Spitting on the graves of children lost to influenza

A friend of mine who has worked in influenza surveillance for years send to me this blog post from the Huffington Post. It’s written by Lawrence Solomon, who, by all accounts, has zero experience in infectious diseases or epidemiology. Still, that doesn’t stop him from attempting to write about influenza deaths in an authoritative way, quoting, what else,  anti-vaccine and anti-science material. In fact, I need not go farther than his first sentence to know what he’s all about in this post:

“Flu results in “about 250,000 to 500,000 yearly deaths” worldwide, Wikipedia tells us. “The typical estimate is 36,000 [deaths] a year in the United States,” reports NBC, citing the Centers for Disease Control. “Somewhere between 4,000 and 8,000 Canadians a year die of influenza and its related complications, according to the Public Health Agency of Canada,” the Globe and Mail says, adding that “Those numbers are controversial because they are estimates.””

Why are these number estimates? It’s simple. We can’t possibly count each and every single case of influenza, or influenza-related deaths, in the world. What we can do is use the tools of science and mathematics to come up with a best estimate. If you read further in Lawrence Solomon’s piece in the Huffington Post, you’d think that we epidemiologists come up with these numbers at random, or, if we do use science and math, that we adjust those numbers to some sort of agenda. To make his point, Lawrence Solomon goes to the latest go-to guy in Peter Doshi, PhD (who is not an epidemiologist of any sort but still wants to be some sort of authority on influenza and influenza vaccine science):

“Peer reviewed publications accept Dr. Doshi’s vaccine research, even if he doesn’t meet your standards. But are you saying that you would accept the views of epidemiologists who turned thumbs down on vaccines? It would be my pleasure to present some to you, if that is your test.”

Yes, they accepted Peter Doshi’s “research” — which was all about looking at published studies, misinterpreting/misunderstanding data from surveillance sources, and coming up with his own conclusions on the matter. It doesn’t mean that he was correct. In fact, it has been explained to Peter Doshi, PhD, by people far more knowledgeable than me, that his statements about influenza vaccine and influenza disease and its consequences were inaccurate.

And, yes, I would like to see epidemiologists (bona fide ones, with jobs in public health or teaching public health) who dislike vaccines. Because the only epidemiologists I know that dislike all vaccines for all sorts of weird reasons are anti-vaccine weirdos that decided an MPH degree from an accredited institution somehow made them epidemiologists. It didn’t. Any epidemiologist worth their weight in salt knows that vaccines reduce the incidence and mortality from vaccine-preventable diseases, period.

So what else does Lawrence Solomon write on his Huffington Post piece about influenza deaths?

“”Controversial” is an understatement, and not just in Canada, and not just because the numbers are estimates. The numbers differ wildly from the sober tallies recorded on death certificates — by law every certificate must show a cause — and reported by the official agencies that collect and keep vital statistics.”

The numbers are different because we epidemiologists have a straight set of standards on what makes a case of influenza death and what doesn’t. Don’t believe me, however? I’m just a pseudonymous blogger (though the people who know me personally know my experience in epidemiology). Instead, believe the word of a public blogger who has been an epidemiologist for going on 7 years (a bona fide one, with a job in public health and now working on his Doctor of Public Health degree at Johns Hopkins). I asked him to explain this for my lay audience:

“I’ve investigated a lot of deaths due to influenza, but mostly in children because that’s what is required to be reported in Maryland. Our case definition states that the child had to die as a result of influenza, not just die while sick. There were a number of children who were sick, taken to the doctor, examined, tested, and then sent home. Once at home, because the parents didn’t want the child to be alone in a crib, the child would be unfortunately smothered to death when sleeping with a parent or an older sibling. Those were not influenza deaths, though influenza was written on the death certificate. With respect to adults, the same thing qualifies. A person my have had the flu and died of a heart attack. While these two events are associated, we cannot definitively say that influenza caused the heart attack. It gets written in the death certificate, but it doesn’t meet our case definition. In essence, our case definition is extremely conservative, so the true number is above what gets reported.”

Spot on. Numbers collected through passive surveillance are an underestimate of what is collected from active surveillance. And numbers collected through active surveillance are an underestimate of what is true in the world. I’d be hard pressed to think of a surveillance system that overestimates numbers from reality. Even when you look at lab tests, these are mathematically underestimates from the truth because the tests are not 100% sensitive and not 100% specific. There is differential misrepresentation of the truth, and that, mathematically, causes underestimates of the true positive proportion of cases. (Now you see why I know for a fact that neither Lawrence Solomon nor Peter Doshi, nor most anti-vaccine activists, ever studied biostats or epidemiology.)

In his Huffington Post piece, Lawrence Solomon continues:

“Only about 15-20 per cent of people who come down with flu-like symptoms have the influenza virus — the other 80-85 per cent actually caught rhinovirus or other germs that are indistinguishable from the true flu without laboratory tests, which are rarely done. In 2001, a year in which death certificates listed 257 Americans as having died of flu, only 18 were positively identified as true flus. The other 239 were simply assumed to be flus and most likely had few true flus among them.”

