Two examples of “antivaccine”

In the process of laying down a little of the ol’ not-so-Respectful Insolence on the National Vaccine Information Center (NVIC), Barbara Loe Fisher, and Jenny McCarthy yesterday, I briefly discussed what the term “antivaccine” means. It’s a topic I’ve discussed at length before and that Steve Novella recently wrote about. The long version is in the links, but the short version is that, unlike the “pharma shill gambit” favored by antivaccine activists and others who aren’t too fond of science-based medicine (SBM), it’s not just a convenient label for supporters of SBM like me to use to demonize opponents. Rather, it’s an attempt to describe their mindset, which is most accurately described as being antivaccine. Hiding behind a veneer of being “vaccine safety activists,” They believe that vaccines are ineffective and harmful, blame them for autism and a host of other conditions, and cherry pick and distort the scientific evidence in order to cast vaccines in the most unfavorable light they can. To them, it’s first and foremost always about the vaccines. Always. One telling indication of this is, as I discussed yesterday and on other occasions, that if you ask an antivaccinationist what vaccines she would support including in the childhood vaccination schedule, you’ll get dissembling, dancing around the question, and self-pitying justifications–anything but a straight answer.

You’ll also see recycling of the same antivaccine talking points.

There were a couple of examples of all of this on display just this week. Regarding the first example, I can’t make up my mind whether this lazy regurgitation of a spectacularly stupid (and already refuted) talking points was due to contempt for his audience combined with the need to fill space between Christmas and New Years with a minimum of work or whether he forgot, but Joe Mercola is defoliating all of Kansas in order to gather together the raw materials to rebuild a massive straw man that I took a flamethrower to when Mike Adams first proposed it back in October. It’s no better when Joe Mercola is amazed to discover that New Study Exposes the “60% Effective” Flu Shot as 98.5% Useless. This would be an example of what I’ve described as trying to spin a study to put it in the most unfavorable light.

Like Mike Adams two months before, Joe Mercola is amazed–or pretends to be amazed–that there is a difference between absolute risk reduction and relative risk reduction. Like Adams, Mercola is shocked–shocked, I say!–to discover that the finding of a 60% reduction in the risk of getting the flu due to the flu vaccine doesn’t mean that the vaccine prevents the flu in 60 out of 100 people who get it. Seriously, Adams at least has the excuse that he’s not a scientist or physician. Mercola has a DO degree, and in the US DOs learn pretty much the same thing as physicians. Consequently, while Adams might genuinely (and ignorantly) think that he’s discovered some deep, dark secret about the flu vaccine, Mercola should know better. In fact, I strongly suspect he does and has so little respect for his readers that he thinks nothing of deceptively portraying this concept as some sort of great revelation that proves that flu vaccines don’t work.

In addition, Mercola goes on and on about how “most flu-like illnesses are not the flu.” Ya think? No one ever said that the flu vaccine protects against flu-like illnesses. It’s only designed to protect against influenza. What that does mean is that flu-like illnesses are a confounding factor that make the determination of the efficacy of flu vaccines more difficult than it is for most vaccines. Mercola also seems inordinately impressed with himself when he points out that the yearly flu vaccine doesn’t protect against all strains of the flu. No kidding, Sherlock. Scientists never said that it did. To imply that is to construct a Burning Man-sized straw man argument, pour gasoline over it, and apply a lit match. Scientists try to figure out in advance which strains of influenza virus will be circulating each flu season and then design the vaccine to cover those strains. That’s part of the reason why the relative efficacy of the flu vaccine is only around 60%, which, by the way, is actually pretty darned good given the scientific and logistical problems producing the vaccine every year.

Next up is Mercola harping on a study that’s rather interesting. Basically, back in 2005 a group of investigators investigated whether there was bias in studies of the flu vaccine in the elderly. To do that, they tracked a cohort of over 72,000 people age 65 or over for eight years and looked at their risk of death from any cause as a function of time during that period. What they found was that the risk of death was decreased in the vaccinated seniors was decreased relative to the unvaccinated in all three time periods, before, during, and after flu season. Their conclusion was that this represents a “healthy user effect” in which healthier seniors tended to get vaccinated.

This study is all very well and interesting, but it has a number of problems, many acknowledged by the authors themselves. First, it’s an observational study. More importantly, it didn’t look at flu-specific outcomes. Mercola claims that you have to understand mathematics before you can understand the flu vaccine. Too bad he doesn’t apply that same principle to his own writing. As the authors of this study state:

It is important to note that, like other observational studies, we did not evaluate outcomes specifically due to influenza infection, because influenza infections are rarely documented by laboratory testing. The limitation of this approach is that prevention of influenza-related complications may have relatively little impact on the broader, non-specific study outcomes. This problem can be illustrated by considering the possible effect of influenza vaccination on the risk of all cause mortality. Assuming, for example, that influenza vaccine reduces the risk of fatal influenza infection by 58%, which is the level of efficacy against serologically confirmed influenza infection reported by a randomized trial of older adults, and that influenza infection accounts for 10% of all deaths during influenza season, then influenza vaccination would be expected to reduce all cause mortality during influenza season by 5.8%. The corresponding estimate of the relative risk of all cause mortality for vaccinated persons compared with unvaccinated persons, in the absence of bias, would be ∼0.94.

