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Dr. David Brownstein fought Shingrix, and Shingrix won

Dr. David Brownstein is a “holistic” family practice physician in my area. Consistent with being “holistic,” he is antivaccine to the core. That’s why he’s unhappy with the recent CDC recommendation that adults over 50 receive the new shingles vaccine. He thinks he’s found a clever argument to show it doesn’t work. Unfortunately, his argument only reveals his bias and misunderstanding.

Dr. David Brownstein
Dr. David Brownstein, a local “holistic doctor” who’s been featured on NaturalNews.com and is very, very antivaccine. This time around, he tries to show that the new shingles vaccine is not worth taking and doesn’t work. As usual, he fails.
Michigan, and Detroit in particular, are unfortunately like most large states and metropolitan areas in that here we have our share of “holistic” doctors and other practitioners peddling nonsense, including antivaccine pseudoscience. For instance, in the northern suburbs we have a naturopath named Doug Cutler peddling all manner of antivaccine quackery, along with the usual naturopathic quackery. (Of course, the two almost always go together.) Among the “real” doctors (i.e., actual, honest-to-goodness MDs or DOs), one prominent antivaxer is Dr. David Brownstein, a board-certified family physician practicing in the northern suburbs who’s big into “integrative medicine” (or, as I like to put it, the “integration” of mysticism, pseudoscience, and quackery into real medicine). Sadly, it seems that the northern suburbs seems to have an unusually high concentration of such “holistic” doctors, at least compared to the rest of the Detroit metropolitan area.

I’ve written about Dr. Brownstein a couple of times before, having first become aware of him when a friend and local internist named Dr. Peter Lipson took him to task for promoting antivaccine fear mongering among the large Jewish community in the area where he practices. Specifically, he was protesting the requirement for vaccines for Jewish children to attend Camp Tamarack, a Jewish summer camp. Both Dr. Lipson and I discussed how full of misinformation Dr. Brownstein’s screed was. Later that same year, I was amused by Dr. Brownstein’s unhappiness over the preponderance of questions on his family practice board recertification examination about medications and medication interactions. It was a tantrum full of sound and fury, signifying nothing, at least nothing with much, if any, science behind it. Now, I can understand the unhappiness with board recertification examinations, as I am facing my own surgery board recertification in early December. Such exams are massive time (and money) sinks that have never been shown to improve patient care. However, I complain about them for the right reason (that they are massive time and money sinks that have never been shown to improve patient care, particularly for subspecialists like me), not because they don’t include quackery and pseudoscience on them.

Dr. Brownstein, not surprisingly, is at it again. This time around, he’s very unhappy over the new recommendation that basically everyone over 50 receive the new shingles vaccine, Shingrix. Hilariously, he entitled is little screed I am trying NOT to write about vaccines… I can only retort that, for someone trying not to write about vaccines, Dr. Brownstein sure does write about vaccines a lot. For instance, a recent post on his blog complains about the “CDC whistleblower manufactroversy” and how, three years later, nothing has been done. Of course, the CDC whistleblower nonsense is an antivaccine conspiracy theory with basically nothing behind it touted by Andrew Wakefield and company, and I’ve written about it more times than I can remember. Then, another recent post by Dr. Brownstein is his annual rant against the influenza vaccine, full of the usual antivaccine tropes specific to the flu vaccine. Other recent posts by Dr. Brownstein include rants about how supposedly the AMA opposes vaccine research (hint: it doesn’t—it just opposes a “vaccine commission” headed by an antivaxer like Robert F. Kennedy, Jr.) and a post about the measles outbreak among Somali immigrants in Minnesota, in which he once again complains that nothing has been done about the CDC whistleblower. I could go on, but why bother, at least here? It’s the same old antivaccine pseudoscience regurgitated again and again.

The reason I took note of Dr. Brownstein’s latest bit is because he seems to think he’s found a slam-dunk line of argument against vaccines. As I go through his post, see if you can pick apart his argument before I get around to doing it later in this post. It’s an argument that he seems to think to be so clever that he’s used it in multiple recent posts. Before I get to that, though, I can’t help but note that laughed out loud at his introduction:

During our week in Colorado, we saw Suzy [Suzy Cohen—America’s Pharmacist] and her husband Sam many times. During one visit, we were talking about our respective blogs and I stated to her, “I am trying not to write about vaccines.” Suzy commented, “But you always write about vaccines, why are you trying not to write about them?”

I explained to Suzy and Sam that I am tired about writing about the problems with vaccines. I have been writing about the toxic ingredients of vaccines for well over a decade now. I do not want to be defined as an anti-vaxxer.

