I’d Like to Play a Game

…But I can’t. I can’t play a game with anti-vaccine people because Game Theory assumes that you’re dealing with rational players. When it comes to the people who peddle in anti-vaccine conspiracy theories, you’re not dealing with rational people. You’re dealing, for the most part, with some incredibly irrational individuals who believe any and all conspiracy theories put forth to them by the people they worship.

They’re kind of like a cult, or a loose federation of cults. They have one or two (or three) high priests in the forms of Andrew Jeremy Wakefield, Robert F. Kennedy, Jr. or Del Bigtree. Those three men could sacrifice a virgin at an altar streaming live on social media, and it’s a safe bet that their anti-vaccine followers would find a way to justify the ritual. “It had to be done to stop the vaccine holocaust,” they would probably say. And the people would swallow it up hook, line and sinker.

Look at how they see vaccine package inserts. Package inserts are legal documents required by regulatory agencies to accompany medications. When it comes to vaccines, the package inserts name the ingredients in the vaccines, how the vaccine works, when it should be administered, to whom it should be administered and what kinds of side-effects (if any) were seen during the clinical trials of the vaccination.

Mind you, anti-vaccine people claim that there have been no clinical trials of any of these vaccines. Then, when you point out that it’s in the package inserts — the very same goddamned inserts they want you to read because they contain the truth — they flip it around and say that the package inserts are full of lies. If your head is spinning, wait for it. There’s more.

A few weeks ago, some dude who is a hardcore anti-vaccine advocate/activist/loon physically assaulted a California State Senator. The dude has a following on social media, and he ran unsuccessfully for the senator’s seat. Anti-vaccine luminaries followed the dude and praised him. Ah, but the minute the dude gets violent, they all turned on him and started the conspiracy theory that the dude was in cahoots with the senator in order to make anti-vaccine people look violent and nutty.

Then, just last week, some woman woke up in the morning, went to the state capitol in Sacramento, sat in the gallery of the senate, reached down into her vagina, pulled out a menstrual cup that had blood in it and threw the damned thing on to the senate floor, striking several of the legislators. As she was detained by police, she stood there and screamed to whomever could listen that she did it for the dead babies that vaccines caused.

Well, that is what happened in reality. In nutty-land, she was not an anti-vaccine activist and no one had ever heard of her. She wasn’t there to protest vaccines, either. She was there to protest abortion. And what she threw at the senators was not blood, it was paint, a cup of fruit or nothing at all, depending on which anti-vaccine lunatic you’re listening to.

Of course, there is the grand delusion that anything bad that happens to a person after getting a vaccine is the direct result of the vaccine. Car accident? The vaccine did it. Blood clot when you’re morbidly obese, a smoker and on birth control, months after a vaccine? The vaccine did it. Stroke when you’re in your 90s, have had high blood pressure all your life and are on anticoagulants? The vaccine did it. Suffocated to death under the weight of your high-as-fuck mother? The vaccine did it. Trump? The vaccine did it. Hillary Clinton? The vaccine did it.

Don’t even get me started on health care people who decided that they are going to be anti-vaccine. When you spend years of your life studying the sciences, and then you decide to deny the evidence and make some money off of lies… That’s psychopathic. That’s someone who cannot be trusted to be licensed to take care of a dog, let alone a human being. (With all due respect to veterinarians who do take care of dogs.) These so-called physicians and nurses who decide to peddle anti-vaccine nonsense should not be licensed to practice anything even remotely related to caring for the health of people.

And that’s why, as much as I want to play games with anti-vaccine people and get them all riled up in order to have them see the error of their ways, I cannot. They’re not rational. They don’t play by the rules of society, let alone reality. They live in either Crosby’s Labyrinth or something eerily similar to it. Up is down. Left is right. What you are seeing is not what your eyes are witnessing but some gummed up version of reality put in front of you by people who control the world and do not allow a shred of truth to get out except through their websites, blogs and social media channels… Channels to which you can subscribe and donate your money since they are not being paid millions. (Not by pharma, anyway.)

