We are all Batman, kind of

This is the tenth post not having anything to do with vaccines.

Thank. The. Lord.

I wanted to talk to you about something that has been on my radar the last few weeks as school has resumed and some of my students have been asking me for my background. They seem to want to know who this guy standing in front of them talking about epidemiology is and why they should listen to him. I wanted to point out my degrees, but that would have been too easy. After all, they have the syllabus. They know what my degrees are. Instead, I talked to them about my work.

I’m not going to bore you with all the stuff that I do, however. I’m just going to tell you that the main part of my work consists in trying to change the world. Much like Batman, I sometimes feel like I am fighting some pretty big and evil forces out there. And I feel alone, although I have a great team of friends who are always ready to come to the rescue.

One truth that you need to keep in mind is that this persona of Reuben Gaines is a lot like Batman. That is, I’m not just one person. You’ve read on this blog before about how I considered myself to be an idea (and how ideas don’t die). You’ve also read how I strive to be more than just a man. After all, my enemies (or people who don’t like me) will always find something in the human part of me to attack. If they look hard enough, I’m sure they could find something that is unpalatable to someone somewhere.

Much like the Batmen in the movies, there are different people who have donned the cowl and cape of Reuben Gaines and taken on the anti-science and anti-vaccine nuts out there. You may have noticed it if you’ve been reading this blog from the beginning. One or two, or more, blog posts don’t have the same structure as the others. In those cases, other people who are great people and know a lot more about other stuff than I do have taken it upon themselves to write. This is one of the main reasons why complaints from The Weirdo John Stone and others about me don’t really scare me.

He’s complaining about a group of us… A group who wants to change the world.

I’m kind of glad that I’m not alone in wanting to and working toward changing the world because one person should not be alone in doing so and should not even succeed in doing so. I’m flawed. I might impose a dictatorship if I do end up gaining all the power. (Not likely.) I think this video puts it best:

So I want to thank you, dear reader or two, because you are also kind of like Batman. You want to change the world as well, and that’s why the things that I (or we) write interest you. That’s why you keep coming back, why you share links from this blog, and why you also do some pretty amazing things out there in the big, bad world.

Now that the ten non-vaccine posts are up, now that the trolls are a little underfed, let us dive into the craziness of the anti-vaccine and anti-science idiots who would be the end of us all if we left them in charge of the Ebola response…

A crash course on Ebola you should be reading right now

This is the ninth blog post that has nothing to do with vaccines. I’m glad because I’m getting a rash from not writing about them.

With all the craziness going on about Ebola, a friend decided to give us his epidemiological perspective on Ebola. Here is the first lesson, and here is the second one. You should go read them.

Seriously, go. I won’t feel bad if you do.

Someone wasted their time in biostats class

There have been many times when I’m standing before master of public health (MPH) students, giving them a presentation on epidemiology, and I wonder how any of them can even put on their shoes in the morning. Don’t get me wrong; they’re bright students. Many of them have graduated from college with impressive grades and great projects. They wouldn’t be in these top-notch universities if they were not bright. (Or if their benefactors didn’t see brightness in them.) Still, I’m not surprised when I see many of those kids getting an MPH in epidemiology and not become epidemiologist.

Being an epidemiologist is tough. It requires you to be able to think critically and analyze a problem from different sides and different points of view. Most public health problems requiring epidemiological analysis are big, huge puzzles with many working parts. Just being book smart is not enough. Being street smart is not enough. Being charismatic is not enough. Having an MPH in epidemiology or otherwise is not enough.

Like many people, I have issues completely comprehending biostatistical analyses. Biostats is tough. Few people get through it and continue to take classes in it. In fact, I look at the biostats crew at my job and shake my head in amazement. They can slice and dice data in ways I can’t even dream of. So I go to them with questions about biostats. It was one of them, a PhD-level young lady, who explained to me why the paper by Dr. BS Hooker was full of, well, BS.

I have never claimed to be all-knowledgeable on things like epidemiology and biostats. I just know what I know, and I know when to ask for help. I don’t like to pound my chest and say that I’m the best epidemiologist out there. I’m not.

So who wasted their time in a biostats class? Who else, the kid. What leads me to that opinion? First, some background.