You see, I am not anti-vaccine. I am pro-health. If vaccines were safe and effective, I would be on-board with the CDC’s (Centers for Disease Control and Prevention) recommendations. However, we are presently giving too many ineffective vaccines which contain toxic ingredients and do not work as advertised.

“I am not antivaccine. I am pro-health.” Yep, Dr. Brownstein is antivaccine. Anyone who says something like that is 99.999% likely to be antivaccine, and Dr. Brownstein hasn’t provided me any evidence to suggest he’s part of that 0.0001% who say things like that and isn’t antivaccine.

Let’s just put it this way. If Dr. Brownstein is trying not to be perceived or defined as an antivaxer, he sure as hell is doing a piss-poor job of it. At least a third to a half of the posts on his blog are antivaccine rants. I’ve never seen him write or say anything good about vaccines, other than grudgingly admitting that the MMR vaccine does decrease the incidence of measles. Even then, he immediately followed that tortured admission with caveats, such as bemoaning how the vaccine doesn’t produce “natural immunity” and how it causes autism (even though it doesn’t). Let me put it this way: Does Dr. Brownstein routinely recommend any vaccine for any patient? I suspect you know the answer to that one. I certainly do. If he does think any vaccine is worth giving, I’ve yet to see a public statement from him saying so.

But let’s get to his “devastating” argument against the shingles vaccine. As you might have seen in the news, recently the CDC recommended a new vaccine against shingles, Shingrix, manufactured by GlaxoSmithKline, for all adults over 50 years of age without contraindications to the vaccine. For those unfamiliar with shingles, it’s a condition caused by the varicella zoster virus that can cause a painful rash and even nerve damage. Basically, if you’ve ever had chickenpox (and most of us over a certain age have—certainly I had it when I was seven years old or so), you’re at risk. Basically, after the chickenpox passes, the virus lays dormant in nerve cells, and can reactivate as shingles, where it can a painful rash that can include ugly skin ulcers along the distribution of major nerve roots. The illness can cause strokes, encephalitis, spinal cord damage, and, if it affects one of the facial nerves or optic nerves, loss of vision. One in three people with shingles can have lasting sequelae, such as chronic nerve pain that is difficult to treat. So, yes, shingles is a big deal. Personally, before my next visit to my doctor, I’m going to make sure he has the vaccine to give me, along with the hepatitis A vaccine given the outbreak going on in my area.

Dr. Brownstein, however, thinks the vaccine is worthless because…well, I’ll let him explain:

Let’s look at the Shingrix data. I went to the Physicians Desk Reference information on Shingrix. In section 14, the clinical trials used to get the vaccine approved are described. There were 14,759 subjects aged 50 years and older who received two doses of either Shingrix or placebo. In the NYT article, it was written that SHingrix was about 98% effective at preventing shingles for one year. The PDR report stated that same thing. If this vaccine was truly 98% effective, then I would have to seriously consider recommending Shingrix.

Here’s the actual data:

Six people out of 7,344 who received the two doses of Shingrix developed shingles—that is 0.08%. 210 out of 7,415 people who received the placebo became ill with shingles—that is 3%. How do they get 98% efficacy out of these numbers? Again, I have written about how the Big Pharma Cartel manipulates statistics to make a poorly performing drug or therapy look better than it actually is by using the relative risk (RR). Dividing .08% by 3% and subtracting from one provides the RR decline of nearly 98%. However, the relative risk is an inaccurate statistical model that should never be used to make clinical decisions. The more appropriate statistical model to determine if a drug or therapy should be used is the absolute risk reduction (ARR).

The ARR for this study can be calculated here: 3%-0.08%=2.9%. Therefore, a more appropriate determination of the effectiveness of Shingrix is that it is 2.9% effective at preventing shingles for a median of 3.1 years (the length of the study). And, a true statement about Shingrix is that it takes 34 people to be vaccinated with Shingrix (1/2.9%) to prevent one case of shingles. That means the drug failed 33 out of 34 who took it which is a 97% failure rate!

No, no, no, no. It is not a 97% “failure” rate. It’s not true that the vaccine “failed” in 97% of the cases. What happened is that for those 97%, the vaccine was irrelevant to whether they got shingles because they wouldn’t have gotten shingles anyway. Among the people destined to get shingles, though, it was highly effective. Of course, this sort of calculation is an issue for any intervention designed to prevent disease, like a vaccine. In any population, the vast majority of the population won’t get the disease that the intervention is intended to prevent, whether they get the intervention or not.