In other words, all-cause mortality is not a very sensitive outcome to use to determine whether the flu vaccine works in the elderly. As explained above, even if the flu vaccine were very effective at preventing death from the flu during flu season, one could expect to see a reduction in all-cause mortality of only around 6%, which could easily be missed if there were confounding factors not adequately accounted for in the study. This is probably at the high end. What if flu only caused 5% of all deaths in the over-65 age group during flu season? Then you’re looking at a reduction in all-cause mortality of only around 3%. For the reasons cited above, the authors of the study conclude:

For this reason, our finding that differences in health status between vaccinated and unvaccinated groups leads to bias in estimates of influenza vaccine effectiveness against all cause mortality and other non-specific outcomes does not mean that there is no effect of vaccination against serious complications of influenza infection. Our results do suggest, however, that other methods for evaluations of influenza vaccine effectiveness should be explored. These methods could include prospective ascertainment of influenza-specific outcomes, to improve study sensitivity to detect a true vaccine effect, as well as more accurate characterization of disease severity and functional status, to allow better adjustment for confounding. In future studies, assessment of the effect of adjustment in the before influenza period may assist in evaluating the degree to which influential differences between vaccinated and unvaccinated persons are controlled for in analyses of events during influenza season.

In other words, all this study suggests is that there’s a factor not being accounted for in observational studies. This factor could be obviated by concentrating more on flu-specific outcomes. Moreover, it’s not coincidental that Mercola picked a six-year-old study. Let’s look at a more recent study. Authors in this study tried to quantify the magnitude of biases and found that vaccinating the elderly against flu decreased all-cause mortality by 4.6%, which represents approximately a 47% decrease in risk from dying from the flu. This is actually also pretty good, and, given how safe the flu vaccine is, suggests that the risk-benefit ratio for flu vaccination in the elderly is strongly in favor of being vaccinated.

Mercola then demonstrates yet again that he only “understands” math when it suits his purpose with this truly mind-numbingly stupid section:

Vaccine effectiveness simply cannot be taken at face value, and this applies not only to the flu vaccine but also to other diseases, like measles. Measles cases have greatly increased in parts of Canada and the United States this year. Although unvaccinated children and teens are often blamed for driving the high numbers, a recent investigation into a measles outbreak in a high school found that about half of the cases were in teens who had received the recommended two doses of vaccine in childhood.

In other words, many of the cases were among those whom health authorities would have expected to have been protected from the measles virus. Conventional medical wisdom states that the measles vaccine should protect against measles infection about 99 percent of the time.

This is, of course, a common fallacy used by antivaccine advocates. Sheer numbers don’t tell us much, particularly in this report, because we need to know at the very minimum what percentage of the population was unvaccinated to estimate the effect of vaccination on this outbreak. To get a real estimate that’s worth hanging your hat on, we also need to know what percentage of the two groups, vaccinated and unvaccinated, caught the measles to be able to figure what the relative risk of getting the measles is depending on vaccination status. When studies are done correctly, they have consistently found that the risk of getting a disease is much, much higher in children who have not been vaccinated against that disease. An excellent example was a study from a couple of years ago that demonstrated that children not immunized against pertussis have a 23-fold increased risk of getting pertussis.

Even with these numbers, we can still make a quick and dirty estimate of what’s going on. 52 out of 98 teens who got the measles were reportedly “fully vaccinated,” which means that 53% of the students who got measles were “fully vaccinated” and 47% were presumably unvaccinated or inadequately vaccinated. If vaccine uptake rates were 90% (a typical number), that would leave approximately 10% unvaccinated. If further the measles vaccine were actually completely ineffective, we would then expect that the cases of measles would be divided roughly evenly between the vaccinated and unvaccinated, or that roughly 90% of the cases would occur among the vaccinated and 10% among the unvaccinated. We don’t see that. Instead we see that 47% of cases occur among the 10% of the population that’s unvaccinated. If the number of unvaccinated is even lower, say, 5%, the disproportionate attack of measles among the unvaccinated (47% of the cases in 5% of the population) becomes more stark.

Of course, Mercola probably knows that.

Now, it could well be that MMR vaccine protection wanes in the teen years, but that would be easily remedied by adding a booster vaccine in that age group. It might well be that the relative risk of getting measles in vaccinated teens compared to unvaccinated teens has declined to too low a difference in Quebec. As epidemiologists point out, if that’s true, then it’s not evidence that the vaccine is ineffective. It’s evidence suggesting a reappraisal of how the MMR vaccine is given. In any case, the MMR is still pretty potent, based on the numbers cited by Mercola itself.

