Scrub-a-dub-dub, because you’ve been called out

First and foremost, Happy New Year. Here’s to another year of giving you bits of stuff to mentally nibble on as you go about your day. Now, on with 2015…

Remember Peter Doshi, PhD? He’s the “Hopkins Researcher” non-epidemiologist who claims to know more about influenza than epidemiologists, virologists, and other people who have made influenza research their life’s work. He’s presented on influenza at a conference sponsored by an anti-vaccine organization. And, as I told you before, he signed a letter from the “AIDS Rethinkers” stating that the HIV-AIDS association should be, well, “rethought”. It’s nothing more than AIDS denialism dressed as “skepticism.”

Anyway, Dr. Steven Salzberg, who is a Hopkins researcher, took Peter Doshi, PhD, to task:

“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.”

That’s not all, however. Dr. Salzberg asked Peter Doshi, PhD, about signing that AIDS denialist letter:

“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.”

I, too, emailed Peter Doshi, PhD, a while back (October 2013) and asked this:

“I was recently informed that you have taken the position of associate editor with the British Medical Journal. While doing some research on your work, and seeing what influence you have and will have on evidence-based medical practice, I came upon a website (http://aras.ab.ca/rethinkers.php) which lists you as a signatory to a statement denying the existence of a causal relationship between HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immune Deficiency Syndrome).

I hope you can see how “AIDS denialism” may put into question your judgment of medical and scientific findings submitted for review at BMJ. My questions to you, if I may have a few minutes of your time, are:

– Did you sign that HIV/AIDS statement denying the existence of a causal relationship between the virus and the disease?
– Are you in fact now an associate editor at BMJ?

I extend you much gratitude for taking a moment to answer these questions.”

He never replied, though I never received a notice that the email was not delivered, and I copied him on all known emails he’s used on publications.

On that website, his name was listed thus, a few names under Australian anti-vaccine loon, Meryl Dorey:

The list looks like this today:

No more Peter Doshi on the list. It appears that he did as he said he would to Dr. Salzberg and asked that his name be removed. The thing about that page is that it is querying the list from an external database, so we can’t use the “Way Back Machine” or Google to his name when it used to be there. All we have are these screenshots, but, as you can see on Dr. Salzberg’s blog post, Peter Doshi, PhD, never denied signing that letter. (To be a “signatory” you have to contact the list’s administrator, apparently.)

So there you have it. An associate editor at the British Medical Journal has scrubbed his name from a list of AIDS denialists. Do with that what you want. He also doesn’t think the flu is a big deal, so do with that what you want. From Dr. Salzberg’s blog post:

“As for the flu itself, Doshi says “I don’t agree with CDC’s portrayal of influenza as a major public health threat.” So he and I have a serious disagreement there. I asked if he agrees with the anti-vaccinationists who are using his writings to claim that the flu vaccine is ineffective, and he replied that while “ineffective” is “too sweeping,” he has found ”no compelling evidence of hospitalization and mortality reduction in [the] elderly.””

As an epidemiologist doing research into infectious diseases, I will not submit anything to the BMJ for publication for the foreseeable future. I just don’t trust their judgment anymore when they have as an associate editor someone who seems to deny that AIDS is the result of an HIV infection (something 99.999999999% of scientists have agreed on and on whose authority antiretroviral therapy has saved lives) and definitely doesn’t see influenza as a major public health threat. I can only imagine what would happen to any manuscripts I submit on infectious disease.

One more thing…

The HIV “Rethinkers” write thus on their page:

“The next time the media announce that tens of millions of people are dying from Hiv in Africa, ask them how they know that. Remind them that journalists are supposed to question dubious assertions from powerful, drug-industry funded agencies like the WHO, not parrot them as if they were indisputable. Ask them why they report these numbers as if they were actual Aids cases, when in fact they are projections made by WHO’s computer programs, based on very questionable statistical methodologies and contradicted by many facts including the continual large population increases experienced in the countries supposedly worst affected.”

Note the part about the media.

This is what is written on Peter Doshi’s page at his current job with the University of Maryland:

“Doshi also has strong interests in journalism as a vehicle for encouraging better practice and improving the research enterprise.”

Yeah, it should be the reporters that guide the science, not the other way around. Not.

Just in time for Halloween, an anti-vaccine “expert” rises like a zombie

I was looking through the blog’s stats the other day, and I found out that a ton of people were checking out the post about Peter Doshi, PhD. You know the one? The one where I explain to you that Peter Doshi, PhD is not an epidemiologist and how his attempt at epidemiology, at explaining to his audience that the flu is not that bad and that flu deaths were not really flu deaths, how all of that was pretty goddamn awful. Well, his screeds are back, and the anti-vaccine and conspiracy theory websites are plastering it all over the place. Lucky for humanity that people are skeptical about his claims, go and Google his name, and come to this blog.