So I’ll have to look to another theory that is not Game Theory in order to better understand these nuts and continue to fight them. Because you should not have a shred of doubt that I will fight them until I cannot fight them anymore. And, even then, even when I cannot fight them anymore, someone else will. We’ve been doing it since Jenner, and we’ll do it beyond the age of Offit.

Your move, mother Hubbards. Your move.

Another one for Dr. Peter Doshi

It’s been a while since I’ve written to you about Peter Doshi, PhD, the guy who thinks that the flu is not a big deal and who may very well be an HIV-AIDS denialist. He is probably not as prominent now in the anti-science media because he’s busy being the associate editor of the British Medical Journal and calling on drug companies to be more transparent with their data. (Big Pharma is the big fish everyone wants to take down nowadays.) Nevertheless, his work against the stockpile and use of neuraminidase inhibitors (NI) like oseltamivir (aka “Tamiflu”) is still out there. It still gets quoted.

The Lancet put out an article recently about the effectiveness of NIs and their effect on mortality in hospitalized patients. It is a meta analysis. This means that they took together a whole bunch of studies and looked at them in the aggregate. I don’t generally like these studies because it is easy to be biased in the analysis by discounting or ignoring some studies while favoring others. Still, when done well, these studies have more power because they’re looking at more subjects and more outcomes. This particular study took 78 studies done between 2009 and 2011 and looked at the outcomes for treatment while hospitalized. This is what they found:

“We included data for 29 234 patients from 78 studies of patients admitted to hospital between Jan 2, 2009, and March 14, 2011. Compared with no treatment, neuraminidase inhibitor treatment (irrespective of timing) was associated with a reduction in mortality risk (adjusted odds ratio [OR] 0·81; 95% CI 0·70—0·93; p=0·0024). Compared with later treatment, early treatment (within 2 days of symptom onset) was associated with a reduction in mortality risk (adjusted OR 0·48; 95% CI 0·41—0·56; p<0·0001). Early treatment versus no treatment was also associated with a reduction in mortality (adjusted OR 0·50; 95% CI 0·37—0·67; p<0·0001). These associations with reduced mortality risk were less pronounced and not significant in children. There was an increase in the mortality hazard rate with each day’s delay in initiation of treatment up to day 5 as compared with treatment initiated within 2 days of symptom onset (adjusted hazard ratio [HR 1·23] [95% CI 1·18—1·28]; p<0·0001 for the increasing HR with each day’s delay).”

In other words, giving an NI early in the course of the disease is associated with lower mortality, and giving it versus not giving it was also associated with a reduction in mortality risk. Note this: “These associations with reduced mortality risk were less pronounced and not significant in children.” That’s “clutch” right there and something that infectious disease doctors and pediatricians should keep in mind.

NIs are not a magic bullet against influenza. Nothing is, not even the influenza vaccine. But something is better than nothing, and something backed up by evidence is best. Contrary to Dr. Peter Doshi’s assertions about NIs, evidence keeps coming in that it is better to give them than to not give them, and that they actually reduce the risk of death from influenza in some groups. There is both observational and experimental evidence of this.

But you don’t have to just take my word for it.

I wish I had that kind of money

The only reason I’m not making money hand over fist is because I chose to work in the public sector. I’m a public health worker who has been sticking with a local government that is having a hard time with its budget. I get paid peanuts. Contrary to what all the anti-vaccine people have accused me of, I am not getting a dime from “Big Pharma,” not a dime. Living in the DC metro area is expensive, and my checking account is the perfect example of it. I’ve paid some hefty overdraft fees, and it’s not like I have a cocaine or heroin habit, or some high-demand mistress to please. I just do my work where the bugs are, like my hero used to say when he was told that he could make ten times more money in private practice.

One day, my name will finally be up there after all I’ve done around here.

Ask a chemist, for all I care

If you ever took an anatomy class in high school or college — or if you ever went to medical school — you will no doubt remember the effects of formaldehyde on body tissues. The long and short of it is that formaldehyde is used to dry out tissues in order to preserve them. The formaldehyde moves into the tissue and the water moves out. So why would you ever want it inside you?

