Tdap vaccine is not linked to autism, just like any other vaccine (including the flu vaccine)

I remember when my dad told me that there was no such thing as Santa Claus. He sat me down and told me that it had been him all these years who had been buying me gifts and placing them under the tree. It was quite a shock to have this revealed to me; it shook my world. I did everything in my power to reason it through. In my head, dad was a liar. Dad wanted to take the credit for the big jolly guy who’d given me all the gifts I’d ask for in the letters I sent him through my dad.

I was 27 years old.

Soon enough, I came to accept the truth. All the evidence was there in the form of my dad’s receipts for the gifts he had gotten me. People had seen him buy me those gifts. Mom swore to having helped him wrap them. The evidence was compelling, substantial, tangible, credible… Santa Claus was no more.

I’m sad to say that this is not the case with the anti-vaccine crowd. You can tell them all you want that vaccines do not cause autism, and that vaccines actually protect from diseases that are deadly and/or disabling. But they will refuse to believe it because their entire ecosystem depends on the belief that vaccines cause autism. Anything short of that sucks away their life, their reason for living.

One such anti-vaccine zealot is everyone’s favorite “kid.” Even with a master of public health degree in epidemiology, he seems to remain convinced that vaccines cause autism. He’s stated on his blog that evidence he saw in school to the contrary is all a conspiracy from the pharmaceutical industry. It seems that, to him, the lies he has been exposed to over and over from a very young age have made up his mind. To him, Santa Claus (i.e. vaccines cause autism) still exists, and it will continue to exist because anything short of that eliminates his reason for living.

Seriously, he doesn’t seem to live for anything other than that. The primary example is a recent blog post of his where he takes a study that clearly shows that the Tdap (Tetanus, Diphtheria, and acellular Pertussis) vaccine doesn’t cause autism, and then he states that the study confirms that the influenza vaccine does cause autism.

Yeah, I was confused too.

His whole argument hinges on one table in the Prenatal Tetanus, Diphtheria, Acellular Pertussis Vaccination and Autism Spectrum Disorder by Becerra-Culqui et al.

This is table 3:

Screenshot 2018-08-14 10.18.59

Table 3 states that women who were vaccinated with Tdap during pregnancy had a similar incidence rate per 100,000 person-years of having an autistic child. Vaccinated women had an incidence rate of 3.78 autistic children per 100,000 person-years while un-vaccinated women had an incidence rate of 4.05. The ratio between the two was 0.98, meaning that vaccinated women had a lower incidence rate than vaccinated. Anything over 1.0 would indicate that vaccination leads to more autistic children being born.

Because this is one study with a limited number of people, and not a study looking at the entire universe of children born, scientists also report the 95% confidence interval (0.98 – 1.09). The 95% confidence interval is a way of us saying, “We are 95% confident that the true hazard ratio in the entire population (the whole of the population) is between 0.88 and 1.09.” Because it includes 1.0, we cannot say that this observation is not by random chance.

But look at how the kid displays the table on his blog:

Screenshot 2018-08-14 10.18.22

Only point out the things that seem to support your argument.

He points out that the adjusted hazard ratio of 0.85 (with a 95% confidence interval of 0.77 to 0.95) is adjusted for, among other things, influenza vaccination during pregnancy. In epidemiology and biostatistics, “adjusted for” means taking it into consideration. Let me give you an example:

Suppose that there are a group of people from Texas and a group of people from Alabama, and that we look at their test scores in biology. The group from Texas had an average test score of 77% while the people from Alabama had an average test score of 89%. You would conclude that being from Alabama leads you to having a better test score, right?

But what if we told you that they don’t teach biology in all schools in Texas? What if we told you that they only teach it in private schools in Texas, and that only 30% of schools in Texas are private schools? And then we told you that they teach biology in both types of schools in Alabama, and that there is a 50-50 split in the proportion of private to public schools in Alabama? How does this change your conclusion?

To reach the proper conclusion, you have to compare apples to apples, and oranges to oranges. You would compare the private school scores in each state to each other, and likewise with the public school scores. This is an adjustment. This is taking into account the differences in the distributions of a characteristic between the two groups being studied.