Some of the most recent visitors are coming over from a blog called IO9. They are coming over specifically from a post by Tara Haelle about the myths and facts about the flu vaccine. It’s a good post. My only objection to it is the number of myths she’s trying to debunk all at once. There’s a lot of them, and blog readers are usually TL;DR kind of people. Keep it snappy and keep it short, says the guy who once wrote a 6,000-plus blog post on diabetes. Someone in the comments mentioned an article by Peter Doshi, PhD. It’s the same article from years back, but it has been resurrected, like a zombie, to try and scare people away from the flu vaccine.

I’m glad that so many are skeptical of Peter Doshi, PhD, and I truly hope that someone asks him about the AIDS denialist bit in his history. After all, we wouldn’t want a current professor at the University of Maryland and associate editor at the BMJ being an AIDS denialist, do we? It would be a little bit bad for science. So thanks for the natural news whackaloons for resurrecting Peter Doshi’s article from last year. It’s always fun to deal with zombies.

“Scary” Peter Doshi, PhD (taken off the conspiracy website and altered a bit)

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?

HIV leads to AIDS, plain and simple

FYI: This is the second of ten posts that will not be related with vaccines.

Back in the late 1970’s and early 1980’s, there was a lot of scientific confusion as to what the relationship was between Acquired Immunodeficiency Syndrome (AIDS) and a newly discovered retrovirus first known as HTLV-III and then renamed to HIV. Thirty-plus years and millions of dollars later, we have come to understand that HIV infection, if left untreated, progresses on to AIDS. We came to understand this because we observed people with HIV and people without it. Then we went one more step further and observed people infected with HIV who were treated and those who were not treated. We did these observations in real-world situations and also in controlled situations. We also did these observations in animal models.

All the evidence is there, and it is very clear that HIV causes AIDS.

Still, there are a group of people out there who honestly believe that HIV doesn’t cause AIDS, that AIDS is the result of things other than HIV, or that neither HIV nor AIDS actually exist. (There are wilder theories than those, if that is possible, but I don’t have time for them.)

A few years ago, I came upon the comments of a man who has some “interesting” views of the relationship between HIV and AIDS. Here is the comment:

“Whether ORAC knows anything about medicine or science is unclear, but he knows NOTHING about how to conduct an investigation.

Having conducted thousands of criminal, civil and military investigations since 1980, it was clear from the onset that Deer’s so-called investigation resembled more of a hit-piece than a real investigation. As such, it was the perfect pretext for the kangaroo court known as the medical board review.

ORAC’s outrage is also telling. Since truth is the best defense in such cases, Deer’s defense should be extremely easy – unless, of course, he lied to destroy Dr. Wakefield’s career.

Because I have been involved in more than 100 criminal, civil and military cases involving medical and scientific incompetence since 2009, I am not at all impressed that ORAC is funded by the DoD, NCI or any other US government agency. And having recently cleared a US Marine of criminal charges by impeaching a top military infectious disease expert, I’d say that ORAC’s outrage is likely based upon his fear that he will be eventually be discovered as a charlatan as well.

If ORAC is telling the truth, nothing would preclude the use of his real name. The fact that he blogs on this pharmaceutical marketing website is telling.

Clark Baker LAPD (ret)”

He did us all the favor of directing us to his website, the “Office of Medical and Scientific Justice”. It’s a pretty legit-sounding website that talks a lot about clearing people who are innocent from false accusations against them. Just read the “About” page:

“Having conducted thousands of criminal and civil investigations since 1980 with the LAPD and as a licensed investigator, Mr. Baker founded OMSJ in 2009 after witnessing the reluctance of government agencies and research centers to investigate allegations related to medical and scientific corruption (also known as JUNK SCIENCE).

Many of the agencies and companies that market junk science fund activist groups and local, state and national politicians who facilitate corruption that has cost taxpayers billions of dollars in wasted research dollars. Junk science is used to keep predators on the streets, convict the innocent and injure or kill 2-4 million Americans annually.”

Read in a vacuum, that all sounds great… Until you start reading into Mr. Baker’s ideas. (Tip o’ the hat to regular reader/commenter “Lilady” for the link.) It seems that Mr. Baker is an HIV/AIDS denialist. Among some of the claims on his website are the usual bits of anti-science strategy. First, deny the science and call it “junk science”, but never mind that 99.9% of scientists (that is, 100% of reputable scientists) know and understand that HIV does cause AIDS, that HIV is not a “passenger virus”, and that HIV without antiretroviral treatment is pretty much a death sentence. Second, to try and back up those anti-science claims, find something by a member of the 0.1% of whacky scientists and publish the hell out of it. Third, find instances of scientists misbehaving and then try and discredit their scientific work and that of their colleagues. Finally, cater to what the far right-wing groups and their members want to hear.