I’ve told you before about how it’s all in the chemistry, and, still, there are some of you out there who read that (I have a way of tracking your IP addresses now) and then wrote on your blogs or tweeted that either I didn’t know what I was talking about, or that Big Pharma was paying me to convince people to “poison” themselves with the formaldehyde in a vaccine.

Poison themselves?

Let’s do another chemistry class. But, first, let’s see what the Food and Drug Administration has to say about formaldehyde in vaccines:

“The body continuously processes formaldehyde, both from what it makes on its own and from what it has been exposed to in the environment. The amount of formaldehyde in a person’s body depends on their weight; babies have lower amounts than adults. Studies have shown that for a newborn of average weight of 6 -8 pounds, the amount of formaldehyde in their body is 50-70 times higher than the upper amount that they could receive from a single dose of a vaccine or from vaccines administered over time (1,2,3).”

And here’s what the Children’s Hospital of Philadelphia has to say:

“First, formaldehyde is essential in human metabolism and is required for the synthesis of DNA and amino acids (the building blocks of protein). Therefore, all humans have detectable quantities of natural formaldehyde in their circulation (about 2.5 ug of formaldehyde per ml of blood). Assuming an average weight of a 2-month-old of 5 kg and an average blood volume of 85 ml per kg, the total quantity of formaldehyde found in an infant’s circulation would be about 1.1 mg, a value at least five-fold greater than that to which an infant would be exposed in vaccines.”

But I bet you’ll say that they’re paid by Big Pharma too.

So is the field of chemistry paid by Big Pharma? Because any chemist — or student of chemistry — will tell you that we get rid of formaldehyde through a series of chemical reactions in our body, and that those chemical reactions readily eliminate formaldehyde at the levels found in vaccines, or even higher. I mean, there are 28 grams of alcohol in two beers, and the same chemical “factory” in your body gets rid of that in a jiffy. (If you do get “buzzed” from two beers, it won’t last long.)

Then again, based on the stupidity you communicate to the public about formaldehyde and vaccines, you probably will say that big pharma pays for chemistry books, too.

Who is in bed with Big Pharma?

One of the first things that anti-vaccine and anti-science people will tell me when I present them with a fact is that I’m in bed/league/association with “Big Pharma.” They have no evidence of this. I’ve told them that I don’t hold any financial stake in any pharmaceutical or healthcare company. But they don’t let facts get in the way. You know how it is.

I was stunned, but not surprised, to find out that a notorious anti-vaccine physician and his son were in league with Big Pharma. Okay, “in league” is a big phrase. They are only slightly separated from Big Pharma. As we know, in the world of the “vaccines cause autism” crowd, close associations mean direct implications.

What am I talking about? There exists a doctor and his son. The doctor and his son think that mercury causes autism because mercury binds with testosterone. It binds with testosterone under lab conditions, which would never be replicated in the human body. Anyway, the doctor and his son are convinced that chemically castrating children with autism (boys, for the most part) will reverse their autism. Block and get rid of testosterone, and the bound mercury will go away, get it?

So the Maryland Board of Physicians got a hold of this unapproved, unproven, probably even dangerous way of “treating” autism and told the father and son to stop it. Well, it went further than that. The board took away the father’s medical license and charged the son with impersonating a physician. Their whole empire is crumbling, hard.

The anti-vaccine forces are all angry and worked-up over the board of physicians protecting the public telling them to stop and charging them with several offenses. The anti-vaccine forces also think that anyone slightly associated with Big Pharma is not to be trusted and is possibly eating babies at Thanksgiving (I’m not joking). Well, guess what…

The father and son have an association with a third person, a person named Trigg. (Yes, the no-names rule will have to be bent a little bit.) Check this out:

“Young” is a whole other story for some other day

Who is this Trigg fellow? He’s likely this executive medical director at a pharmaceutical company. Of course, I could be mistaken. If I am, I’ll correct this. (And any reader is invited to offer evidence of any mistake I’ve made.) But this Dr. Trigg has the same exact name and approximate location of the Dr. Trigg who is suing his partners, the father and son.

Again, I could be wrong. These could be two doctors who share the same name and approximate location.