This is a typical trick played when you want some facts to agree with you, not the current facts. The current facts is that pediatric deaths due to influenza were made reportable in the country back in 2007. Before then, like in 2001, all we had to go on was whatever someone wanted to report to us. They were not required to do so, but they did. Again, underestimates. Furthermore, look at what he says about flu tests. Rhinovirus, aka “The Common Cold”, does not give you a “flu-like illness.” A flu-like illness (ILI) is defined as a fever of greater than 101 PLUS a cough OR a fever grater than 101 PLUS a sore throat. What common cold does that sound like? (He’s obviously parroting what Peter Doshi has written.)

Solomon continues:

“Because death certificates belie claims of numerous flu deaths, CDC enlisted computer models to arrive at its 36,000 flu-death estimate. But even here it needed to bend conventional medical terminology to arrive at compelling death numbers.”

Again with the looking at the past to explain the present. The fact is that CDC has modified its estimate based on better knowledge of what goes on and on a lot of active surveillance where we epidemiologists went to the hospitals to look at the medical charts of people who died from influenza. We did not count deaths due to aspiration pneumonia, as Doshi would like to believe. And we certainly did not count deaths where there was no lab evidence of influenza infection, thus coming up with an underestimate in those cases who had the flu but tested negative (which far outweigh those who don’t have the flu and test positive in the winter). The estimate is now between 3,000 and 49,000, depending on how bad the season is. This is more realistic and different than the old estimate given by Solomon as evidence of something.

Finally, Solomon wrote in his Huffington Post blog:

“The CDC unabashedly decided to create a mass market for the flu vaccine by enlisting the media into panicking the public. An obedient and unquestioning media obliged by hyping the numbers, and 10 years later it is obliging still.”

There you have it. The real reason why we worked late into the night so many winters reading medical charts and calling the homes of parents who lost their children to influenza: GREED. It couldn’t have been that we were genuinely interested in keeping people safe from the complications of influenza the next time around. No, no, no, no! It’s just that we in the world of public health and epidemiology wanted to sell more vaccine by “panicking the public”.

I shouldn’t be surprised that Lawrence Solomon decided to go with the flawed research of someone who may very well be an HIV/AIDS denialist. This is not Lawrence Solomon’s first attempt at misinforming the public on the science behind public health recommendations for vaccines. Previously, he wrote this post in which he basically serves as an apologist for all the bullshit that anti-vaccine activists have pulled over the years. In that post, Lawrence Solomon wrote:

“How hard, for example, should it have been for the press to notice the views of Dr. Bernadine Healy, the former head of the National Institute of Health, the former head of the American Red Cross, and the former Chair of the White House Cabinet Group on Biotechnology, one of several White House positions she held in service to three U.S. presidents.

Dr. Healy criticized the public health establishment for being “too quick to dismiss [vaccine concerns] as irrational…The more you delve into it, if you look at the basic science, if you look at the research that’s been done in animals, if you also look at some of these individual cases, and if you look at the evidence… what you come away with is that the question [of vaccine safety] has not been answered.”

Dr. Healy’s views would have been particularly easy to find because they were actually aired by one of America’s leading journalists, Sharyl Attkisson of CBS News, in one of the rare instances in which the mainstream press fairly presented a skeptic’s perspective on the vaccine issue.

Journalists should also have had no trouble finding Dr. Diane Harper, a lead developer of the controversial Gardasil vaccine and another interviewee of Attkisson’s. Dr. Harper believes this vaccine, which is being recommended for teens and pre-teens to combat cervical cancer, is less effective than the common Pap smear, and that it may harm more children than it helps. “Parents and women must know that deaths occurred,” she stated in arguing that parents need to know that they could be subjecting their children to needless risks.”

Two things that Lawrence Solomon failed to mention are that Dr. Healey had been flirting with the anti-vaccine crowd for a while, and she may very well had swallowed their lies. The other thing is that Dr. Harper was not a “lead developer” for Gardasil. She was just a researcher who did research on it. What did the research show? It showed that Gardasil works, and it works safely. That these findings didn’t fit Dr. Harper’s world view doesn’t make them less invalid.

But that’s the thing about every piece of “evidence” that the anti-vaccine crowd wants to throw at the public, it’s not evidence. It’s all sentiment and feelings. Even Andrew Jeremy Wakefield said that he felt the MMR vaccine caused autism, though his own 1998 fraud of a paper stated that there was no link. There is no good science, no actual studies, nothing. It’s all an empty and sad-filled world of conspiracies and false associations. Sadly, some of them manage to get a blog on the Huffington Post and gain a wide audience, misinforming as many people along the way as possible.

Writing openly — or saying openly — that influenza isn’t that bad, that we exaggerate influenza deaths because we’re greedy, and that the influenza vaccine (though not as good as it should be but the best we have right now) is all sorts of evil is pretty much like spitting on the graves of children lost to influenza. Their deaths were very real to their loved ones and even to those of us who didn’t know them but put our entire hearts into learning as much from their deaths so we could prevent others. Anti-vaccine weirdos may call me “despicable” and “dishonourable” because I point out their lies and do so with glee, but nothing that I will ever do will compare to what they’ve done.