Vaccines against the human papilloma virus (HPV), such as Gardasil and Cervarix, seem to have a strange power over people who are otherwise reasonable about science and vaccines. For some reason, HPV vaccines seem to have an uncanny ability to turn such people into raging antivaccinationists almost as loony as the merry band of antivaccine loons over at Age of Autism. At the very least, they seem to make seemingly reasonable people susceptible to blandishments and tropes for which they’d normally otherwise never fall. Truly, Gardasil and Cervarix seem to be vaccines that make reasonable people lose their minds. I tend to think it’s about the sex. After all, HPV is largely a sexually-transmitted virus, hence the tendency for fundamentalist Christians to find it particularly objectionable.
Whatever the reason for the outsized negative reaction to Gardasil and Cervarix (and I really do think it’s all about the sex, given the prudery of American society), antivaccinationists are aware of it. Indeed, they nurture it and take advantage of the undeservedly bad reputation that HPV vaccines have. Sometimes they are able to take advantage of it in a spectacular way, as they did last week. That’s when a board member of the antivaccine Canary Party and the founder of a website so full of antivaccine pseudoscience, quackery, and pure misinformation appeared on the Katie Couric’s daytime talk show. Even better for the antivaccine movement (but much worse for the reason-based community), these bits of background were not revealed. What Couric showed her viewers were two mothers, one of whom thinks that Gardasil killed her daughter, the other of whom thought that Gardasil made her daughter ill. Against this sympathetic portrayal, no pediatrician could stand, although Dr. Mallika Marshall valiantly tried at the end.
What was particularly gratifying was how rapid and negative the reaction of the blogosphere was to the episode. Sure, a few antivaccine and quack sites praised Katie for telling the “truth,” but virtually all other reaction from mainstream sources, science bloggers (including yours truly), and news publications was relentlessly negative, with one even going so far as to refer to Couric as the “new Jenny McCarthy.” That was an obvious shot, but not entirely undeserved. After all, it takes talent and hard work to take a reputation for supporting science-based medicine built up over years of promoting colon cancer awareness and destroy it in a single 25 minute segment on a daytime television show.
It’s gratifying to see that Couric and her producers are feeling the heat. It’s obvious from a rather blatant notpology that Couric posted on that wretched hive of scum and antivaccine quackery, The Huffington Post, which she entitled Furthering the Conversation on the HPV Vaccine. I suppose that’s what Couric managed to do, but so minimally as to be virtually pointless. Basically, what Couric does is whine, justify, and (sort of) partially apologize for screwing up so royally:
Last week we devoted several segments on my TV talk show to the issues surrounding the HPV (human papillomavirus) vaccine. Learning about this relatively recent preventive measure is tremendously important, and I felt it was a subject well worth exploring. Following the show, and in fact before it even aired, there was criticism that the program was too anti-vaccine and anti-science, and in retrospect, some of that criticism was valid. We simply spent too much time on the serious adverse events that have been reported in very rare cases following the vaccine. More emphasis should have been given to the safety and efficacy of the HPV vaccines. As someone who has spent the last 15 years relaying important medical information with the goal of improving public health, it is critical to me that people know the facts.
You know, given all of Couric’s good work, I bent over backward to give her the benefit of the doubt the first time around, but it was hard, given the sheer level of misinformation and false balance in her HPV segment. After this notpology, I’m having an even harder time. “Some of that criticism was valid”? All of that criticism was valid. OK, I understand. This is about as close to an apology as one can expect after a segment as bad as the HPV segment on Couric’s show.
If that were all Couric said, I could accept it for what it is, particularly given how Couric followed it up with a discussion of how the rate of HPV infection has fallen markedly since the introduction of Gardasil and how significant adverse reactions to Gardasil are rare. All of this is true, but then Couric had to come back and try to justify why she had two antivaccine activists on her show to tell stories that blame Gardasil for death and illness when there is no evidence that Gardasil caused either in either girl:
As a journalist, I felt that we couldn’t simply ignore these reports. That’s why we had two mothers on the show who reported adverse reactions after their daughters had been vaccinated for HPV. One could hardly get out of bed for three years, and the other tragically died. There is no definitive proof that these two situations were related to the vaccine. Every life is important. However, the time spent telling these stories was disproportionate to the statistical risk attendant to the vaccines and greater perspective is needed.
I might not be a journalist, but as a scientist and physician I can tell Couric that she was wrong. Not only is there no “definitive proof” that either of these reported adverse reactions, death and a strange, poorly described chronic illness, had anything to do with Gardasil, there’s no evidence whatsoever behind only a vague temporal correlation. As much sympathy as I have for a mother who has lost her child, as Emily Tarsell lost her daughter Christina Tarsell, a journalist, as Couric claims to still be, has a responsibility not just to regurgitate her story for to tug at the heartstrings of her audience. A major claim that goes against what we know about Gardasil has been made. It is a journalist’s responsibility to examine not just the story as told by the grieving mother but the evidence supporting whether her story might be correct. Couric and her producers failed epically at this basic task from Journalism 101. Indeed, it was worse than that in that she didn’t even require Tarsell to answer a very basic question about what symptoms her daughter noted before her death, letting her demur by refusing to answer because she has a “case pending.”
Never mind that it’s easy to find all sorts of information about Christina Tarsell’s case all over the Internet, mostly told by Mrs. Tarsell herself. For example, it’s easy to find this particular document: EMILY TARSELL, As the Executrix of the Estate of CHRISTINA TARSELL…. FINDING OF FACTS. Yes, it’s the finding of fact from the Special Master:
On November 20, 2007, Christina saw a doctor for chronic sinus congestion. The doctor detected an irregular pulse rate. Exhibit 4 at 136. An EKG was abnormal, indicating premature atrial contractions and that Christina ’s heart was beating in pairs. Id. at 142.