However, if I’m not wrong, and he is both a partner of the father and son and an executive at a pharmaceutical company, then the question begs to be asked…

Who is in bed with Big Pharma?

But I’m not the conspiracy theory type. I’ll just wait and see what happens.

You don’t need the government until you need the government

Whew! That’s was a crazy little hurricane. Several people dead in the Caribbean and in the United States. Lots of property damage. Schools and businesses closed. It was a mess, and it will probably continue to be a mess for a while.

I was listening to the local radio this morning, and they were interviewing a woman from Delaware who stayed in her house on the beach despite the mandatory evacuations issued by the governor and local officials. She said that she was flooded, had raw sewage in her basement, a neighbor’s house was gone, and that she was basically isolated because the only road to the peninsula where she lived was gone. She was also very angry because no one was coming to her aid. She said that she was a taxpayer, and she expected her taxes to pay for her rescue. When she was reminded that she chose to stay despite the evacuation orders, she said that the people who decided that the evacuation order was necessary were useless.

On the one hand, she needed the services of the government she helps fund. On the other, she didn’t pay attention to the expert recommendations of the government she helps fund.

If this sounds familiar, it should. This is the mindset of the conspiracy theorist, the hardcore anti-vaccine person, and all sorts of other individuals and groups. But let me stick to what I know best: the anti-vaxxer.

The anti-vaxxer will typically point to a study as evidence of their fears on vaccines. Said study will be conducted by some academic institution or government agency. However, if the study disagrees with the anti-vaccine worldview, then whatever organization conducted the study is said to be “pharma funded” or have some other “conflict of interest”. The anti-vaxxer wants it both ways.

Likewise, many anti-vaccine organizations will point to records in the Vaccine Adverse Events Reporting System (VAERS) as evidence that vaccines cause harm. Then, in the same sentence, they will demonize the Centers for Disease Control (CDC) for hiding the “truth”. Well, it happens that VAERS is maintained by epidemiologists and staff from CDC. Again, they want to have it both ways. When asked if the CDC lies or not, the answer is “it depends”, and it’s enough to make you want to pull your hair out at the level of hypocrisy displayed.

And that’s how it goes. If something agrees with their fears, the run with it. If it disagrees, then that something is part of a big conspiracy. Just like many people who are against “big government”, they don’t want it interfering in their lives, until they need it to interfere in their lives… Until they need to be saved.

It annoys me.

There are monsters under your bed, in your closet, and just about everywhere else

There’s this kid who is studying epidemiology. He means well by trying to learn a discipline where you get to learn how event B coming after event A doesn’t mean that A caused B. But that’s not how his brain seems to work. In his mind, there are monsters everywhere. There is nothing that happens by chance in his world. Everyone is connected, and everyone is against him.

When he wasn’t allowed in to harass his target of choice, he claimed that it was because Big Pharma considers an enormous threat. Here’s his explanation of why he was not allowed in (CFI is the “Center for Inquiry”, a skeptic group based in Washington, DC, where the kid goes to school:

“CFI’s pharmaceutical ties run deep. Dr. Jonathan Tobert – retired Merck scientist who developed the first statin drug – sits on CFI’s board of directors. Prior to his appointment to the board, he had already supported the organization for 30 years according to CFI’s website. For 24 of those 30 years, he was employed by Merck until retiring from the company in 2004 to join an FDA panel through that ever-revolving door between government agencies and the pharmaceutical industry. CFI president, bio“ethicist” Ronald Lindsay, headlined a recent conference with bio“ethicist” Arthur Caplan, director of the Penn Center for Bio“ethics.” Caplan chaired GlaxoSmithKline’s bio“ethics” advisory panel for three years and is vehemently opposed to vaccine choice.”

That’s right. Merck and GSK tremble at the thought of this kid. It doesn’t stop there, however. The conspiracy goes all the way to the White House.

When a PhD who is the father of a child with autism and has done research on autism was named to a federal committee on autism, the kid went off on a rant about it. Aside from all the ad hominem attacks, his rant included a conspiracy theory that the White House named the person on some twisted logic of ties and associations.