As it turns out, in the study in question, women who get their Tdap were much more likely to get their influenza vaccine. It makes sense, right? Women who vaccinate in general are more likely to vaccinate in particular. So, in order to compare apples to apples, the researchers adjusted for influenza vaccination. That is, they compared flu-vaccinated women who got the Tdap and flu-vaccinated women who did not get the Tdap, AND non-flu-vaccinated women who got the Tdap and non-flu-vaccinated women who did not get the Tdap.

Taking flu vaccination into account, and the bias that would creep in because women who vaccinate against influenza seem to be more likely to vaccinated with the Tdap vaccine, vaccinating with Tdap is not associated with having a child diagnosed with autism.

So why does the kid think this proves that influenza vaccine causes autism?

It beats me. All they did was make the adjustment to make things equal between the two groups, something every epidemiologist worth their salt should do… Unless you want to misinform the public?

Hmmmm?

He then takes a table from a different, unrelated study and points out to just one result on it as evidence that influenza vaccine causes autism:

Screenshot 2018-08-14 10.35.03

The red circle seems to be his way of saying, “Only this matters! Pay no attention to the whole of the evidence!”

This is another misrepresentation of the findings, and I kind of blame the authors of the study for making the table so busy. Look at the “Variable” column on the left. All that the data circled in red are saying is this:

“Of the 13,477 children whose mothers were vaccinated in the first trimester, 258 (1.91%) of them were diagnosed with autism. Their hazard was 26% higher for an autism diagnosis when compared to children whose moms were vaccinated in other trimesters. However, when adjusting for maternal allergy, asthma, autoimmune conditions, gestational diabetes, hypertension, age, education, race/ethnicity, child conception year, conception season, sex, and gestational age, the hazard of autism diagnosis went down to 20% over children whose moms were vaccinated in other trimesters.”

The fact that the hazard ratio went down after adjusting tells us that there is something else explaining the elevated hazard (risk). Look at what happened in the adjustment in the other trimester groups… Nothing changed. Look at what happened in the adjustment in the “Anytime During Pregnancy” group… Nothing changed. So what could that “something else” be? I’m not an obstetrician, but it’s reasonable to conclude that outcomes measured in the first trimester are different than outcomes measured in the other trimesters.

Finally, look at the reasoning that the kid used. In the first table, because numbers were adjusted for influenza vaccination, then it must mean that influenza vaccination causes autism. In the second, he doesn’t say that all the factors adjusted for cause autism… Because that would tear down his narrative.

I’m not surprised at all by his misunderstanding of all this. After all, to my knowledge, he doesn’t work as an epidemiologist anywhere. Like any good muscle, lack of practice of your epidemiology skills leads you to lose them. Being unpublished, not working as an epidemiologist, and a staunch defender of the so-called autism-vaccine risk leads the reasoning muscle to atrophy.

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Peter Doshi is at it again with the anti-vaccine stuff

Let me start with the conclusion, because Peter Doshi’s article can be a little dry if you let it. I don’t want you to miss the point…

In the end, yes, CDC and vaccine manufacturers are out there paying for pushers of vaccines to push vaccines on the population. But we’re talking about vaccines and not heroin. Independent agencies (like local and state health departments, academic institutions, and competing pharmaceutical companies) all continue to validate the need for vaccination as a life-saving public health intervention. That is the difference between this kind of “pushing” of a “pharmaceutical” and pushing something that truly harms. We don’t need Peter Doshi or Sharyl Attkisson or Age of Autism to be the watchdogs because their anti-vaccine intentions are, in our opinion, very clear. For truly making sure that vaccines do far more good than any harm, we have the dedicated healthcare providers, epidemiologists, biostatisticians, and other public health workers who look at the evidence (observational and experimental) and continue to promote vaccination against all the hate and vitriol of the anti-vaccine cult.