Let’s look at an example that I like to use to demonstrate that ARR is an important measure. I bring it up myself many times when referring to the efficacy of chemotherapy. A good rule of thumb is that, in appropriate patients, adjuvant chemotherapy for breast cancer reduces the relative risk of recurrence and death by roughly 30%. (I’m rounding for ease of computation; the number can vary a bit depending on the subtype of breast cancer and the chemotherapy regimen chosen.) In early stage breast cancers, that means that the actual ARR can be fairly small. For instance, let’s say a woman has a breast cancer with a ten year recurrence-free survival rate of 90% without chemotherapy, meaning she has a 10% chance of having a recurrence and dying if nothing is done. A 30% relative reduction in that risk due to chemotherapy would translate to an absolute risk reduction of around 3% (0.3 x 10% risk of recurrence and death = 3%). Her chances of survival would then be 93%. What that means is that, for 90% of women in this population who undergo adjuvant chemotherapy, the chemotherapy had no bearing on their disease. They wouldn’t have recurred anyway. For 7%, the chemotherapy “failed,” in that they recurred despite chemotherapy, while the chemotherapy prevented relapse and death in 3%. The problem, of course, is that we have no reliable way of predicting which women will recur and which won’t, which is why we treat them all. Basically, the chemotherapy saves 3 women out of a hundred (on average) from death. That means 33.3 women have to be treated to prevent one death, for a “number needed to treat” (NNT) of 33.3.

Of course, I also can’t help but point out that the benefits of adjuvant chemotherapy for breast cancer in terms of absolute risk reduction increase along with the risk of recurrence. If you have a patient with a 50% chance of recurrence and death in 10 years, then a 30% relative risk reduction would translate into an absolute risk reduction of 15%, resulting in a 65% chance of long term survival.

The reason I bring up the example of breast cancer is because of the similarity in the numbers to Dr. Brownstein’s example, at least for early stage breast cancer. Let’s just put it this way. Many women view an ARR of 3% of dying at the cost of undergoing toxic chemotherapy to be an acceptable tradeoff. Now let’s consider the Shingrix. Take a vaccine with minimal risk in order to cause a 3% decrease in the absolute risk of getting shingles. Look at it another way. Basically, this translates into a number needed to treat (NNT) to prevent one case of shingles of 33 or so. For a vaccine, that’s a pretty damned good NNT! For any preventive intervention in medicine intended for patients without symptoms, that’s a hell of a good NNT, particularly given how safe the vaccine is. But it’s even better than that. Out of the 3% who would get shingles in the time frame of the study (median 3.1 years of followup), the vaccine prevents 98% of cases. That is simply incredible efficacy.

Dr. Brownstein, as clever as he thinks he is being, is blatantly downplaying the benefits of the shingles vaccine using a misunderstanding of the statistics of preventive interventions. Notice that he focuses on just 3.1 years (the median duration of observation of the subjects in the study) and the general population. In other words, the ARR for shingles is 3% at one year, but what about subsequent years? Well, we can get an idea from the graphs showing vaccine efficacy from one of the actual studies (Study 1 and Study 2). In the second study, I note that the curves showing the incidence of shingles in the vaccinated and unvaccinated populations were still separating at four years after vaccination. In other words, the ARR was continuing to grow, because, as time goes on, more and more of the patients in the study were at risk for developing shingles. I’m betting that a subsequent publication of the data from this study, which is now five years old, will likely show that the ARR is much larger than what Brownstein cites.

You can look at the issue in terms of absolute numbers, as well, given that the law of large numbers means that even a relatively small ARR can translate into a lot of cases of disease prevented. Consider: There are over 100 million Americans over the age of 50 now, a number that is still growing. What’s 3% of 100 million? Three million. So if every older American were vaccinated with Shingrix, that would, by Brownstein’s own interpretation, prevent 3 million cases of shingles over roughly three years, a number that would definitely grow as time goes on.

Finally, let’s look at Dr. Brownstein’s hypocrisy for a moment. Using ARR to dismiss a treatment is disingenuous when it is not applied to other treatments. For instance, can Dr. Brownstein produce evidence for any of his favored treatments, which I’ve listed before, that indicates an NNT for disease prevention better than that of Shingrix? Let’s list some of them again:

  • Acupuncture
  • Massage Therapy
  • Polarity Therapy
  • Manipulative Medicine
  • N.A.E.T.
  • Micro-current Facials
  • J.M.T.
  • N.M.T.
  • Emotional Freedom Technique (E.F.T.)
  • Vitamin and Mineral Supplementation
  • Intravenous Vitamin and Mineral Therapies
  • Elimination and Allergy Diets
  • Body Composition Analysis (B.I.A)
  • Electro-Dermal Screening (E.D.S.) Full Bio-Profile Reports

Oh, and Dr. Brownstein is a graduate of the Desert Institute School of Clqssical Homeopathy. Homeopathy is, of course, The One Quackery To Rule Them All, being basically water mixed with sugar pills. Given that Dr. Brownstein he accepts an NNT of infinity as being acceptable, as long as it’s not one of those evil pharmaceuticals or vaccines being used, for which an NNT of 33 or so is utterly unacceptable.

