority only has preliminary evidence might be called confusing correlation with causation. But thanks for the pop quiz.
Jay
It would most likely be called contempt of court, but thanks for playing.
@Dedj
I was thinking possibly perjury.
Jay - If the girl's medical records had no mention of the tumor, it's because it was "undetected".
During an autopsy, the internal organs are removed and examined. They are cut open, observed for lesions, samples of abnormal areas are taken for microscopic exam ... it would be extremely difficult to not observe a tumor, especially a large one.
After the autopsy, testifying that that there was a "large and previously undetected tumor" would be a matter of reporting an observed tumor and a lack of mention of the tumor in the girl's medical records.
Tsu, are you a pathologist? I seem to recall that you are. Thanks.
The cause of death has not been well-presented in the stories I've read. I certainly agree that the tumor, and not the vaccine may have caused her death, but the findings read as somewhat preliminary.
This type of sensational occurrence, as usual, causes more heat and very little light.
Jay
Of course not! But statistical bias is about probabilities, not certainties. So while a child who has good health insurance as a child will not necessarily have good insurance as an adult, that child is more likely to have good health insurance as an adult than one who had bad insurance as a child.
Oh this gets even better. So Jay, you concede that the pathologist found a tumor?
So why are suspicious of the claim that it is what killed her? Do you think massive tumors do not kill people?
And, no offense to Tsu Dho Nimh, but he didn't actually say anything all that profound. Did you really not know what happens at an autopsy and have to learn it here?
@Pablo
Remember, Dr. Gordon's clinical experience is more important, as he's repeatedly stated, than anything that might be found in the literature. So, he probably was not aware of what happens during an autopsy, as he may not have ever performed one.
Neither have I, but that doesn't stop me from knowing it.
I was going to say something about whether he ever talks to a pathologist, and I figured that he's such a pretentious prick, that it is possible that other doctors won't talk to him.
I feel a little foolish dignifying your comments with a response. But that's ever stopped me before, has it?
Pablo, finding a tumor (or giving a shot) and proving causation are two very different things. Most of the time a coroner does not issue definitive findings until he's 100% certain. That may be the case here but I haven't seen those details in news reports.
I speak with pathologists from time to time. To continue to clarify, I'm a pediatrician in private practice and neither a major force in the autism community nor a media luminary. I practice general pediatrics every day and have for quite a while.
Pablo, if this were my site, I'd ban you for being uninformative and relentlessly nasty. You lower the level of discourse and add nothing.
@ Todd
"I was thinking possibly perjury."
Hmm, I thought perjury was giving false testimony?
Perjury is lying under oath but lying by omission is still a form of lying too, so withholding evidence is also a form of perjury. .. the truth, the whole truth and nothing but the truth, so help me..."
So while Dr. Gordon considers a mere temporal association to be persuasive evidence of a connection between vaccination and autism, when it comes to inferring a relationship between a large tumor affecting the heart and sudden death, he suddenly becomes a model of caution.
Lol, Jay if this was your site none of us would read it.
If this were your site, I wouldn't be within ten miles of it, dumbass.
And I will say, I am only nasty with the idiots. You are a frickin waste of time to talk to sensefully (see trrll's comment - it's dead on). I tried, but came to my senses pretty quickly.
Since I've been here, I've seen you accuse Orac and commentors, as well as the AAP, of being Pharma shills, and now accusing a random medical examiner of incompetence or fraud. Why should I respond to that nonsense with any thoughtful discourse?
Good one, Ramel.
No, trrll, I don't consider temporal association "persuasive evidence." Just another piece of evidence to be considered with all the other pieces.
Jay
That's because it means he can't use it to support the aforementioned association.
Remember his words: science doesn't matter to him.
"Captain, I get the impression that you are not taking this project seriously!"
"On the contrary, sir, I take this project VERY seriously. It is YOU I don't take seriously"
Pablo! I have never accused you of "thoughtful discourse."
Jay
Jay -
I am a medical technologist. The lab director, a board-certified pathologist, had the quaint idea that the more we knew and did the better we would be at our part of patient care. One of the things we were allowed to do at his hospital - if we were interested - was observe or help at autopsies if the lab was not overloaded with work.