Mathematics, Joe. Mathematics.

Joe also seems to misunderstand herd immunity, which is not surprising, given that he relies on Barbara Loe Fisher as his information source. Read Mark Crislip, a real infectious disease specialist, instead. Barbara Loe Fisher lays down a swath of burning stupid, too, about how “natural immunity” is better:

“In most cases natural exposure to disease would give you a longer lasting, more robust, qualitatively superior immunity because it gives you both cell mediated immunity and humoral immunity,” Barbara explains. “Humoral is the antibody production. The way you measure vaccine-induced immunity is by how high the antibody titers are. (How many antibodies you have, basically.)

But the problem is that cell mediated immunity is very important as well. Most vaccines evade cell mediated immunity and go straight for the antibodies, which is only one part of immunity. That’s been the big problem with the production of vaccines.”

Sure, all you have to do to get that natural immunity against measles is to accept the risk of encephalitis and possible death. To get that “natural” immunity against pertussis, all you have to do is to get pertussis. If you’re a baby, you’ll suffer with coughing so severe that it causes pain and you can’t catch your breath, not to mention a distinct possibility of hospitalization, secondary pneumonia, or death. But, hey, “natural immunity” is worth it, right? It never ceases to amaze me that parents who insist that vaccines be absolutely, positively, 100% safe will blithely subject their children to the risk of serious complications and death in search of that “natural immunity” when the risk of vaccination is so incredibly low. It boggles the mind.

So does this, the second example of antivaccine idiocy on this week. It’s Barbara Loe Fisher speaking out against vaccines:

Get a load of some of the analogies she makes! She starts out by saying just how much compassion Americans have for those less fortunate than themselves, pointing to examples of relief efforts in Haiti, victims of hate crimes, children living in poverty, and victims of floods, violence, disease, and other disasters. To her, all of these are just like the “vaccine-injured,” except for this:

So it is sad to see what happens in America today when babies, children and adults react to vaccines and become permanently injured or even die. When healthy people suffer complications from infectious diseases, they are treated with compassion. But when healthy people suffer complications from vaccination, often they are not treated with compassion.21 22 Many times, vaccine victims are victimized all over again by those who deny the reality of what happened or use a utilitarian rationale to dismiss them as acceptable losses in the War on Infectious Disease.

Except that we do treat such children with compassion, to the point that our government set up a compensation fund, the National Vaccine Injury Compensation Program, that bypasses the regular courts and has a lower standard of evidence for compensation. It even pays for the legal costs of claimants arguing for compensation! What we do not have so much compassion for are antivaccine activists like Barbara Loe Fisher and their fear mongering about vaccines based on bad science, cherry picked studies, and outright pseudoscience, particularly their tendency to advocate subjecting “vaccine-injured” children who are not vaccine-injured to various forms of quackery, up to and including stem cell quackery and beyond, all in order to try to “recover” or “cure” them of conditions that were not caused by vaccines. As I have said before,

I was going to march through each point Loe Fisher makes in this video, but a quick perusal demonstrates that I’ve addressed all of them before at one time or another. I’m more interested in Fisher’s attitude, which is exemplified by this passage:

When you enter the Holocaust Museum in Washington, D.C., you see an inscription that says “The first to perish were the children…. From these a new dawn might have risen.”71

The loss of compassion and, then, freedom in any society always begins with people looking the other way when those in power justify exploiting a vulnerable minority for what they say is the benefit of the majority.

Yep, because vaccination and the issues of risk-benefit analyses for various vaccines are just like the Holocaust and vaccinating children is just like the Nazi T4 euthanasia program, which is what the inscription cited by Fisher is referring to. Yes, indeed. I’m surprised that Fisher restrained herself from explicitly likening vaccine manufacturers and doctors promoting vaccination to Hitler. Of course, that’s what she just implicitly did. In fact, it occurs to me: This video is excellent ammunition to use against the NVIC antivaccine ads in Times Square this New Year’s Eve. It’s also the “compassion gambit” writ large, in which any criticism of promoters of vaccine pseudoscience is spun as a lack of compassion for children with autism or other severe conditions that people like Fisher incorrectly attribute to “vaccine injury.”

Both of these examples from are also examples of what I mean by “antivaccine.” Mercola bobs and weaves, twisting the actual scientific evidence into pretzels in order to support his preexisting notion that vaccines are useless and harmful, while Fisher likens vaccination programs to the Nazi T4 euthanasia program. This particular Nazi atrocity, as you recall, was a precursor to the death camps and was intended to kill disabled and developmentally delayed children who were deemed “life unworthy of life.” In both cases, vaccines are viewed as evil, a plot designed to dominate and control, a means of making our children sick (although why the government would want to make our children sick is something I could never figure out). No matter what the scientific evidence says, to people like Mercola and Fisher, it’s first and foremost all about the vaccines. It’s always been all about the vaccines. No matter what new science is done, it will always be all about the vaccines.