In epidemiological studies, there is a hierarchy of what studies contribute the most evidence. At the very bottom is professional opinion. Surely, you would not guide public health policy based on what I or any other person would write on their blog or in an op-ed, or in a letter to the editor. Right above professional opinion are cross-sectional studies. Cross-sectional studies are basically surveys. You survey the population to get an idea as to what is going on before you move on to bigger, better-designed studies, like case-control and cohort studies. After case-control and cohort studies come randomized trials, where issues of confounding and bias are better addressed, and the results have a lot more weight on how to go about solving a public health problem. At the very top of the hierarchy are meta analyses and systematic reviews, where you take all the data from different studies and weigh all the evidence to separate the wheat from the chaff.

Did you notice how I bolded where cross-sectional studies lie on the hierarchy? Why would I do that? Again, some more background.

The paper by BS Hooker took the data from the DeStefano study and treated those data as a cohort study. That right there was one of many flaws in the BS Hooker paper. You don’t take case-control data (which was how the DeStefano study was conducted) and treat it as cohort data. You just don’t.

When the kid tried to defend the findings of the BS Hooker paper as if his life depended on it, using only a screenshot from a video published by Andrew Jeremy Wakefield (and nothing more), someone pointed out to him (again) the flaws in the BS Hooker approach:

“Hooker didn’t crunch the data as a case-control; he crunched it as a cohort study and without knowing temporality of MMR vaccination with ASD diagnosis, it’s dead in the water.”

The kid took exception to this and made what I believe to be the epidemiological and biostatistical mistake of the year:

“No, he crunched it as cross-sectional.”

I spat my coffee all over my desk when I read this. Not only did BS Hooker torture data, his protege is now saying that BS Hooker downgraded the way he treated the data. Remember where cross-sectional studies rank in the hierarchy? I mean, holy sh!t. I knew the kid wasn’t that good at epidemiology, but this confirms how bad he is with biostats.

The same commenter tried to correct the kid (again):

“Anyone looking at how he modelled the data can see that it was a cohort design and if that wasn’t enough, Hooker explicitely states that, “In this paper, we present the results of a cohort study using the same data from the Destefano et al. [14] analysis.” Taking a tumble down the hierarchy of study-design strength, particularly when the dataset available to him was sufficient to conduct a case-control is a bizarre strategy to salvage Hooker’s miscalculated results.”

But the kid can’t be wrong, not even in this case:

“He should have said cross-sectional in that sentence, but it doesn’t change the validity of his results. Relative risk would be more meaningful to the average person than odds ratios and this is an issue which effects (sic) everybody, so I would imagine that is why Brian Hooker conducted it that way.”

HOLY SH!T. He thinks that cross-sectional analyses are better than cohort, and better than case-control as well!!! Even worse, he thinks people are effected, not affected. So call the grammar police!

Of course, to the uninitiated, this doesn’t matter. To the true believer antivaxxer, the kid is an authority on epidemiology and biostatistics. God help anyone who places their faith on him for analysis of scientific evidence. But thank God that, although my comments are not being allowed through by the kid, he allows comments from other people who can see through his, well, BS.

If you have some minutes to waste, and you want to have a good laugh, go read the comments section of the kid’s blog post. It’s comedy gold. If you know epidemiology and biostatistics, you’ll have a good laugh at the errors in logic and reasoning that are pervasive throughout his commentary and his readers’ comments.

This was the eighth post that has nothing to do with vaccines, for the most part.

Age of Autism makes fun of Autism, draws in the AIDS denialists

This is the seventh post that has nothing to do with vaccines, for the most part.

Age of Autism, the web “newspaper” of the “autism epidemic” had a blog post that was supposed to be poking fun at the CDC response to autism, but it fell flat:

“Dr. Tom Insel, who is the nation’s leading expert in funneling funds away from research that seeks to pinpoint causation or could lead to cure, has been pulled from his post as head of the Interagency Autism Coordinating Committee to head up the HeEbeeGeeBee program.

An unidentified HeeEbeeGeeBee researcher said, “We anticipate results from HeEbeeGeeBee in approximately 50 – 75 years, really, a blink of an eye in genetics.  We’ve begun studying cockroach leg movement in detail and should progress to small worms within just seventeen years.”