Though it evidently perturbs Dr. Jay, it does not surprise me that the pathologist found that the cause of death in Natalie Morton's case was her large thoracic tumor. That's one facet of what pathologists do...perform autopsies and report on the cause of death. It obviously was a matter of public interest having significant public health consequences, so it was the job of the pathologist (and the coroner, who under British law may have been a separate individual) to make clear what happened in this case in a timely manner.
Dr. Jay: "I'm naturally as suspicious about a pathologist who would make this public "massive tumor" announcement as you would have been about a "definitive" public diagnosis of vaccine-caused death."
As a physician, what makes you "suspicious" about an advanced tumor affecting the heart and lungs as a cause of death? Orac has nicely summarized mechanisms by which tumors can and do rapidly kill patients. I realize it is uncommon for pediatricians (apart from pediatric oncologists) to have contact with pathologists, but we're talking here about basic physiologic mechanisms with which physicians having direct patient care responsibility should be widely familiar.
Dr. Jay: "And, yes, the group of women who get the best medical care are the least likely to benefit from this vaccine. Implying that the HPV shot is a big "life saver" is a misrepresentation of the science at hand."
This comment misrepresents the benefits of the HPV vaccine. It is designed not only to reduce death from cervical cancer, but to cut down on the morbidity associated with HPV-induced cervical disease, including the biopsies and surgeries which HPV-infected women currently undergo. This mischaracterization of the benefits expected of the vaccine is widespread in the debate over its use. I am not fully convinced that the rather costly HPV vaccines currently in use offer enough advantage over current surveillance systems to make their universal adoption practical - but on the other hand if I had a daughter in the critical age group I'd want her to have this protection.
In Australia the HPV vaccine has been rolled as a free program for all girls of the appropriate age in high school.
I am an Australian anaesthesiologist. When I was training I was the senior registrar at a major teaching hospital in western Sydney. I routinely gassed for a gynae oncology list. The head of the gynae oncology service estimated that 98% of the operations he was performing ( had we were talking major pelvic debulking here -with all the associated complications and misery such big operations bring) could be prevented by a regular pap smear. Now we have socialised medicine in Australia, pap smears and all follow up (including major surgery if needed) is "free" and yet some poor women still suffered.
Any measure which can reduce that overall burden of suffering ( even if it is a rich affluent society luxury and the cost benefit ratio yet to be determined) can in my opinion only be a good thing.
Chris Ryan
Wanna bet?
Oh really? So what are "all the other pieces" of evidence that vaccinations cause autism? The only "evidence" that you've cited aside from temporal association is your own alleged clinical intuition.
Guidelines on timing of pap smears in women varies depending on whom you look at (ACOG versus NCI versus ASCCP versus USPSTF), but in general, given what we know about HPV and cervical cancer, women who are over the age of 30 with a history of normal paps and with the same partner can space out their pap smears to once every 2-3 years. The pap smear itself as a one-time test has a false negative rate up to 30% (heard that somewhere, I don't have a source), which goes down if used over time.
Again, I lack a source, but my understanding on cervical cancer in the US is that women who are diagnosed frequently have not had a pap within 5+ years of their diagnosis. Pap smears as a cancer screening tool works. Get them done. I've had a patient die a particularly horrible death from her cervical cancer. I'm trying to get the rest of my patients to not follow in her footsteps.
Dangerous Bacon does have it right about the HPV vaccine. Part of what it's supposed to do is decrease the burden of HPV disease, so fewer colposcopies, fewer LEEP's, fewer cones, etc. It does not negate the need for regular paps. Only getting rid of HPV in the human population would likely do that and since that ain't gonna happen, I get to keep doing pap smears. Wee ha!
You know, children with good insurance who end up having good insurance when they're adults?
Ok, Orac, how do you know kids with good insurance as kids end up having good insurance when adults? I (and my brother, sisters, cousins, friends, etc.) had great health insurance as a kid but rarely had health insurance at all as an adult (I'm 54 now) -- I couldn't afford it for years and years after grad school (I can barely afford it now). Aren't people in their 20s and early 30s the largest group of uninsured in the US? Do you really think a 25-year-old barely scraping by spends her dollars on a pap smear?
If you're going to render an opinion on the cost-benefit of the vaccine, at least share the stats on which you base your calculation, please.
Why thank you Jay. Oh wait, were you attempting snark?
I was pointed to this rather execrable piece on AOL news.
http://news.aol.com/article/growing-vaccine-skepticism-worries/698882
They talk to some fleabrained chiropractor as if she were some sort of expert. She's not going to give HER baby The Vaccines, because AS A MOM she finds them not to be effective.