It really is quite humorous that Baker follows the same playbook of almost all other anti-science activists follow. Cherry pick and discredit. Cherry pick and discredit. Cherry pick and discredit and be mean about it. Cherry pick, discredit, be mean, and put yourself up on a pedestal as being more than you really are. Oh, and sue people. Don’t try and fight the science, just goddamn sue!

Unfortunately for humanity, Clark Baker is not the only AIDS denialist out there. There are plenty, and there are plenty with advanced degrees whose letters after their names give them some degree of credence. For one reason or another, people listen to them, and we all pay for it dearly.

Twist and bend the truth to fit your views on abortion

I asked Pedro (not her real name) about her views on abortion the other day. She told me that she supports a woman’s right to choose and that she hopes women will have universal and affordable access to contraceptive medications and technologies. If women had as much as say in their reproductive rights as they should, abortion would be an incredibly rare thing. It would be a choice that women would not have to make. And that’s what puzzles me about anti-abortion (anti-choice) activists. They oppose abortion, but they don’t do anything to make unintended pregnancies a rarity. They stand at corners and protest (because they don’t pray, really), but they don’t talk to girls and young women about the many ways that they can prevent an unwanted/unintended pregnancy. Worse of all, they lie.

Before we go any further, I’m going to have to warn you that the blog post I am going to link to contains some very graphic images, so please exercise some caution if your computer is public or near susceptible persons. The blog post talks about a woman who died in 1989 as a result of sepsis (blood infection) after having an abortion. The main gist of the blog post is that women are dying by the bunches during abortions and that this one death is only the tip of the iceberg. Worst of all, they are using the pictures of the 18 year-old woman to further their agenda:

“Today, the pro-life group Life Dynamics, in cooperation with Operation Rescue and Priests for Life, will release autopsy photos of 18-yr-old Marla Cardamone, who died following a “safe and legal” abortion, along with her 17-to-19-wk-old preborn baby, Christopher Michael, whose photo will also be displayed.”

Another mother who’s given up on her “lost” child

Here we go again with another parent of an autistic child referring to said child as “stolen.” This time, it’s a “Thinking Mom” who goes by the name of “Mama Mac”. I know who she is in real life, but we don’t need to go there. Mama Mac wrote a post titled “Who Will Pay the Piper?” in which she talks about how she “lost” her child to autism:

“When I look at pictures of Nick at 8 months old, happy, healthy, and then at 18 months old suddenly vacant, sickly, and sad . . . the word “stolen” flashes through my mind.

He was taken from me right under my nose. In fact I was advised to GIVE him much of what stole him away from me; vaccines, antibiotics, anesthesia. I was encouraged to participate in what would ultimately take my child from me.”

It’s always the goddamned vaccines, isn’t it? Ah, but she goes on about how dire the situation is, or isn’t:

“I’ve spent the past eight years bargaining with his kidnappers, trying desperately to bring him home. Yes, he’s sitting next to me while I type this, and, yes, these days he is present and ‘with us’ emotionally 95% of the time. But what of his future has been stolen? What of his future health? What about the devastating trauma we have endured? What if I can’t really get him back?

The Piper didn’t just take Nick. He’s taking a generation of children while their parents stand idly by.”

I don’t know about you, but I know plenty of parents of autistic children who didn’t “stand idly by.” They put on their big boy, and big girl, pants and got to work on the things that matter to their children: Better access to services, education, jobs, medical care. They went to their local schools and their elected leaders and are making the world a better place for all children who are not “normal”. (By the way, there is no normal.)

But I’m thinking that Mama Mac is talking about standing idly by as their children got vaccines and those things that “steal” or “kill” or make children “disappear”. And whom does Mama Mac blame for these horrors? “The Pied Piper”, of course:

“The Pied Piper is comprised of the biggest chemical and pharmaceutical companies who create, market and sell their poorly safety-tested products in the name of a healthier life.”

Of course, all those things that are not “natural” are never tested for safety. Chemical and pharmaceutical companies just pay off people and sell their stuff, and we all die or become autistic of something:

“We thought we’d traded crop weevils, childhood illnesses, dirt and inconvenience for corn crops bred with innate pesticides, the promise of childhoods free of chickenpox and measles, blinding white smiles and bleached kitchen counters. What we’ve actually ended up with is the sickest generation of children to come down the pike.”

Yeah, the sickest. That’s why childhood mortality is at an all time low. That’s why chronic diseases of adults are now the number one killers instead of, you know, childhood diseases. That’s why we’re making technological advances by leaps and bounds generation after generation, because we’re getting dumber or less mentally adept. Yeah, that’s why.

Of all the people who I think should walk away from their children, I think Mama Mac is right up there. Not only is her child “lost” to her, but the child has been taken by a monster under her bed.