He added, “If you think you have been exposed to Ebola, we assure you that you are wrong.  You have not. However, you are welcome to ask for a quarantine of up to 18 years from your local school district.””

In the minds of these people, Ebola is like autism, or autism is like Ebola. When will they stop comparing autistics with sick people, dead people, or worthless people, or kidnapped people?

Not to be outdone, the comments section has become a cesspool of AIDS-denialists claiming that the PCR test being used to diagnose Ebola cases is not reliable:

“As we know from our autism carnage (and all the other consequences of vaccines), the Media and CDC, et al. are not at all interested in objectively figuring out cause & effect along with their cock-ca-manie PR releases that some “previously healthy” people have come down with such as Ebola (or AIDS).”

AND

“My red flag IMMEDIATELY went up when I read with horror that they are using the PCR test to ‘diagnose’ Ebola cases. I learned via research into the HIV/AIDS issue the pitfalls with various diagnostic tools that were touted at the time to be the BEST diagnostics available during the HIV/AIDS crisis several years back.”

AND

“So the question is: can the PCR test allow researchers and doctors to say how much virus is in a patient’s body?

Many years ago, journalist John Lauritsen approached a man named Kary Mullis for an answer.

Source-1: For a brief excerpt from John Lauritsen’s article about Kary Mullis, see Frontiers in Public Health, 23 September, 2014, “Questioning the HIV-AIDS hypothesis: 30 years of dissent,” by Patricia Goodson. (See also this.)

Source-2: For John’s 1996 article in full, see “Has Provincetown Become Protease Town?”

“Kary Mullis… is thoroughly convinced that HIV is not the cause of AIDS…”

AND

“Already killed thousands Larry? And we should believe this because …. the main stream media is telling is us that it’s so???

There are only two places where the Ebola outbreak exists Larry:

1. In the mainstream media
2. In the heads of sorry asses like you, who are stupid enough to believe them”

Guess what? PCR works. Just because they don’t understand, or want to understand, the science doesn’t mean the science doesn’t work. You don’t screen with PCR for a virus on a healthy individual. Like all lab tests, you assess their risk of being infected and their symptoms. PCR is not used for general screening. It’s a diagnostic lab test.

But the best comment so far, which I’m sure is going to get deleted is this:

“So you reject Sin Hang Lee’s Gardasil claims, the finding of PCV in rotavirus vaccines, Wakefield’s finding of measles virus in cerebrospinal fluid, and any number of autism-related gut-brain papers?”

Science denialism cuts both ways, jerks.

Why is HIV/AIDS so deadly?

FYI… This is the fifth of ten posts that have nothing to do with vaccines.

Once in a while, a new loon is pointed out to me, and I read their insanity. This is the story of such an occasion:

Why is HIV/AIDS so deadly? According to the World Health Organization, AIDS kills about 1.6 million people per year. We know what causes AIDS. We know that HIV infection can be prevented through safe sex, no sex, proper screening of the blood supply, administering drugs to HIV-positive people to lower their virus counts. We have very good screening tests to administer to people and make sure they get the care that they need. And we can explain all this to millions at a time through the use of all sorts of media.

So what gives?

The answer can be a little complicated. There are some political interests involved that misuse (or don’t use) the resources given to them to combat HIV/AIDS. There are also people in very high positions of authority who believe that the disease is a proper and just punishment for all sorts of “immoral” ways of being, e.g. homosexuality.

But there is also a group of people who believe that HIV doesn’t cause AIDS, though they should know better. One of these people is Kelly Brogan, MD. According to her website, she received her medical degree from Cornell University and two science degrees from MIT. She did her residence in psychiatry and is board certified in it. With all that education, all those hours, days, weeks, and months invested in learning how to heal people, Dr. Kelly Brogan has some interesting thoughts on HIV and AIDS.

For example, women with HIV should not take drugs to reduce the chances of passing the virus on to their babies. Why? Because:

“This was the case with a now infamous, but little-publicized perinatal trial of the drug nevirapine for the prevention of transmission of HIV from mother to baby. An NIH-funded trial staged in Uganda, HIVNET 012, was hailed as demonstrating a 50% decrease in transmission, and set the stage for world-wide drug dissemination and coercion of women like Joyce Ann Hafford, to their death.”