That's nice.. When you have a degree in epidemiology come talk to me.
At least they bother to quote Dr Paul Offit. although they misquote him a bit. and they do try to explain that vaccine-preventable disease used to kill more people than wars.
But then they go and "Give equal time" to that nut from the National Vaccine Misinformation Center.
JAMA and the NYT summary express excellent observations about the HPV vaccine.
Again, friends, I agree that this girl's tumor was the more likely cause of her death. But, Bacon and Tsu, you might agree that it's unusual to see a pathiologist jump into a public debate within a very short time after a death.
http://www.medicalnewstoday.com/articles/161261.php
Editorial Questions Whether Vaccination Risks Outweigh Benefits of Screening
A JAMA editorial that accompanied the studies questioned whether any risk level is acceptable when vaccinating a healthy population against a disease that can be prevented through screening, such as cervical cancer (New York Times, 8/19). Charlotte Haug, an infectious disease expert from Norway, wrote that it is unknown whether Gardasil will require so-called "booster shots" or whether suppressing the two types of HPV it protects against could encourage the emergence of rarer, equally dangerous strains. She added that the overall benefit of vaccination is uncertain, and women who receive regular screening "should be willing to accept only a small risk of harmful effects." Haug recommended that vaccinated women continue to receive routine Pap tests that can detect precancerous changes in advance (Philadelphia Inquirer, 8/19). Haug said in an interview that although it is "fairly certain" that there "are not a huge number of side effects at all" from Gardasil, the vaccine is being administered "to perfectly healthy young girls, so even a rare thing may be too much of a risk." She said, "I wouldn't accept much risk of side effects in an 11-year-old girl, because if she gets screened when she's older, she'll never get cervical cancer," adding, "You don't have to die from cervical cancer if you have access to health care" (New York Times, 8/19).
Best,
Jay
P.S. Ramel, no snark intended.
J
As someone who is not very surprised anymore at the depths of ignorance that some people go to in order to explain away things they don't like, you know what I am surprised at in all of this?
That at least some contingent of the anti-vaxers hasn't taken the autopsy at face value and claimed that the vaccination caused the tumor.
Maybe I'm wrong and it's already happened. If it has, then I think my response would be to simultaneously laugh (that I was right) and cry (for the future of humanity).
gaiainc: "Dangerous Bacon does have it right about the HPV vaccine. Part of what it's supposed to do is decrease the burden of HPV disease, so fewer colposcopies, fewer LEEP's, fewer cones, etc. It does not negate the need for regular paps. Only getting rid of HPV in the human population would likely do that and since that ain't gonna happen, I get to keep doing pap smears. Wee ha!"
And I get to keep looking at them.* Grumble, grumble.
Dr. Jay: "Bacon and Tsu, you might agree that it's unusual to see a pathiologist jump into a public debate within a very short time after a death."
As has been explained to you by multiple posters, this was required testimony at an inquest, not a "public debate". There is a solid, rational cause of death in this case and it isn't the HPV vaccine. The only caveat I can think of is whether toxicology is still pending to see if any illegal or prescription drugs were involved in the death. But I can imagine no pending test that would implicate the vaccine rather than the big thoracic tumor (incidentally, has a diagnosis of tumor type been made yet?).
Interesting that you should bring up what Charlotte Haug, the putative infectious disease expert from Norway said about HPV infection, notably her comment ""I wouldn't accept much risk of side effects in an 11-year-old girl, because if she gets screened when she's older, she'll never get cervical cancer," adding, "You don't have to die from cervical cancer if you have access to health care".
When that story came out in the New York Times I showed it to a pathologist colleague and we shared an eye-rolling moment over it. While proper cytology and molecular screening greatly reduce the chance of cervical cancer, they do not eliminate it. And of course Haug does not mention the morbidity and cost of dealing with HPV infection detected by those tests. Much better to prevent infection in the first place.
And I'd be more impressed with that theory about super-strains of HPV evolving due to the vaccine, if we were being plagued with super-strains of other viral diseases that have been drastically reduced or eliminated (i.e. smallpox, polio) by vaccination.