And now, the meat of this blog post…

You remember Peter Doshi, don’t you? He’s the dude who wrote a “shocking” report about the influenza vaccine and how it supposedly didn’t work. As it turns out, the report wasn’t all that shocking. As Dr. Salzberg wrote:

“First, as Snopes.com has already pointed out, Doshi is not a virologist or an epidemiologist, but rather an anthropologist who studies comparative effectiveness research. He never conducted influenza research at Hopkins. (He’s now an Assistant Professor at the University of Maryland’s School of Pharmacy.) Second, Doshi’s 2013 article was an opinion piece (a “feature”), not an original research article, and it did not report any new findings. Third, it is highly misleading to suggest (as the anti-vax article’s title does) that Doshi somehow represents Johns Hopkins University. At Johns Hopkins Hospital, the flu vaccine is required of all personnel who have contact with patients, as a good-practices effort to minimize the risk that a patient will catch the flu from a caregiver.”

People who ask me about Peter Doshi get one simple warning from me: Be careful with his writings because he’s very good at manipulating language. Dr. Salzberg’s article continued:

“Doshi uses this sleight-of-hand to suggest that the vaccine may not be beneficial at all. He never says this outright—instead, he just questions, again and again, whether the precise percentages reported in published studies are accurate. For example, he makes a big deal of a CDC announcement in 2013 that the vaccine’s effectiveness was only 62%. He casts doubt with phrases like

“the 62% reduction statistic almost certainly does not hold true for all subpopulations”

That is almost certainly true, but is meaningless from the point of view of public health. Of course the vaccine doesn’t have the same effectiveness in everyone. The point is that it works most of the time.”

Earlier this year, Peter Doshi was at it again with “just asking questions” (aka JAQ-ing off) about the Vaccine Adverse Events Reporting System (VAERS). There was a technical glitch on the VAERS system that prevented some users from being able to access it. He made a big deal about it, and he never clarified that it was a technical glitch which was correctable and certainly not part of some big conspiracy to keep people from reporting vaccine adverse events. The VAERS site has since been updated, and it is working well, but Peter Doshi will probably not tell you that.

Well, now Peter Doshi is at it again. This time, it’s those horrible pro-vaccine organizations who get all sorts of funding from all sorts of horrible pro-vaccine agencies in the federal government (i.e. the Centers for Disease Control and Prevention [CDC]). He’s written an opinion piece that is chock-full of nuts. And, as I’ve warned you, he uses language to obfuscate the issue.

So let’s dissect it, shall we? He begins:

“Vaccination programs have long been a centerpiece of public health activity. But policies of compulsion have always been controversial. Against a backdrop of recent measles outbreaks, France and Italy moved this year to mandate certain vaccines for school entry. There’s even a renewed push for mandates in the UK, where public health leaders have long resisted compulsory vaccination on the grounds that it undermines the trust between the public and healthcare professionals and is ultimately counterproductive.”

The policies requiring vaccine are controversial not because vaccines are bad but because people keep spreading the idea that vaccines are some sort of poison. People don’t want to be poisoned, and they certainly don’t want their tax money to go toward poisoning others. That is how anti-vaccine groups are born. They’re born out of an idea that is flawed from the beginning. (Like the idea that HIV doesn’t cause AIDS, which we’ll talk about some more later since we’re talking about Peter Doshi.)

Let’s see some language manipulation:

“The debate is also alive in the US. Although all states require vaccination as a condition for entry to school, most also allow exemptions for families with non-medical philosophical or religious objections. Overall, childhood vaccination levels remain at or near historically high levels, with under 1% of toddlers receiving no vaccines. But beneath the broad national trends there is geographic variation in coverage, and survey data have documented that parental concerns over vaccination safety and timing are common, even among those whose children receive all recommended vaccines.”

Note that Peter Doshi doesn’t mention what a slight drop in vaccine coverage can do. For example, when it comes to the MMR vaccine against Measles, Mumps and Rubella, even a tiny drop in vaccine coverage can lead to an outbreak. So, yeah, it might be good that we’re at under 1% of toddlers, but if that number doubles, or if it reaches 5% in the pockets where anti-vaccine sentiment is high, we can be in for some expensive public health responses.

Peter Doshi continues:

“In 2015, a US federal advisory committee warned that public confidence in vaccines cannot be taken for granted, and some prominent vaccine advocacy organizations are pushing for greater compulsion. But are these groups—which present themselves as reliable sources of information—providing the public with independent information?”