Besides, if you don’t get the vaccine and get shingles, Dr. Brownstein has just the thing for you:

Yes, shingles is a horrible illness. I had it a year ago. A great treatment for shingles is ozone injections into the nerve root where shingles is occurring. It works nearly every time if it is done within a few days of the onset of the illness. Also, taking vitamin C (5-10,000mg/day) and L-lysine (1,000mg three times per day) helps.

Does Dr. Brownstein have any clinical trials to show that any of these interventions does any good whatsoever for a case of shingles? Of course not. He’s using interventions with an unknown ARR or efficacy that is almost certainly zero, meaning that he prefers to wait until disease develops and then use quack treatments with NNTs of infinity, instead of recommending a vaccine with an NNT of 33. Why? Because he is antivaccine. It’s the only explanation for such idiocy.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

69 replies on “Dr. David Brownstein fought Shingrix, and Shingrix won”

OZONE INJECTIONS??? What the living mother earth is this man smoking? He’s definitely a quack, and I’m actually glad he doesn’t practice anywhere near where my family might see him. However, since apparently he has no hospital privileges nor does he apparently accept insurance, I have no worries they might get suckered into seeing him. His website is all “BUY MY STUFF” and his blog. Disgusting. Can he be reported to the MI board of medicine or whatever they are called? Or don’t they care if quack MDs sell stuff?

(I weep that he’s a U-M grad. U of M, how can you embarrass your graduates so? Another reason to quit giving you money.)

However – thanks for the info about shingrix! Since I AM over 50, I’ll see if I can get it and if my insurance will pay for it.

I’m sure most insurance companies will be paying for it within a few months, given that it’s now on the CDC’s list of recommended vaccines. At least, I hope so.

No info here yet as to insurance coverage. Maybe in January.

On the bright side, just got a text from my mom. She and my dad saw their PCP in Detroit suburb today and I quote: “We are duly HepA’d so you can stop worrying. <3”

Nice to know the parents listen to the child sometimes.

I think it needs to go through the stages of approval by the CDC director (almost always given) and publication in the federal register before it’s binding on insurance companies, but they may want to cover it before that to reduce costs associated with treating shingles.

Nice to know the parents listen to the child sometimes.

I’m still pestering my dad about Shringrix and flu vaccine. Seem to be making some progress compared with August, when I was last visiting.

I asked my doctor for a shingles vaccine on my last visit (I don’t think I’ve ever been sicker than when I had chicken pox at age 9) but that my insurance wouldn’t cover it. I said I’d pay out of pocket which, for some reason, was a problem. So, YIPEE! Maybe I’ll be able to get one soon.

Brownstein is often mentioned at AoA.I think they also featured articles by him.
He advocates EFT. Enough said.

I just learned that RFK jr’s World Mercury Project has an IndieGoGo to raise 25000 USD for vaccine safety: they want the government to subject vaccines to the same “rigorous testing” as drugs.

Because I suppose they aren’t tested now.

When I saw “Emotional Freedom Technique” on his list, I thought ‘what the f*** is that!’. Do I actually want to know, or would it just make me more depressed about the state of humankind?

@ sadmar:

I think you might enjoy reading about EFT – there’s a wikip— article and Mercola has quite a few entries about it- which should tell you all you need to know ( use the search on his site)

If you are anything like me, you might get a laugh.

I wish Orac would do a post on EFT. It is the most dire nonsense in the quackety-quack bag of tricks; but along with NLP the EFT “practitioners” have recruited some honest-to-goodness neuro people to endorse it. The theories about how these things work (don’t) is some pretty sophisticated sophistry, and a lot of behavioral and mental health with real credentials are jumping on to this stuff for a whole range of problems.

Its history of founding people fighting over profitable turf, expensive “training” programs, and competing (nonsense) philosophies is hair-curling–not to mention that I’ve run across several clinical psychologists and at least one neuropsychologist who are actively peddling and using it.

He advocates EFT.

I had to look that one up on Wikipedia: “the person will focus on a specific issue while tapping on “end points of the body’s energy meridians”.

Around here we call that spanking.

It’s completely daft. I’ve talked to some mental health people who are actually using this. Their brains have fallen out.

I am trying, without success, to see how Brownstein could think that ARR was the correct measure to use here, unless his intent was to deceive.