*small quibble - few actual Pap smears are being done these days, at least in the United States. The smears have been largely replaced by a monolayer technology in which slides are prepared from a cell suspension in a liquid collection medium, such as ThinPrep. This results in a cleaner and easier to read slide with a better detection rate for abnormalities - though some controversy remains over the significance of those abnormalities and the cost-effectiveness of the newer, more expensive technology.
Hi Jay! Been so long since you've written!
"The cause of death has not been well-presented in the stories I've read. I certainly agree that the tumor, and not the vaccine may have caused her death, but the findings read as somewhat preliminary."
Why do people who claim to NOT be anti-vaccinationists demand such high levels of proof before accepting that a "massive tumor" killed this poor girl? These same people who rush to the conclusion that the vaccine was the cause without so much as a rough guess by an uninformed writer from the Daily Mail?
Bacon writes:
"The only caveat I can think of is whether toxicology is still pending to see if any illegal or prescription drugs were involved in the death. But I can imagine no pending test that would implicate the vaccine rather than the big thoracic tumor (incidentally, has a diagnosis of tumor type been made yet?)."
I agree. On all counts. By the way, this vaccine is an absurd use of health care resources and dollars. Any scientist should know that.
Best,
Jay
Bacon writes:
"The only caveat I can think of is whether toxicology is still pending to see if any illegal or prescription drugs were involved in the death. But I can imagine no pending test that would implicate the vaccine rather than the big thoracic tumor (incidentally, has a diagnosis of tumor type been made yet?)."
I agree. On all counts. By the way, this vaccine is an absurd use of health care resources and dollars. Any scientist should know that.
Best,
Jay
A vaccine that considerably reduces the risk of cervical cancer is an "absurd use of health care resources?" What got slipped into my coffee that transported me to Bizarro World where editorials are given equal weight to the peer-reviewed literature? Oh, wait, this is Dr. Jay World, where peer-reviewed, scientific studies are the lowest form of evidence and personal opinions and anectdotes are the gold standard.
Uh, no. No, it's not. Take this from someone who has actually been skeptical not of whether this vaccine is safe and effective but whether it has been promoted too early. It is most definitely not an "absurd" use of resources.
Do you have any idea what it costs to treat an abnormal pap smear? Often in excess of 10x of what Gardasil costs if it involves laser surgery. And that's just for one treatment. The initial work up costs more than Gardasil as well.
Also, these issues can be on-going, requiring multiple work ups and repeated procedures.
And what about the personal cost to the patient? Potentially having your fertility reduced from getting your cervix burned, possibly multiple times, isn't exactly appealing to a young woman.
There's really nothing to say about anyone who takes Adams seriously beyond that they have zero critical thinking ability.
By the way, this vaccine is an absurd use of health care resources and dollars.
I imagine that Dr. Gordon, as a pediatrician, sees little or no cervical cancer. Given that it's essentially an STD I certainly HOPE he never sees it. However, this may give him a...biased...view of the significance of a vaccine that may reduce the incidence of cervical cancer. Not to mention head and neck cancer, anal cancer, and possibly some skin cancers. HPV is an all around bad actor and eliminating it would not use excess resources but rather save resources.
No, it's not an absurd use of health care resources. The vaccine costs, what, $300 or so? Maybe it's even $500. Say $500 for the moment. The vaccine isn't comprehensive enough to replace pap smears so I'll ignore the cost of Paps and colposcopy for the moment, but I expect that if the vaccine or a future vaccine proves out as permanent protection making cervical cancer as common as smallpox at some point in the future then the cost savings from not needing these tests would be a win in itself. But that's for the future, if ever.
Right now, treating cervical cancer is expensive. The standard treatment for stage II-III disease is radiation+chemotherapy+/-hysterectomy. The chemotherapy, cisplatin, is moderately expensive in itself and quite expensive to give. It requires a day of intensive and expensive monitoring by highly trained chemotherapy nurses to administer followed by 1-2 days of post-hydration* to avoid toxicity. It is given weekly along with external beam radiation then with internal radiation seed implants. Patients are generally hospitalized during the radiation seed implants to avoid endangering others. Then a hysterectomy may be performed as well, also requiring hospitalization, OR time, etc. I'm guessing about the total cost, but it can't possibly be less than $100,000 per patient. Heck the anti-nausea medications alone are around $500 a pill. So for every person who does not get cervical cancer and require 6 weeks of chemotherapy, 6 kids could be vaccinated for HPV on the savings in anti-nausea drugs alone.