He is now beginning with the JAQ-ing off, and it’s a question that seems to imply that non-independent information is bad. He continues with the example of Senate Bill 277 in California, a bill that became law and removed personal and religious exemptions from vaccine requirement. Instead of saying that their personal belief or their religion prevented them from vaccinating, anti-vaccine people had to find “vaccine friendly” physicians (like noted Douchebag Dr. Bob Sears) who would acquiesce to their fears and allow them to be exempt from vaccination “for medical reasons.” Organizations that were involved in the promotion of that bill’s passage was Every Child By Two (ECBT), the American Academy of Pediatrics (AAP) and the Immunization Action Coalition (IAC). And they were correct to do so because vaccines save lives. But, Peter Doshi writes:

“IAC, ECBT, and AAP have a few things in common. They are all non-profit organizations with large online presences that promote themselves as sources of reliable information on vaccines. They also receive funding from both vaccine manufacturers and the Centers for Disease Control and Prevention.”

Oh, noes! CDC promoting a public health intervention with a great track record of working? What shall we do? Vaccine manufacturers promoting their safe and effective products against deadly diseases? Say it ain’t so.

He finishes that section with a mention of his old nemesis, the influenza vaccine:

“And, in their advocacy for compulsory vaccination, they all have in common a goal that pushes beyond official governmental policy and, in the case of influenza vaccines, the evidence.”

Classic Doshi.

The rest of the article has several more questions for us to consider. “Education or lobbying?” is one of the questions because these organizations dared lobby for a public health bill that has probably saved several lives by now (and all without causing autism, to boot!). “Did ECBT and AAP’s support of the California bill cross a line for the CDC?” Peter Doshi asks. He asks this because there is regulation against CDC using money for lobbying pro or against pending legislation. This is a grey area when it comes to vaccines because CDC’s mandate is to protect health and save lives. For that, vaccines are needed. So support of a bill that has increased vaccine uptake in California fulfills the mission of the agency. Then Peter Doshi goes after the influenza vaccine again:

“One of the non-profit’s use of evidence is also questionable. Multiple reviews have found insufficient evidence that mandatory influenza vaccination for healthcare workers has benefits for patients. As one team of systematic reviewers put it, “evidence from observational studies suggests that a vaccine mandate increases vaccination rates, but evidence on clinical outcomes is lacking.””

I told you the vaccine was his nemesis. Peter Doshi can’t seem to get off of it. Or, rather, he seems to get off on not getting off of it? (I’m just asking.)

The questions keep on coming from Peter Doshi:

“In broad terms, the CDC and vaccine advocacy non-profits share a common goal of increasing vaccination rates. But when it comes to the details—which vaccines, when, for whom, and how to achieve those goals—is there a need for independent sources of information on vaccination policy?”

And…

“But do advocacy organizations with financial ties to the CDC and vaccine manufacturers have sufficient distance to offer such a service?”

What? No questioning of Dr. Paul Offit’s intentions? Shame on you, Peter. Shame on you.

As far as originality, I have to say that this anti-vaccine article is not very original. (It is anti-vaccine, Peter, because you seem to be questioning the need for vaccine mandates, vaccine information to the public, use of the influenza vaccine, and promotion of the use of vaccines, over and over and over again without a single mention of the good that vaccines have done.)

It’s a lot like this blog post by Age of Autism whose thesis was that ECBT got a lot of pharma money and thus vaccines cause autism, or something. And this other blog post by the same cesspool of so-called reporters which contends that the Immunization Action Coalition got a lot of sweet, sweet cash from CDC.

Noted anti-vaccine activist and conspiracy theory loon, Sharyl Attkisson asked the same questions (or did the same JAQ-ing off) as Peter Doshi did, except that she did it in 2008. (Little late to the party, Peter.) Sharyl wrote:

“There’s nothing illegal about the financial relationships, but to critics, they pose a serious risk for conflicts of interest. As one member of Congress put it, money from the pharmaceutical industry can shape the practices of those who hold themselves out to be “independent.”

The American Academy of Pediatrics, Every Child By Two and Dr. Offit would not agree to interviews, but all told us they’re up front about the money they receive, and it doesn’t sway their opinions.”