UPDATE (9/25/14): It looks like Dr. Kelly Brogan has taken down her article. But here is Google cache to the rescue: http://webcache.googleusercontent.com/search?q=cache:http://kellybroganmd.com/snippet/hiv-pregnancy-pharma-abusing-women/

Dr. Kelly Brogan quotes a Harper’s Magazine author who seems to claim that there was no control (or placebo) group in that study. But there was a control group…

The HIVNET 012 trial was conducted in 1998 in Thailand, with some startling results:

“In February 1998, a randomized, double-blind, placebo-controlled trial sponsored by the U.S. Centers for Disease Control and Prevention in Thailand of 393 mother/infant pairs showed that a short course of oral ZDV could reduce HIV-1 transmission by about 50% over a placebo—to an overall rate of 10%—in a non-breastfeeding population (CDC, UNAIDS, NIH, and NRS, 1998; Shaffer et al., 1999). 1 As a result, HIVNET 012 researchers formally dropped the placebo arms in a letter of amendment (known as Amendment I) to the protocol, and stopped enrollment on February 18, 1998.”

The study didn’t stop there, though:

“HIVNET 012 was redesigned and reopened on April 6, 1998—with approval of the Ugandan and U.S. institutional review boards—as a randomized, open-label, Phase IIB clinical trial.2 In this newly approved protocol, the target enrollment was 400 to 600 mother/infant pairs randomized in a 1:1 ratio. Women in the NVP arm of the trial would receive a single, oral 200-milligram dose of NVP at the onset of labor. Their infants would receive a single, oral 2-milligram-per-kilogram-of-body-weight dose of NVP suspension within 72 hours of birth. Women in the ZDV arm would receive 600 milligrams of oral ZDV at the onset of labor, followed by 300-milligram doses every 3 hours during labor. Their infants would receive oral 4-milligram-per-kilogram-of-body-weight doses of ZDV twice daily for the first 7 days of life. Boehringer Ingelheim Pharmaceuticals and GlaxoWellcome, respectively, donated the study drugs.

The HIVNET 012 protocol specified follow-up of mothers for adverse events for 6 weeks after delivery. Infants were followed for adverse events until 6 weeks of age, and for serious adverse events until 18 months of age. Researchers graded such events based on toxicity tables from the National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS (DAIDS) for neonates, children, and adults, ranging from grade 1 (mild) to grade 4 (life-threatening). The 1997 Study Specific Procedures manual included the DAIDS toxicity tables, as well as a special grading system for adverse experiences related to skin rashes and dermatitis and hemoglobin in mothers (Jackson et al., 1997). As the medications were given for a week or less, the study did not modify drug doses for toxicity.”

It wasn’t all without some issues, though, and the trial was adjusted again:

“Researchers amended the study protocol in February 2000 (Amendment II) in response to findings in other studies that some women could develop viral resistance to NVP, and that some children treated with various antiretroviral drugs in utero or perinatally could possibly experience mitochondrial toxicity. The modification entailed extending follow-up of women in the NVP arm and all children in the 18-month study to 5 years, with yearly evaluations for NVP resistance in women who had received NVP (HIVNET 012 Investigators, 2000).”

And what were the final results?

“The 1999 Lancet paper also analyzed adverse events and toxic effects based on the first 556 mother/infant pairs assigned to treatment with ZDV (279 pairs) and NVP (277 pairs). The authors reported that “the rates of maternal serious adverse events were similar in the two groups (4.4% in the ZDV group and 4.7% in the NVP group),” and that “the occurrence of clinical or laboratory abnormalities in mothers was similar in the two groups.” The authors also reported that for infants, “the rate of occurrence of serious adverse events in the two groups was similar up to the 18-month visit (19.8% in the ZDV group and 20.5% in the NVP group).” The “frequency and severity of laboratory-detected toxic effects … were similar in the two groups.”

The second Lancet paper (Jackson et al., 2003), reported that infants assigned to the NVP arm continued to have a significantly lower rate of HIV-1 infection and a significantly greater likelihood of HIV-1-free survival through 18 months of age (Table 2.2). Specifically, the efficacy of NVP compared with ZDV was 41%.”