Then there's head and neck cancers. Again, chemo/radiation is the standard for advanced disease. The regimen is similar, although the chemo generally given as fewer, larger doses if cisplatin is used. In addition to the costs listed above, head and neck cancer patients also need G-tubes put in because they inevitably get mucositis (sores in the mouth) so bad that they can't eat for a good 1-2 months during and after treatment. Many need tracheostomy as well. Surgery, if it is needed, is often mutilating as well as expensive (cutting parts of the face off: there's just no pretty way to do it, no matter how good the surgeon is.)
And, of course, the treatments mentioned above sometimes have permanent side effects. One unfortunate example from the treatment of cervical cancer is radiation proctitis or damage to the rectal and anal area from radiation which causes pain, bleeding, and inability to defectate normally. The patients who suffer this side effect often end up with diverting colostomies. And I haven't even discussed recurrence...
So, how is preventing people from experiencing these debilitating and deadly diseases a POOR use resources?
*Though if given weekly it's lower dose so doesn't require quite so much hydration and so on.
Hello bloggers
I appreciate that you take issue with Dr Halvorsen. But can I point that what he says is based on 6 years study of the relevant medical research for his book The Truth about Vaccines, and over 25 years as a GP. In the interest of science, and fairness, you may want to read his full arguments first. He is one of the few people who has reservations about vaccines that pro-vaccine experts are happy to debate the issue with.
Kind regards, Karen Woods
Gibson Square Publishers
Why doesn't Dr. Halvorsen publish his study in a peer-reviewed medical journal related to vaccines or autism? Really. If he has the goods he should publish in the peer-reviewed medical literature. Publishing a book instead of in the peer-reviewed literature is a tack frequently taken by devotees of pseudoscience and quackery. Whether Dr. Halvorsen is one of those things or not, that's how he will be perceived if he publishes his "study" in a book rather than in a peer-reviewed medical science journal.
My guess is that he knows that even bottom-feeding journals wouldn't accept his tripe. But that's just my guess.
It is difficult to have respect for Dr. Halvorsen when you read dreck like this article.
In addition to Halvorsen leaping prematurely (and embarassingly wrongly) to condemn the HPV vaccine as supposedly having caused Natalie Morton's death, his article is full of misinformation and straw men. He seems to think that medical science is claiming victory over TB due to vaccination (?) and that physicians believe a "medical utopia" is possible through vaccination. What nonsense! And this is a guy who supposedly runs an immunization clinic?
Halvorsen comes off as just another misinformed and biased antivaxer who covers up his prejudices with the preamble "Now I'm not antivaccination, but... and takes credit for "research" which seems to consist of superficially thumbing through the literature for anything that'll support his biases.
If you think that Halvorsen article was bad, check out the quotes from him in this even worse news story which the Sunday Express ran yesterday. Halvorsen seems to be "channeling" Jay Gordon (judging by this thread), sees conspiracies, and near as damnit accuses the pathologist of lying.
http://www.dailyexpress.co.uk/posts/view/131817/Jab-as-deadly-as-the-ca…
Re. Dr Jay's weird obsession with why the pathologist would be reporting on Natalie Morton's death, as several people have already pointed out it was part of the normal procedure in England for an unexpected sudden death. The coroner, who is an appointed public official, convenes an inquest and orders a coroner's post mortem, done by an accredited and experienced forensic pathologist. So the whole process was entirely standard.
From the Wikipedia entry for "Inquest_(England_and_Wales)"
And the tumour was apparently growing into the heart:
- NB: Not hotlinked to bypass the spam filters, sorry.
Ms. Woods, I would also echo Orac's and the other comments. And to let you know that Dr. Halvorson is not the only one whose book on vaccines has been criticized. Do read this review of Dr. Sears' book on vaccines.
Also, there is absolutely no excuse for the vaccine being blamed even after it was discovered the girl had a tumor.
Karen Woods has left the same comment on two posts on my blog (Stuff And Nonsense) and two more at the Lay Science website - on an article I wrote about Halvorsen and on a post by blogger JQH.
My posts on Lay Science can be found here: http://www.layscience.net/blog/7
and I left the following reply:
Hmm. A collective IQ in single digits right there!
I'm interested in Halvorsen's "six" years of "research". Ms Woods doesn't give any clue to the quality or shoddiness of this "research" I suppose! Or whether is consists entirely of trawling for for statistical insignificances and misrepresented analyses that might just fit Halvorsen's own fantasy (and business plan). Just curious to see if the world is supposed to be impressed because of the "six" years, or something more substantial.