Perhaps not everyone is a monster in the mind of this kid. He absolutely worships the man whose fraudulent study brought about the fear of the Measles Mumps Rubella vaccine. He worships this fraudulent man so much that the kid now sees an elaborate conspiracy behind a recent legal finding against his deity:

“Amy Clark Meachum, the judge who threw Dr. Andrew Wakefield’s case out of district court by essentially saying that BMJ, Fiona Godlee and Brian Deer can libel him all they want since they are from the UK, is married to a lobbyist named Kurt Meachum of Philips & Meachum Public Affairs.

According to Texas Tribune Lobbyist’s directory, Kurt Meachum’s client, the Texas Academy of Family Physicians, earned him $10,000-$25,000 in 2011 alone. What is the significance of this? Family physicians give many vaccinations as a considerable part of their practice. But that’s hardly the beginning of the story.

In 2010, the Texas Academy of Physicians sponsored a talk given by none other than Pharma Front Group President and Founder Alison Singer at a vaccine industry conference no less. Her group, “Autism Science Foundation,” was founded for the expressed purpose of discouraging vaccine-autism research. Despite telling parents to vaccinate recklessly at the 2010 Texas Immunization Summit, Singer split the measles, mumps, rubella vaccine in three separate shots for her second daughter, who does not have autism, unlike her first who received the combined shot.”

See that? The judge’s husband works for a PR firm that had the Texas Academy of Family Physicians as his client. The Texas Academy of Family Physicians had Alison Singer of the Autism Science Foundation as a speaker in 2010. And, because the Autism Science Foundation is a “Pharma Front Group” in this kid’s mind, then the judge ruled against the deity because…

Because…

Well, I really don’t know. How do that many degrees of separation represent a conflict of interest? Did Big Pharma pay money to Alison Singer in 2010 to speak to the Academy to influence their PR person to tell his wife to rule against the deity, when the [expletive deleted] deity didn’t file the suit until 2012?

Is that how it works?

It must be tough to live in that fearful little mind.

But that is the modus operandi of this silly little boy. He sees conspiracies and conflicts of interest and associations everywhere. They’re probably under his bed and in his closet.

When the disgraced son of a former politician wrote an anti-vaccine article and then the article was retracted (as it was full of misinformation), the kid saw a conspiracy.

When a reported at TIME magazine rightfully called his deity a fraud, the conspiracy behind that article went all the way to the United Kingdom.

And when CBS and the Huffington Post began publishing stories about the irresponsibility of anti-vaccine writers, the conspiracy there was that Big Pharma is making editorial decisions at those outfits.

And the motivation behind THIS blog post? I’m sure he’ll find out that Big Pharma paid the daughter of the wife of an immigration lawyer who represented my groundskeeper who did a hell of a job with my lawn… And that’s why I’m writing this. 😉

We, Pharma Shills

There is a particularly petulant internet troll cruising some pro-science and pro-vaccine blogs and websites who has done two things to really scare the crap out of me. Number one, he once wrote that what is bad for public health is good for him. Number two, he keeps accusing people who work in public health of just being paid-off or even outright employees of pharmaceutical companies. “Epi Ren” once took him to task over his comment about public health. So let’s look at his conspiracy theory that public health workers are in the pockets of “Big Pharma”.

To believe that conspiracy, you first have to believe that vaccines are profitable to pharmaceutical companies. See, the cost of the vaccine schedule ranges from free (when subsidized by the government or a charitable organization – or pharmaceutical companies themselves) to a few hundred dollars. For that amount of money, you get to be protected from diseases that will cost thousands if not hundreds of thousands of dollars to treat. For example, hepatitis B is a chronic infection that may even end up costing you your liver. Do you know how much a transplant goes for? Not only that, but how much is the immune-suppressive therapy to keep you from rejecting the organ?

That cost is much more than vaccines.

So, to believe the conspiracy, we have to believe that pharmaceutical companies do not want to make money from drugs for transplant patients, antibiotics for meningitis and other bacterial infections, antivirals for influenza or rotavirus, or supportive drugs for those on life support or in assisted/nursing care. No, no, no… No, they want to make money from vaccines that prevent all of those things.