If 3% of unvaccinated people contract the disease, then the ARR for any intervention cannot exceed 3%. The probability of contracting the disease after vaccination cannot be less than 0. But the difference between a 1-in-30 risk and a 1-in-1200 risk is huge. For example, if this were flood insurance, this would be the difference between uninsurable (no sane person would underwrite an insurance policy or mortgage on a property that had a 3% chance of flooding in any given year) and an excellent insurance risk (the insurer is unlikely to have to pay a claim over the course of a 30-year mortgage on a house with less than a 0.1% chance of flooding in any given year). I do not see how the logic that applies to flood insurance would not apply to the present example of vaccination.

Or, he simply does not understand statistics. I try not to ascribe to conspiracy what can be explained by stupidity.

I think that he is simply stupid. The correct argument would have been to balance the 2.9% who are spared from shingles with the X % side effects of the vaccine (if they can be estimated). But talking about 97% failure means that he doesn’t understand what he is saying.

Cutler’s posted here on RI in the comments more than once.

I actually used his ignorance against him and convinced a fence sitter to vaccinate her kids. I told her exactly what he would say, exactly which studies he’d link, and how he’d refuse to discuss design, etc.

I nailed every single one.

I knew shingles was a horrible illness 20 years ago when a friend at church got it, so I got the old vaccine when I was eligible at 60.

It can be tricky to diagnose, too. A long time friend had a bad outbreak and it took her 3 doctor visits before the figured it out and got it under control (I think with antivirals). Her husband got it shortly later and they recognized it right away. His was controlled pretty well, but she’ll probably be in pain for many years.

I’ll be discussing this one at my next appointment, as well as the other pneumonia vaccine.

I notice he also discussed Zostavax, which I mentioned to mjd yesterday. Obviously his answer to the question is that he would recommend neither!

But, no, he’s not anitvax at all !!!!

Of course, he never discusses the safety versus effectiveness tradeoff.

And he doesn’t present any source on the NNT for his Vitamin C or L-lysine recommendations either.

But I was especially struck by his referring to the New York Times article about the Shingrix announcement as a “a fake news medical article” !!!

His use of NNT for a clinical trial is disingenuous too as you’ve demonstrated. While mathematically-correct, the intervention administered on a large-scale will decrease the NNT. Also not everyone gets shingles which decreases the true NNT, if you will. Given what a nasty disease shingles is, even a reduction of 3% is worth it.

Over the past 7 years, I’ve had 3-4 people at work whom I personally know get shingles. Most were in a lot of pain, one had it near her eye and was scared to death she’d go blind. Another had a medically fragile family member and was very worried about caring for that person.

I’m always on the alert for it in myself and my children, who unfortunately had to suffer through chicken pox because they had had it by the time the vaccine was approved, as well as my parents and siblings. I can remember when my grandfather had shingles and he was in agony (it went around his whole waist area, like a waistband). I don’t want to have to experience that. Yay for Science!

You already know the answer, Michael.

Multiple doses are given because enough people don’t get full protection with one dose. If you miss the second dose you might be OK, but I wouldn’t want to chance it. If you get it within a reasonable time frame, you probably don’t have to repeat the series.

Thanks Panacea, it’s nice to finally read a response that’s informative, reassuring, and not laced with profanity.

The new RI site has some of the minions on edge, although probably to Orac’s liking.

An NNT of 33 is really good for just about anything. Even Pap smears in unvaccinated populations are not that good, and they are probably going to be much worse in vaccinated women.

Another doc who needs to lose his license.

I read Frownstein’s post. Do I have this right? He says don’t take a vaccine for a potentially debilitating disease, which could cost a lot to treat and end up causing permanent damage, because Big Pharma just wants to take your money? Oh, and by the way, if you do get it, I have a nice, expensive, unproven treatment for it, if we catch it in time. Better I should have your money and you suffer than those nasty drug companies get it!

I tried Emotional Freedom Therapy once. It didn’t end well. Luckily the police officer let me go with just a warning.

Hi Roger, nice to see you’re back. Hope you are well. To answer your question, yes and no. You may have a detectable antibody titre to zoster virus but still get shingles and you may not have a detectable antibody titre to zoster virus and not get shingles. Cell-mediated immunity plays a large role in shingles disease and is not routinely assayed.

I weep that he’s a U-M grad. U of M, how can you embarrass your graduates so? Another reason to quit giving you money.

Any school the size of the University of Michigan is going to have some clunkers among their alumni. The universities I have degrees from are less than a tenth that size, and they have some real clunker alumni, too. It’s worse when people like this are on the faculty, as is happening at far too many medical schools (Orac has done a bunch of posts on that topic). In the former case, the school could not have known in advance that the student in question would turn out to be a clunker. By the time they are far enough along to be applying for faculty positions, it’s far more likely that the faculty search committee should know to stay away from such candidates. (Although that is also not 100% guaranteed–there is the phenomenon of “going emeritus”.)