"I'm interested in Halvorsen's "six" years of "research"...Just curious to see if the world is supposed to be impressed because of the "six" years, or something more substantial."
Did he even go as far as the Geiers and order the "Junior Scientist Lab Kit" through the mail, and get to play with actual Pyrex beakers and stuff?
Or maybe his "six years of research" involves activities like Googling for unfavorable blog mentions and showing up to post brain-dead snark.
It is so easy to talk about science when it doesnt personally affect you! My sister and aunt both died from cervical cancer. However, they did not have one of the few types that the vaccine MIGHT protect against. Given the family history, we decided that my 12 yr old daughter should be vaccinated. My beautiful, healthy, artist, singer, ballerina, went in for her check up and vaccine...within seconds she fell on the floor, went unconcsious, and died while we were still in the exam room. She DIED! No abnormalities were found on the autopsy, and the cause of death listed by the pathologist was vaccine reaction. I have no need to sue, and it is reported in this vaccine's database. The point is, she died for something so STUPID. I was stupid. You dont just catch HPV in the air. You can prevent it without a vaccine! Nobody needs the vaccine. She could have had a life, and if she got cancer later, so be it...instead, we took her life away with a needle. It is a worthless vaccine. It is a waste of money for the few types of hpv it even protects against. She was a gifted student with an IQ over 140. She could have made her own smart choices with her life. She wanted to be the scientist that would cure cancer because of her aunt. I have never had an abnormal pap, why would she? We chose the vaccine, and she is dead! Please stop pushing such a worthless vaccine that will help so few if any. You cant catch it from a sneeze! It doesnt matter how much it cost or doesnt cost, it is irrelevant! It can cause death! This isnt about science or money. This is about young girls that you dont know, real people's lives that you arent associated with. You may be able to distance yourself and hide behind paperwork, but I watched my daughter die on the cold, hard, floor of an exam room within seconds of receiving the hpv vaccine for no reason! I get so tired of people arguing about things that have nothing to do with them.
The plural of anecdote is not data.
Leah,
Could you please provide more details from the coroner's report?
Chris, if that is in reference to me...you are a truly sick individual. Our doctor, the pathologist, and all the emergency professionals involved have all diagnosed it as caused by vaccine. It IS listed in the data you heartless beast. I accepted it as a risk. Why do you have to be so ruthless? A young girl is dead for something that poses no threat to you or your family. That particular vaccine is not worth it! The world doesnt need your evil assumptions.
Leah, regardless of how you feel, your anonymous story, shared in the comments section of a science blog, is by definition an anecdote. And as sad and touching as your story may be, most of us have no way to judge if it's true or not.
If it is true, then it can be argued that you have a moral obligation to prevent what happened to your child from happening to others. You could do that by suing for damages, but for some reason you don't want to do that. Another way to prevent a similar tragedy is to share details of the coroner's report, as Tom suggested.
But until we have more information, your story cannot be taken as anything more than an unconfirmed anecdote. I think you can understand that.
@Leah: Do you have the VAERS ID of your report? Or an approximate date when you filed the report?
73 sorry. I have not looked at that in almost 2 years. I can barely speak in generalities, let alone specifics. It just isnt about numbers and cost, it is about people.
You have given us one unverified anecdote, and I'm a sick individual? I am also surprised that given the publicity in the UK, that we have not heard anything. This should have been blasted all over the news networks. Perhaps you want your privacy (which is why you are posting this on a blog anonymously).
I did do a look see, and found Reports of Health Concerns Following HPV Vaccination, which says:
... and it continues ...
Perhaps what happened to you was just in the last month. If that is the case, it probably too early to tell. From this slide presentation there is a table on page 19, that says:
Perhaps your case falls in the last category.
Still, I only work with data. And so far the data are 23,000,000 doses versus less than a half a dozen cases of unknown cause of death.
Oh my. It should be interesting when and if my last comment gets past moderation. It has something to do with the September 1, 2009 date.
As a pathologist, I would not have done this. I would have stated "Cause of death not identified on autopsy". I would instead have mentioned the proximity of the sudden death with the vaccination in the summary. Autopsies fail to identify cause of death around 1 or 2% of the time. Failing to take this into account has led to the occasional false conviction for murder.