Check out this awesome webpage explaining the costs of treating vaccine-preventable diseases from my friend Todd W: http://antiantivax.flurf.net/costs

Alright, so let’s say that vaccines are somehow profitable to pharmaceutical companies. How much money do they pay out to their “employees” to push vaccines on the population? To answer that question, we would first have to see who is involved in this conspiracy. I’m only going to cover the United States for this exercise. Alright, so there are 50 states and several territories in the United States. Let’s look at the States.

In every State, there are three branches of government. To pass a bill requiring immunizations, all three branches of government have to agree to the bill – or at least two of three if the legislature can override an executive veto. So “Big Pharma” has to have a majority of legislators at the state level, the executive, and a majority of the courts in their pockets. How much do they charge? How much money would you take to pass a bill that “pushes” vaccines to people only for the profits of the drug companies? Me? I wouldn’t settle for anything less than a cool million dollars, or two, or three… I’m a greedy bastard, yes, but it would mean the end of my political career if this is ever found out. I’d want to have a nice, comfortable parachute for a soft landing into an island in the pacific.

But it doesn’t stop there. You’d have to pay-off some of the politicians’ staff members. I mean, the politicians don’t do their jobs all by themselves, do they? They have secretaries, assistants, go-fers. All of them would have to be paid off lest they run to their blogs or to wikileaks with information on the conspiracy. Would they settle for less than their bosses? Maybe, but I wouldn’t trust human nature that much.

Alright, so that takes care of the decision-makers, what about the implementers? In every State, there is a Department of Health headed by a Health Secretary. Then you have their deputies, their deputies’ assistants, the State Epidemiologist, the epidemiologists, their assistants, the community health nurses, their assistants, and every other person involved in telling the public about the vaccines and giving them to the community. Not only that, but then you have to pay-off all the people at the local level who will actually, physically give the vaccine to the people.

Does the conspiracy go that deep?

Maybe not, but those people at the “bottom” of any State’s public health system are not stupid. They read – get this – scientific papers and know about the benefits and risks of vaccines. They would be able to smell a rat – and bullshit – and say something about it. At least some of those people would need to be paid off. So multiply all that times the number of local health departments in the country and then times the number of States in the Union, and you begin to see the huge investment “Big Pharma” must be making in promoting “the lie” that are vaccines, according to anti-vaccine groups and people.

Ah, but a good conspiracy would not stop there, would it? Big Pharma would have to pay an overwhelming majority of healthcare providers (MDs, DOs, PAs, NPs, Nurses) and allied health professionals (Medical Technicians, Respiratory Therapists), and basically everyone else who has seen the evidence of vaccines and promotes them.

So how much money would go into that? And would it be covered by the few hundred bucks per person in the United States? Of course not.

Then again, like good conspiracy nuts, they will say that you only need to have a few key people in your pocket and fool the rest of the people. That is also a stretch. You’d need to fool all of the scientifically-inclined people in the world. You’d have to fool doctors at all levels who agree that vaccines are quite the public health intervention. You would also have to fool law enforcement and those over-eager prosecutors. You’d even have to fool investigative journalists who are always looking for some juicy story to sell. What better story than “VACCINES DON’T WORK, ACTUALLY DEADLY”?

Seriously. Tell me.

But that will not stop the anti-vaccine groups from playing what is called the “Pharma Shill” gambit, where they accuse everyone and anyone of being an “employee” of the pharmaceutical industry if they should happen to support vaccines. In “The Poxes”, you will read over and over again how this accusation is used to place doubt in the hearts of many people looking for answers about what happened in the first chapter. See, it’s been my experience that anti-vaccine people will rabidly attack first during a time of crisis. Just ask the parents of that child in Australia who died from whooping cough. Not only did they have to deal with the death of their child, but they also had to deal with harassment from an anti-vaccine person who wanted them to claim the child did not die from pertussis.

In their universe, there is more than enough money to pay everyone off, except them. Also, vaccine-preventable diseases do not kill anyone. In real life, and in “The Poxes”, they do kill, and maim, and bring the world to its knees.