As for why Brownstein would be practicing in the northern suburbs of Detroit: That’s the part of Michigan with the highest concentration of people who can afford to pay cash for his services. My only visit to Michigan was the time a missed connection left me stranded overnight at DTW, and even I have heard of the Grosse Pointes and Eight Mile Road.

@Eric Lund: I know. There are a lot of rich neighborhoods just north of my parents, and that’s not counting the Grosse Pointes.

Orac and I were at U-M at the same time for undergrad, though we never knew that. I know there are quacks in every group – the nursing school also had them.

Yes!! I’d love to not wait another 6 years for my Shingles vaccine. My next appointment is in the spring, hopefully I can get it then.

“And, a true statement about Shingrix is that it takes 34 people to be vaccinated with Shingrix (1/2.9%) to prevent one case of shingles. That means the drug failed 33 out of 34 who took it which is a 97% failure rate!”

No, that’s not a true statement about the number needed to vaccinate for shingles prevention. Dr B is co-mingling efficacy (or the lack of efficacy that he wishes had occurred) with an incorrect interpretation of NNV. If the vaccine “failed” to prevent 33 of 34 cases of shingles it would neither be licensed nor receive a Category A (i.e. routine use) recommendation by the ACIP. The correct interpretation of the NNV in this case is that a HCP would only have to vaccinate 33 subjects (with inclusion/exclusion criteria and incidence similar to those in the clinical trials) to prevent one case of shingles. Compared with other medical interventions that is a desirably low number indeed.

On the other hand, Dr B stipulates in his post that the efficacy is 98% (QED that the vaccine will prevent the vast majority of the hypothetical 34 cases). Is Dr B malevolent? Unfit for practice? Stupid? I like to think it’s because he’s anti-vaccine, and the result is that his cognitive bias against vaccines is so pervasive that he fails to see it in his own writing even when pointed out by others. Da’ Nile ain’t just a river in Egypt…

I’m with Orac; it is terrific that there is such an efficacious vaccine for we old trees in the forest.

Yeah, looking back at my post, I wish I had phrased it a little differently. Basically, what I should have said is something like this:

It’s not true that it “didn’t” work in 97% of the cases. It’s that those 97% didn’t get shingles (yet) and therefore the vaccine had no impact on whether they got shingles or not. Among the people destined to get shingles, though, it was highly effective. Of course, this is an issue in any intervention designed to prevent disease, like a vaccine. The majority of the population won’t get the disease, vaccine or no vaccine. These are the members of the population who inflate the NNT. The same is true for statins to prevent MI, etc.

Maybe I’ll go back and add something like this…

No, that’s not a true statement about the number needed to vaccinate for shingles prevention. Dr B is co-mingling efficacy (or the lack of efficacy that he wishes had occurred) with an incorrect interpretation of NNV.

Thanks for pointing that out so efficiently. I neglected that important point in my hasty reading of the post.

I’m due for my yearly physical soon. I will certainly ask about the new vaccine when I go in. Shingles is something I wouldn’t wish on anyone. 🙁

Were the test subjects selected for risk factors for shingles, that is, did they all have a history of childhood chicken pox? If not, surely that boosts they actual efficacy of the vaccine? I understand why you would vaccinate absent such a history, but it would be interesting to know the selection criteria for subjects.

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blockquote>Were the test subjects selected for risk factors for shingles, that is, did they all have a history of childhood chicken pox?

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blockquote>

I’m not going to burrow too deeply, but I doubt it.

If not, surely that boosts they actual efficacy of the vaccine?

I’m not sure what you mean here, but I’m tired.

^ Well, that’s a marginally interesting failure mode (the slash was missing from the first closing blockquote tag).

When I got my hepatitis B vaccine some years ago, from the city Department of Health, he nurse checked that I’d had the MMR vaccine, looked at my date of birth, and asked if I’d been born in the United States. When I said yes, she said I didn’t need the chicken pox vaccine, because almost everyone born in the United States before 1980 (or was it 1988?) has had chicken pox. If you’re over 50 right now, you were born before 1980: even if that’s not true of immigrants, or of some immigrants, your medical records should include your date of birth, and it’s easy enough to ask people whether they had chicken pox, and follow up with “where were you born?” for the people who say no or aren’t sure.

(I didn’t ask about the chicken pox vaccine: they were set up to vaccinate for a long list of things, as part of protecting the public health.)