I’m just asking questions here

One of the favorite pastimes of denialists of all shapes and sizes is the “I’m just asking questions” gambit. They pose questions about something that has already been scientifically settled and say that they’re just looking for “honest debate” on the subject. But it’s often, again, on things that have been settled. It’s like the holocaust revisionists who say that they just want to “set the record straight” about what happened in German-controlled Europe in the 1930s and 40s. They’ll put a little bit of untruth in the truth and seed doubt in the minds of their readers and followers.

Anti-vaccine activists will say that there have been no double-blind clinical trials on vaccines and then walk away from the conversation, knowing that they have put doubt in the minds of people who don’t know better. While there have been such trials on most vaccines, a lot of what we know about vaccine safety and efficacy comes from observational studies. We know that vaccinated people are less likely to be part of an outbreak as a group and that individuals are less likely to catch a vaccine-preventable disease if they’re immunized. It would be highly unethical for us to take a group of babies at birth and randomize them into a “to be vaccinated” and “to not be vaccinated” group now that we know what we know about vaccines and the diseases they prevent.

You want me to “prove” to you that HIV causes AIDS?

Someone denies that HIV causes AIDS. They want me to prove it to them.

My response?

http://www.tubechop.com/watch/1532347

Those who have eyes but won’t see (UPDATED)

I woke up this morning to two very different bits of news that really put the world in perspective. First, a friend of mine delivered a talk on how research studies are carried out and how people in the field of mental health should “analyze” them, no pun intended. It was a good talk, and I could tell that it was difficult for him to explain to his audience the difficult concepts of biostatistics and research studies. These are difficult concepts, as my friend put it.

See, there is a hierarchy to research studies. Graphically, that hierarchy looks like this:

It’s in the shape of a pyramid to distinguish the amount of these types of studies out there. There are a ton of editorials and way fewer systematic reviews. However, systematic reviews are better than all other studies (from an evidence point of view) because they’ve adjusted for biases and other internal and external threats to validity. Epidemiological studies (Case-Control, Cohort, and Randomized Controlled Trials), are in the middle of the pyramid, and they’re how we go from case series to systematic reviews. Epidemiology, as you can see, is what holds the whole goddamn thing up.

This is how reasonable, science-oriented people see evidence. We trust editorials and case series, but we need that science to make sure that what we’re seeing is not based on our own biases and is not the result of chance. Just ask Wakefield how it went when he went backwards and issued his “expert opinion” that the MMR caused autism when his case series paper showed no association between the two things. Even people who are not scientists want to make sure that policy is driven by evidence. Otherwise, you’re just doing things because they feel good, and the chances of failure are multiplied endlessly when you do that.

(CONTENT IN THIS SECTION DELETED AT THE REQUEST OF KAREN ERNST)

Copyright infringements aside, the intent of this woman, as you can see, is to (once again) collect anecdotes from people who are convinced that vaccines “stole” their children. So I went on Facebook and asked a pertinent set of questions, as you can see:

“I know that some pro-vax “sciency” people are probably going to give you a hart time for this, but, personally, I’m looking forward to [how] you collect the data, analyze it, and present it to us. Quick question: Where will you draw the control group from? People who have not been harmed by vaccines? [An anathema to antivaxxers.] And how will you collect THAT data? Or are you going the case series route? ‘Cos case series don’t really rank well in the hierarchy of evidence.”

Now, I’m only making an assumption here, but I bet you dollars to doughnuts that “DK,” who commented after me, went to look at what “hierarchy of evidence” meant, and made what is perhaps the most idiotic statement from an anti-vaccine activist I’ve read this week (besides the ramblings of some petulant kid). As you can see above, she wrote:

“Individual cases and even (horrors) stories are part of the pyramid of evidence based medicine. Epidemiological studies are not. True, individual case histories are at the bottom of the pyramid, but there they are.”

Read it again: “Epidemiological studies are not.”

I must be seeing things. Because I see “case control,” “cohort,” and “randomized clinical trials” right there. Am I crazy?

Of course I’m not. Ren saw the same thing in his presentation yesterday. The people who attended saw the same thing. When I studied for my MPH, my professors and my colleagues saw it.

We all [expletive] saw it!!!

Except for the people who have eyes and won’t see.

Anti-vaccine notions and the people who follow them are dangerous in more ways than one

I came across this the other day:

“Are vaccines causing more disease than they are curing?”

The answer, simply, is a resounding, astounding, non-confounding and unrelenting “NO!” Never mind that vaccines don’t “cure” diseases. They prevent them. Some vaccines are given after exposure to a pathogen, but they are not given to cure. They are given to give the immune system a head start in building a response to the pathogen. But, as always, facts and reality and stuff like that don’t get in the way of a juicy article that goes from being anti-vaccine to diving head-first into being an all-out AIDS denialism diatribe.