So I wonder where Peter Doshi got his inspiration for his latest anti-vaccine post?

Let’s quickly go back to what Dr. Steven Salzberg wrote about Peter Doshi, because it reveals something troubling about Peter’s view of the world:

“Perhaps even more disturbing is that Doshi signed a petition arguing that the HIV virus is not the cause of AIDS, joining the ranks of HIV denialists. He signed this statement while still a graduate student, so I contacted him to ask if he still doubted the link between HIV and AIDS. I also asked him if he supports flu vaccination, if he agrees with the anti-vaccine movement’s use of his statements, and if he believes the flu is a serious public health threat.

On the question of signing the HIV/AIDS petition, Doshi responded that “Seeing how my name was published and people have misconstrued this as some kind of endorsement, I have written the list owner and asked for my name to be removed.” He declined to state directly that he agrees that the HIV virus causes AIDS—though I gave him ample opportunity.”

It seems to me that Peter Doshi has a conspiratorial view of how the world of science works. If 99% of scientists say that HIV causes AIDS, it seems that Peter Doshi (a young Peter Doshi, a graduate student Peter Doshi) rebelled against that. If 99% of scientists and physicians and epidemiologists say that the flu vaccine is a good idea at a population level to mitigate the effects of the seasonal epidemics, it seems that Peter Doshi rebelled against that. Now, if 99% of pediatricians, epidemiologists, and public health authorities are finding ways to counter anti-vaccine nut jobs who are convinced that vaccines are poison and that they can endanger us all, it seems that Peter Doshi rebells agains that.

It would all be fine and well if he wasn’t an associate editor at the BMJ, a highly-respected journal. It makes me fear that articles submitted for review that shed a positive light toward vaccines, or toward the HIV-AIDS causal pathway, are not being accepted, or that hey may be stonewalled. Of course, I have no evidence of this, and pushing that idea without evidence would make me no different than Peter Doshi and Sharyl Attkisson and the bunch of weirdos at Age of Autism. But, still, I can’t help but wonder… And shudder.

Laugh it up, jerks. Laugh it up.

I used to have a boss who was well into his 70s when he decided to retire. He had worked at the health department where I was just a young number-cruncher longer than I had been alive. He joked about starting to work as a public health inspector in the Johnson Administration. Slowly and steadily, he moved up the ranks to becoming the director of a very busy infectious diseases unit at a very busy health department.

He was there in 1976 when Legionnaires’ Disease appeared. He told me about being on a call with people in the White House and how they wanted something, anything done, and done immediately. That same year, the swine flu fiasco happened, throwing the flu vaccine program into disarray. And he was at his highest position when all the crazy was unleashed over “Vaccine Roulette” and the resulting anti-vaccine nonsense.

He survived all that, and more. From one administration at the federal and state levels to another. His bosses came and went. The things they stood for changed and changed, and tragedies happened. And he was still there in his old age, fighting the good fight.

As you might have guessed, anti-vaccine zealots from The Kid to the anti-Semitic jerks at Age of Autism are celebrating the Trump victory since Trump has questioned vaccines and has embraced certain anti-science people. Apparently, Andrew Jeremy Wakefield once posed for a picture a few feet away from Trump, so Trump is now likely to ban all vaccines everywhere for all time. Makes sense, right?

Much like their knowledge of vaccines, anti-vaccine activists show an ignorance of how public health works in America. The vaccine advisory committee is not made up of political appointees or partisans. It’s made up of experts on the subject matter. They recommend what vaccines to give to what age groups, and the recommendations are followed (or not) at the state and local level. In order to shut down all vaccines everywhere forever, anti-vaccine-obsessed people would need to convince all states and territories that the Earth is flat, or something just as ludicrous.

Could a Trump Administration pull the plug on funding? Yeah, maybe, but we’ve done a lot more with a lot less. (That’s what my old boss used to tell us stories about. One year, they had their budget cut by 70%, and they still managed to expand their services year after year, even if just a little bit.) See, unlike anti-vaccine activists, we in public health are not in it for the money. We don’t travel to far-away and very dangerous places for money. We are okay with being held at gunpoint when something gets lost in translation at a checkpoint in a banana republic because we know we’re there to serve, and, frankly, dying for what we do is a badge of honor. We’d become immortal if we ever die in the service of public health.