I think that nearly everyone over the age of — what, 50? — has a childhood history of chicken pox. It’s also very easy to check for the relevant antibody, so it wouldn’ have been hard to check, but they may have felt it wasn’t necessary.

Well, another thing that could prevent shingles is a chicken pox vaccine in young people…oh, wait….

I will RUN–not walk–to get this vaccine when it is available to me. In my family, shingles has been the beginning of the decline of a number of seniors. Not just the pain (which is clearly awful). The disfigurement keeps them at home and out of their social circles. This leads to depression and isolation. Terrible in every way–you know, something that a person who claims to be thinking “holistically” would consider.

How does this guy sleep at night?

I’m old. I’m cranky. I’m cynical. I pretty much despise humans as a class of beings. I look at Brownstein (cripes, either stick with Braunstein or anglicize it all the way to Brownstone – it keeps people like me from thinking “Brownstain”) and see someone who has realized that he has no chance of being outstanding as a physician. Can’t be really good? Be “outside of the box” and gull the rubes into believing you’re some kind of savant, rather just an idiot – that way you’ll get the attention you crave so desperately.

~~~
In Other News – again:
Tamara Lovett, who allowed her son to die because she gave him quack remedies instead of medicine, has been sentenced to three years in prison. Much as I detest humans, I can’t say that I think it would serve any real purpose to put her in jail for longer. My opinion, based on what I saw at her trial, is that she certainly isn’t stupid and has some valuable skills. She was gulled by the scum who flog quack remedies – the scum who should be in jail for a thousand years. If she is allowed to, and can rein in her arrogance just a little, I think she can actually be of benefit to other women in prison. I’ll think of her come spring, when I ride my bike past the office of the chiroquack she consulted, instead of an actual doctor, when her son was a baby, and then on up near the womens’ prison.

In the female prison,
There are seventy women …

no auld triangle here

[hanging right in front of me is a key I found – with at tag that says
“Property of Southern Alberta Forensic Psychiatry Centre
if found ….
– she would have been accessed there, and will return to the prison right next door]

QUACK REMEDIES KILL CHILDREN. Brownstein, you filthy purveyor of FUD, you are part of the problem. In this instance, you will cause misery for older people. Be grateful my boot is a long way from your ass.

Wouldn’t RR be the measure of choice for any preventative measure based solely on logic? How would ARR be justified when the outcome basically is up to chance? I totally agree that ARR is the measure of choice for treatments as the object of the intervention is to eliminate a factor, but in prevention we usually only have possible factors (in certain cases they might be probable and further argue for preventative measures though)…

Misuse of absolute risk reduction statistics can easily lead you astray. If a condition has a prevalence of 1% then a treatment with 100% relative risk reduction has an ARR of only 1%. Why bother treating schizophrenia, epilepsy, multiple sclerosis, or many other disorders? What count is the overall risk-benefit balance, which is clearly favorable for shingles vaccine.

Anti-vax quack physicians like Brownstein openly flourish unfettered in the US, including their ability in writing vaccine exemptions (as you’ve covered recently in California) Meanwhile, in Australia, AV docs are losing their licenses very quickly after they’re exposed as anti-vax(http://www.abc.net.au/news/2017-09-15/anti-vaccination-gps-licence-suspended-following-raid-melbourne/8947954), including a underground cell that was trying to avoid publicity because they knew they’d get in trouble if caught–which they were. (http://www.heraldsun.com.au/news/secret-melbourne-cell-of-antivaxxer-doctors-under-investigation/news-story/dbd0d3ba7f5464dcbaa8cc44bcb52576). And (icing on the cake) legislators in Australia are now working to close the loopholes exploited by the now non-practicing AV docs so that other AV docs can write exemptions that way (http://www.heraldsun.com.au/news/secret-melbourne-cell-of-antivaxxer-doctors-under-investigation/news-story/dbd0d3ba7f5464dcbaa8cc44bcb52576).

At least Dr. Pan is trying to close vaccine exemption loopholes in California, but otherwise in the US it’s a giant disease-spreading party for quacks like Brownstein.

Sometimes I hit paywalls on a secondary link from those sites to one of their other articles. My overall point is that Australia isn’t tolerating any of this anti-vaccine nonsense from any of their physicians which is a lesson we really need to take to heart in the US. Dangerous fools like Brownstein need to lose their license.

Is Shingrix recommended for those who have had Shingles already, to prevent recurrence? If so, is there a suggested waiting period between Shingles outbreak and vaccination?

Michelle,

You should make sure all symptoms have disappeared, but other than that there is no reason not to get vaccinated if you’ve already had shingles, nor is there a specific waiting period.