@Leah: There are only 3 VAERS reports involving a 12 year old who died following Gardasil, submitted in 2007. One says the patient died in her sleep, which is not what you said. Another says the patient died a month after. That leaves only one: 275428. Is that the one?
Let me quote some of it:
I dont need you to judge anything or feel sorry for anything. She's dead. I point it out so other scientists, like me, dont ever forget the lives behind those numbers. The arguments above had turned away from science to cost. I was trying to keep in perspective. Our doctor, and the attorney filed all the paper work. All the appropriate data was reported and filed to protect other people. I do NOT need to sue for that! I dont need money, and it wont bring her back.
I am sorry for your loss. While you are entitled to your own opinion, you are not entitled to your own facts. If you make an extraordinary statement such has yours, you must be prepared to back it up.
And when my comment is approved, it shows the numbers. Hint, it is from http://www.cdc.gov/vaccinesafety/vaers/gardasil.htm .
@Leah: You need to be prepared to back up significant claims of this nature, otherwise you're just making it easier to believe that anti-vaxers will go to any lengths to push their agenda, even if it involves making up anecdotes about people who died.
Leah,
The claim that your daughter dropped to the ground and was dead within seconds of receiving a vaccine is rather fantastic. Your grasp of facts is also questionable:
1. A family history of cervical cancer?
2. Contrary to your claim, Gardisil protects against 70% of cervical cancer cases.
3. Normal PAPs are not a familial trait.
Without something more to substantiate the story, it reads like misinformed, anti-vax rant. Kind like the patient version of the Jon Rappoport interview with an ex-vaccine researcher
80 not even close.
82 It is not extraordinary. People have reactions to vaccines all the time. Usually not a big deal, but some die. Have you never heard of anaphylaxis? Worth the risk for other vaccines, but not gardasil. This vaccine will not protect you from cancer if you still make the wrong choices in life. simple
Since the comments have now turned from medical cost to personal medical records instead of taking my post as what it was meant to point out...not forgetting the actual humans behind the data and costs...I will not respond or even read this particular thread past 82(no link)after I post this comment. Too personal. Save your thoughts for each other.
@Leah: At this point I'm of the belief that your anecdote is either made up or deceptive. That's what the evidence suggests, frankly. However, I'm open to any evidence you may present to the contrary, and I will apologize if it's determined that the case is real. At the very least, give us something we can use to find the actual VAERS report.
Anaphylaxis would not result in an autopsy with "no abnormalities".
Leah, I'm sorry about the loss of your daughter. That is a terrible tragedy. However, I have to take exception with your following statements:
Unless you are absolutely certain that neither you nor your partner has ever had sexual contact with HPV, then no, you can't prevent HPV infection unless it is through a vaccine. The virus is highly prevalent. Getting cervical cancer is not a walk in a park either. We can treat, sometimes we can cure, but women still die in the US from cervical cancer.
I also want to say, in a not very graceful way, is that if HPV wasn't so easy to pass around, there wouldn't be multiple agencies and medical organizations that recommend all women get pap smears on a regular basis. If HPV wasn't such a problem we wouldn't need to be so vigilant in our screening. Yet it is and we are.
Making the "right" choices in life also won't necessarily protect you from cancer either. Exposure to more partners makes it more likely that you will pick up the wrong type of HPV. However that doesn't mean that the one person that you're having sex with or ever had sex with doesn't already have the virus and passed it on to you. The vaccine is an attempt to try and decrease the burden of HPV infection. It's not perfect. I don't agree with the marketing at all, but if I ever have a daughter, she's getting it.
Let us take Leah's story at face value - a personal tragedy that reminds us that behind every statistic there is a human story. Even so, having one documented case of death as a result of the HPV vaccine does not detract from the overall health message that the vaccine will reduce suffering and save lives.
Some have pointed to inconsistencies in Leah's story that give them reason to doubt her. I am more concerned with the consistency in her comments - that people contract HPV as a result of lifestyle choices and her daughter died as a result of a plan to protect such people from the consequences of their actions. She is judging people who contract sexually transmitted diseases. While I sympathise with her loss I cannot empathise with her moral stance.
I really should revisit my statistics, but several years ago it was widely reported that one man died of a heart attack during the New York Marathon.
A quick back-of-the-envelope calculation showed that in the general population during the same time period four people would die of heart attacks.