So, yeah, laugh it up, jerks. Write all your little blog posts about how beautiful it will be to live in a Trump-led world. (Spoiler Alert: He’s not leading anyone. He’s not a leader. It’s not some title you are given.) We will continue to vaccinate tomorrow, next year, and next century. We might stumble and fall here and there, yes. But, just when you celebrate at the thought of burying us, you will weep when you realize we’re seeds… When you realize what we’ve survived and, thus, what has made us stronger.

When your math doesn’t make sense

I’m just going to leave this here. It’s a comment published on The Kid’s blog. One of his friends posts a link to another anti-vaccine website and perpetuates a lie. Then he realizes that the math doesn’t work out. So then he pleads that his comment not be published. The Kid publishes it anyway.

“But, what happened in Kenya, uncovered by 27 Bishops of the Roman Catholic Church, is, to me, the signpost for “The Plan.” There, in Kenya, just three months ago, vaccines were used to permanently, and without their knowledge or permission, sterilize forty-two million (42 million) young Kenyan women. The World Health Organization (WHO), and UNICEF, were caught, by the Catholic Church leadership, lacing what they described as “Tetanus Vaccine” with Beta-HCG, a hormone that, when combined with the ingredients in the Tetanus vaccine, leads to sterility.”

Then this (with my link to show you who Tim Bolen is):

Tim Bolens story of 42M Kenyans doesn’t make sense given the total Kenyan pop is 45M – so please don’t publish that comment .”

Comedy gold. Here’s a tip, weirdos: FACT. CHECK.

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The mental contortions of The Kid

Last time, I told you all about how The Kid wrote that Hillary Clinton’s pneumonia was the result of a failure of the pneumococcal vaccine. He wrote:

“Despite her proclaiming that “#vaccineswork”, the pneumonia vaccine obviously did not work for her in that instance assuming she even followed the CDC’s advice as she wanted everybody else to do.”

screenshot-2016-09-14-20-25-19

From his blog post.

Then, on Twitter, he doubles down on his conspiracy theory:

“The fact that you have an infectious disease but came into contact with children.”

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Does The Kid Have Inside Knowledge of Hillary Clinton’s Pneumonia?

Of course he doesn’t. He just seems to think that he does.

In yet another rambling post by The Kid, he seems to think that he knows what kind of pneumonia Hillary Clinton has:

“The US Centers for Disease Control and Prevention (CDC) recommends all adults over 65 receive a pneumococcal vaccine to prevent pneumonia. Yet shortly after collapsing during an early exit from a 9/11 memorial gathering over what her campaign blamed on the illness, 68-year old Crooked Hillary Clinton was photographed hugging a young girl. Despite her proclaiming that “#vaccineswork”, the pneumonia vaccine obviously did not work for her in that instance assuming she even followed the CDC’s advice as she wanted everybody else to do.”

So she has pneumococcal pneumonia, Jake? I mean, how else to interpret that statement. If she took the pnumococcal vaccine, and “the pneumonia vaccine obviously did not work for her,” then she must have pneumoccocal pneumonia. Clinton’s campaign has not revealed what type of pneumonia she has been diagnosed with, but facts have never really gotten in the way of a good rant by The Kid.

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Dr. Bob Sears, our Douchebag Emerit-ass, is in hot water

News came late to me that Dr. Bob Sears, 2014’s Douchebag of The Year, is now in hot water with the California Medical Board for what the legal filing states that he “was grossly negligent and departed from the standard of care in that he did not obtain the basic information necessary for decision making prior to determining to exclude the possibility of future vaccines, leaving both patient J.G, the patient’s mother, and his future contacts at risk for preventable and communicable diseases”

Orac does a great job of covering all this, so I won’t bore you with the details. You can go read his blog and enjoy some much deserved insolence against “Dr. Bob.”

It goes without saying that this should perk the ears of other anti-vaccine so-called physicians (or physicians in title only, as no physician worth their salt would ever be anti-vaccine). They should be very, very careful about how they carry on their business of promoting anti-vaccine science.