I left a comment on Brownstein’s blog. Amazingly it has been languishing in “awaiting moderation” status for days now. Fawning agreeable comments are visible. Another precious snowflake anti-vaxxer he is.

Heheh. I purposely included Dr. Brownstein’s Twitter handle when I Tweeted out a link to this post on Friday. Assuming he’s checking his notifications, he knows I’ve written about him. On the other hand, he doesn’t Tweet very often; so he might not have noticed yet.

I live in a Hep A hot spot and local authorities have been going nuts about it, mass vaccinations and the like. Along with portable washing stations and periodic bleaching of local sidewalks.

My advice comes down to this, get vaccinated. While the fatality rate isn’t really all that great, the disease is still hard on the victim and expensive to treat. You can avoid a debilitating disease by getting vaccinated, save us all the money and resources it would otherwise take to treat the ill.

And should you get the initial shot make damn sure to get the booster in 6 months. I got vaccinated on Oct 2nd 2017 and I’m going to make damn sure to follow up on April 2nd 2018

Hep A may not kill you, but it can make you wish you were dead, and our medical community has more than enough to deal with without adding more strain to the system.

Vicki: When I said yes, she said I didn’t need the chicken pox vaccine, because almost everyone born in the United States before 1980 (or was it 1988?) has had chicken pox.

I think it’s 1988, and even then the nurse is lowballing it. My baby brother was born in 1989, his wife is a year younger, and I think they both had chickenpox. Correct me if I’m wrong, but wasn’t the chicken pox vaccine only made available in 1994?

Yes, the vaccine was made available in 1994. I was born in 1987 and actually had chickenpox twice; just a smattering of spots as a baby, and then a bad full-blown miserable case in 1993 or 1994, when I was in kindergarten.

Naturally my question to Brownstein was not let out of moderation but here’s a howler from his blog comments:

Curt W says:

Wait. I’m confused.

You wrote that 6 patients in the trial developed shingles (0.08%) compared to 210 (3%) in the placebo arm . It looks to me that the vaccine prevented 204 cases of shingles and only failed 6 times.

How is that a 97% failure rate?

I’m not the best at math so forgive me if this is a stupid question.

Curt

<blockquote>David Brownstein says:

Curt,
3% minus 0.08% equals 2.92%. That is a 3% absolute reduction in risk. That means it was successful 3% of the time.
DrB</blockquote>

It appears as though the Brave Dr. Brownstein will let a “critical” comment through if he thinks he can hit it out of the park.

BTW, where is Herr Doktor Bimler?

Herr Doktor Bimler is possibly in a pub or preparing chili con carne. Maybe even working.

He is still here under another ‘nym, you will likely recognize him.

Curt W is me. He apparently fell for my sheep’s clothing. My follow up comment, a more direct criticism, went through without hanging up in moderation but was later removed.

Typical. When losing an argument, silence your opponents.

@ PGP:

Ha! I saw that!

Nearly as hilarious and OT as well:

Mikey ( Natural News) is begging his followers to support NN by buying stuff at his store’s big sale on Friday:

there are less advertising dollars in publishing and there is also ” punitive demonetization” by You Tube and G–gle

NN has no fundraisers to fund its IMPORTANT work:
like its lab, its documentaries, its development of new products and its news operation.

So don’t spend money at amazon FUND Mikey! He’s INDEPENDENT! He has the TRUTH!

Your supposed to get not one but two vaccine treatments?????? Got the one Zoster Vax. Not sure which vaccine?
I was diagonosed with Shingles around the age of 14 or 15. I got the Zoster Vax vaccine at age 57.
This year (age 59) I came down with the shingles virus. Very disappointed it did not work for me, nasty virus that lasted about 8 weeks. Worried that it might leave lasting nerve pain (neuropathy?), it thankfully did not.
1. Every time I tell people I got the vaccine and still got Shingles they all turn their head sideways. Sorry Orac, my personal experience requires explanation well beyond my technical abilities. I then have to say that it likely reduced severity and assisted my immune reaction etc.
2. Previously having Shingles must create a unique situation???
3. Every time I hear of a case like mine it (3 other individuals) usually is in conjunction with a highly stressful time in ones life, Around the age of 55 and up with a death in family etc.
I have to laugh, all medical sources CDC, Mayo Clinic say to try and reduce stress in your life.
Great! Thanks for the advice.

When will we know if Shingrix will be covered by our health insurance? I’m going to shove little old ladies out of line to get that shot!

My husband had a bout of shingles in his 40’s and has corneal scarring thanks to it. Plus he was in excruciating pain for days. I had to keep the room pitch black or he would be sobbing with pain. It was horrible to witness, there was very little I could do to help him and I have no interest in experiencing it for myself.

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