The Institute of Medicine, and others, back the study’s findings. That Harper’s Magazine article? It was widely chided for its inaccuracies regarding the relationship between HIV and AIDS.

So why does Dr. Kelly Brogan see this study as a bad thing? And who is Joyce Ann Hafford?

Joyce Ann Hafford was a 33 year-old woman who died from liver failure from the medications she was being given as she participated in a drug research study. She was HIV-positive, and she enrolled in the research study in an attempt to keep her unborn child from being born with HIV. The whole thing was an enormous mess. Ms. Hafford started showing signs of toxicity from one of the drugs, but her healthcare providers apparently put the blame on her condition and not on the drugs. The National Institutes of Health eventually confirmed that it was most likely the drug.

These things happen. I won’t deny that medications, even the life-saving ones, all have risks. At a population level, antiretrovirals are saving lives, but everyone needs to be monitored for side-effects. At the individual level, there are those who need to be treated for side-effects. Not treating HIV will inevitably lead to AIDS in 99.999999999% of people who are infected. Treating it will cause side-effects in a very, very small percentage of people being treated. It’s about weighing the risks.

Perhaps because Dr. Kelly Brogan is not an epidemiologist and most of her training appears to be in psychiatry, Dr. Kelly Brogan seems to believe that all antiretroviral drugs are the ultimate evil, which fits well with her statements about medical science:

“This medical-scientific-industrial marriage has brought us many a meme that we hold on to societally, as truths:

That depression is a chemical imbalance

That cholesterol causes heart disease

That exposure to bugs equals deadly infection, and vaccines protection

Cancer is a genetic time bomb

That HIV causes AIDS, the equivalent of certain death”

She links her last statement, the one about HIV and AIDS, to a known AIDS denialism group. I’m not even going to touch her statements and blog posts on vaccines. (She thinks that herd immunity is fiction, apparently. Something that made my head explode.)

And there you have it. People continue to die from HIV/AIDS in part because people who should know better continue to perpetuate the idea that HIV doesn’t cause AIDS, with variations to that theory. Some say that HIV is just a “passenger virus” and that it is an incidental finding with AIDS really being caused by the drugs used to treat HIV infection. Others say that HIV is a manufactured virus, aimed at homosexuals or at Africans, but still not a full-fledged cause for AIDS. And so on and so forth.

Without telling us her complete stance on the matter, Dr. Kelly Brogan certainly can seed some doubts in those who may not be initiated. But we are initiated, aren’t we, folks?

When anger is disguised as activism

FYI: This is the fourth blog post that is not related to vaccines… Or is it?

It’s a tricky balance to listen to testimonies and be skeptical about them. On the one hand, you want to believe everything you’re hearing. You want to give the person the benefit of the doubt and take them at their word. On the other hand, if you are a reasonable person in a position of authority and you need to recommend or take action based on the information you’re being given, then you have do use your best judgment and separate the wheat from the chaff.

The Interagency Autism Coordinating Committee recently held a meeting and public speakers were invited. The oral public comments are really something interesting to read. Yet something we need to keep in mind is that these are not the comments of unbiased people. Rather, they are the public comments of people who feel that they have been wronged or that they are currently being wronged by life, the government, members of the committee, etc. Keep that in mind should you want to read them.

My issue with this type of activism is that it is very negative, very angry. Consider this statement:

“Now the numbers continue to rise with little being done to find the cause or cure. My children acquired autism via toxins. We know based on medical tests the toxins were vaccines. Something needs to be done to prevent other children from such injuries. My children have no future. They are extremely affected. It was brought to my attention that some of the studies that this committee uses to base certain opinions were falsified and corruption was taking place. People need to be held accountable because children continue to be harmed.”

Indeed, children continue to be harmed because autistic children continue to be described as having “no future”.

But, if there is no passion, can there be activism and advocacy? Absolutely. Also, anger does not equal passion. Passion is motivation and desire to get something done, to pursue a goal. Anger? Anger just clouds judgment and gets nothing done. Anger only gets you in trouble and makes you sound like a loon (with all due respect).

So how do we take the testimony of an angry mom who sees no future in their living, breathing child who, by her testimony, plays hockey and travels? We take it with an enormous grain of salt.