Approximately one month later, the EKG was repeated. It appears unchanged from the previous one. Id . at 135 and 141. In February 2008, Christina had a transthoracic echocardiogram. It produced normal results. Exhibit 4 at 139.
There are also notations that Christina complained about feeling dizzy and faint. One has to wonder, given this history, whether Christina had an electrical conduction abnormality in her heart. Such abnormalities often have no accompanying detectable abnormality on the echocardiogram, and, although rare, can be a cause of sudden cardiac death in young adults. One also notes that these symptoms occurred several months before the third dose of Gardasil that Mrs. Tarsell blamed for her daughter’s death.
If my readers and I can find that with a brief session on Google, why couldn’t Couric and her producers find it before letting Tarsell falsely blame Gardasil for the death of her daughter on national TV, aided and abetted by Katie Couric. That’s on top of Tarsell’s being one of the founders of SaneVax, a group known for peddling a manual for blaming the death of one’s child on vaccines and peddling pseudoscientific antivaccine fear mongering. More recently, SaneVax published a guide entitled Gardasil HPV: What to Do If You or Your Daughter Suspect Premature Ovarian Failure. It doesn’t matter that convincing evidence supporting a link between premature ovarian failure and Gardasil is basically nonexistent.
Next up, Couric tries to defend herself against charges that Diane Harper, one of the investigators on the original clinical trials that led to FDA approval of Gardasil, spread misinformation:
Another concern expressed was the duration of protection the vaccines offer. An early study showed that they are effective for five years. But more recent research indicates the protection lasts for at least eight years, and potentially well beyond that. The longer the vaccine is available, the more research can be done on its long-term efficacy, and the public will need to be informed.
There is one aspect of the show that I felt was especially critical to communicate to viewers. It is also important for women to have regular Pap smears to detect cell abnormalities that can lead to cervical cancer. There’s been troubling research out of Australia that indicates some women are skipping their Pap tests because they have been vaccinated. That’s a terrible idea. While the vaccine protects against some of the HPV strains that cause cervical cancers, it doesn’t protect against all of them, and regular Pap smears are essential for life-saving diagnoses.
OK, it’s true that vaccination against HPV doesn’t make Pap smears unnecessary. After all, neither HPV vaccine covers all the potential strains of HPV that can cause cervical cancer, only the most common, but Couric’s mentioning it seems like a quick pivot to draw attention away from just how badly Couric screwed up. I’ll give you an idea how bad, courtesy of Dr. Jen Gunter, who picked up on something last week that I should have picked up on as well. Oh, well.
To understand the problem, you have to know that one of the claims that Dr. Diane Harper made was that protection from Gardasil only lasts five years. Let’s take a look:
A paper authored by Harper (and others) from 2009 published in the Lancet specifically shows that the HPV vaccine (Cervarix) is effective for 6.4 years. Yes, Harper participated in and published a study that shows an HPV vaccine (at the time in 2009) was effective for at least 6.4 years. Dr. Harper has written extensively (and very favorably, at least in 2011) on Cervarix. She writes in a 2011 opinion piece (ISRN Obstetrics and Gynecology, Harper and Vierthaler) that Cervarix offers “protection against HPV 16 and 18 lasting at least 9.4 years.”
If Couric were on her show in any journalistic capacity she should have immediately asked, “Why would you say the HPV vaccine only works for 5 years, Dr. Harper, when in your 2009 publication you write, and I quote, Our findings show excellent long-term efficacy, high and sustained immunogenicity, and favourable safety of the HPV 16/18 AS04-adjuvanted vaccine up to 6.4 years. Is your issue specifically with Gardasil?”
However, studies indicate that Gardasil is also effective for longer than 5 years. Data presented last year from two studies expand the proven effectiveness of Gardasil to 8 years. I’m not sure how Harper could be unaware of this data. It’s not exactly brand new in HPV circles.
I’ve actually read Dr. Harper’s article praising Cervarix before. I read it when I last wrote about Dr. Harper before the latest Katie Couric kerfuffle. Back then, I was willing to give her the benefit of the doubt and assume that it was her naivete that allowed the antivaccine movement to enlist her statements into the service of their cause. No more. I find it very difficult now not to conclude that Dr. Harper either lied or was so utterly clueless about the scientific literature on HPV and vaccines against the HPV types that cause cancer as to have forfeited any right she previously might have claimed to be considered an expert.
Not only that, but as Jen Gunter points out, Harper’s own work indicates that adverse events with both of the vaccines was the same as placebo. One wonders why Katie Couric, former journalist, wasn’t aware of these little tidbits of information.
No, actually, one doesn’t.
Couric finishes with a self-righteous flourish, writing about how she’s personally experienced the “devastating impact that cancer has on people and their loved ones” and has “been a passionate advocate for cancer research, education, and prevention.” Fair enough, although she does lay it on a bit thick by talking about being co-founder of the National Colorectal Cancer Research Alliance and Stand Up To Cancer (SU2C). These are all good things. I hope she continues to do them. However, they do not absolve her of the responsibility for the dangerous misinformation she promoted about vaccines. In one segment, she seriously damaged what has taken many years to build up: Her reputation as a promoter of science-based medicine with respect to cancer. One wonders if she would have aired a similar story if Gardasil protected against an infection that led to colon, rather than cervical, cancer. My guess is that she wouldn’t have.