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:

Screen Shot 2013-07-20 at 11.13.15 AM

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. Continue reading

Denialism pure and simple (UPDATED)

When I was in college, I took a course on military science. This course talked about the scientific discoveries we have made through war. By trying to kill each other off in a simpler manner, we’ve discovered a lot, from a scientific point of view. During that course, we spent about three weeks focuses completely on the Nazi medical experiments. If you haven’t heard the story, I invite you to go to the Holocaust Museum in DC and take a look at their exhibits. In essence, Nazi medical “researchers” conducted unethical experiments on humans (concentration camp prisoners, prisoners of war, etc.). We discussed for three or four classes whether or not we — the then future scientists — should use any of the knowledge gained from those experiments in order to expand science.

I won’t bore you with the philosophical and ethical discussions that erupted then. No, I will entertain you with the story of the one guy in class who decided that he was going debunk the “myth” of the Holocaust. Actually, it’s a short story; he was kicked out of class at the discretion of the professor. The guy actually wanted to argue with our professor, a Holocaust survivor.

I laughed out loud. That fool of a student.

But it does lead to an interesting question: How do you know what is true to be the truth? How do we know that the Holocaust really did happen? What evidence for and against can we believe?

Of course, this is a non-starter for many people who are reasonable and understand the concepts of historical evidence. There were thousands upon thousands of first-hand accounts of what happened in Nazi-occupied Europe. There are movies and records kept by the Nazis themselves. There are movies and documents from Allied Forces that liberated the concentration camps. In short, the Holocaust happened. There is no doubt about it.

Yet there are those who walk on this earth and deny that the Holocaust happened. Whether or not they believe that it happened is between them and their god. They go around telling everyone they can that it didn’t happen, that’s is a Jewish conspiracy, or that the Holocaust is a misrepresentation of what really happened. (I’m sure it was nothing but kittens and puppies in Auschwitz.)

Then there are those Holocaust deniers who also deny that the HIV virus causes AIDS. Even better, some of them deny that HIV even exists. They say that it’s all an attempt from the pharmaceutical industry to bleed the public dry through the sale of laboratory tests and unnecessary drugs. (I guess all of those dead people in Africa and elsewhere died of kitten and puppy overdoses.)

There is a particularly interesting person out there who goes by the moniker of “Putin Reloaded“. PR is interesting because there is no conspiracy theory that he doesn’t like. For example, this is what he has to say about HIV not being the cause for AIDS:

Antibody tests are not valid surrogates of virus detection, for all antibodies are heterophile and promiscuous. 

If you don’t know what those words mean look it up! 

About 30% of people have at least one “hiv” antibody in their blood, that’s how absurd the assumption is: http://www.ncbi.nlm.nih.gov/pubmed/2230270 Frequency of indeterminate western blot tests in healthy adults at low risk for human immunodeficiency virus infection. ” 32% (low risk controls) had indeterminate Western blot tests, most of which demonstrated a single band of lowintensity. The most common bands were p24 (47%), GAG p17 p55 (34%), and POL p31 p66 (36%); envelope bands were unusual (gp41, 2%; gp120, 2%).” Confirmed by: http://elcid.demon.nl/1995_Western_blot_35pc_of_donors_have_1_band_at_least.png Antibodies to Human Immunodeficiency Virus (HIV-1) in Autoimmune Diseases. ” 126 blood donors as a control group…At least one band was shown on immunoblotting in 26% of patients with autoimmune diseases and 35% of controls. ” 

So HIV tests are basically tools to fool perfectly healthy individuals into believing they’re carriers of a deadly virus and put them on deadly drugs. A self-fulfilled prophecy.

Oh, really? When PR is confronted with questions about PCR and viral cultures being used to confirm antibody tests, he gets really defensive and claims that one is personally attacking him.

PR is also into Holocaust denial, as I stated before:

“Recall that the Holocaust is an unfalsifiable theory, ie, it is impossible to refute because it is expressly prohibited by law in many European countries. Therefore, the Jewish Holocaust is not a historical fact but a legend that it takes an act of faith to believe.”

(Thanks to Pedro [not her real name] for the translation.)

So why am I writing about PR?

I’m writing about PR because he is exactly the kind of person that needs to be countered at all possible opportunities. In your private life (e.g. at work, in your family) and in your public life (e.g. out with friends) you must counter the ramblings of people who deny historical facts and scientific evidence. I’d advice you to be gentle and respectful, but you know me better than that by now.

To the AIDS denier, you must explain to anyone within earshot of that AIDS denier that we know that HIV causes AIDS because the grand majority of people who are infected with HIV go on to develop AIDS if they are not treated. They also go on to die. We know that the grand majority of people with AIDS have HIV infection. We know that the virus multiplies inside of immune cells, thus killing the immune system and allowing for opportunistic infections. Plenty of us have held the hand of a dying AIDS patient. Are there infected people who do not develop AIDS? Yes. Are there people who develop AIDS but were not infected with HIV? Yes. AIDS is a collection of diseases and conditions, a syndrome. But we see it in people with HIV infection for the most part (almost 100%).

The AIDS denier will try to use rare occurrences as clear evidence of their point. Don’t let them.

Likewise, the Holocaust denier will say that there were no extermination camps in Germany during the Nazi regime. This is true. The extermination camps were outside the country of Germany and in Nazi-occupied Europe. Here’s a map. They will also tell you that Hitler never signed an order to exterminate 6 million Jews and another 6 million “undesirables”. For that, read this.

In other words, stand up to the bigots, the denialists. Tell them and anyone around them why, how, when, and where they are wrong. Be ready to present the evidence, like radioactive decay to young Earth creationists, the physics of water vapor to those who believe that airplanes are dropping chemicals in contrails, or simple epidemiology to those who believe vaccines cause autism. It is important that we do this because they can do a lot of damage with their ideas.

A lot of damage.

**** UPDATE ****

The troll decided to show up in the comments section. Let me make this clear to you, Mr. PR, this is not your blog. This is not your platform to spread more antisemitism, misogyny  and AIDS denialism. Your comments are not accepted, and they will be deleted. (What’s that about misogyny  Mr. PR has told a group of female scientists that women naturally lack initiative and need father figures to guide them and tell them what to do next.)

The reasonable and concerned parent of a child with autism

One of the most ardent anti-vaccine people I know is this man.

This man portrays himself as a concerned parent who is just doing what any parent would do. By his account, his son regressed into autism shortly after being vaccinated. In his mind, this is definitive proof that it was the vaccines that caused it. Because of that idea, he has said things like this:

“With less than a half-dozen full-time activists, annual budgets of six figures or less, and umpteen thousand courageous, undaunted, and selfless volunteer parents, our community, held together with duct tape and bailing wire, is in the early to middle stages of bringing the U.S. vaccine program to its knees.”

That’s the spirit. Let’s bring back the epidemics of vaccine-preventable diseases to levels not seen in decades because of the scientifically unproven fear that vaccines cause autism. And it seems there is nothing that he won’t do, say, and no one he won’t follow (as long as they share the same ideology, of course).

About three years ago, just as the 2009-2010 influenza season was starting, a young woman from the Washington, DC area made the news because she claimed to have had a neurological condition thrust on her from an influenza vaccine. Here is the whole story, but pay attention to this part:

“Once the Internet was buzzing with this story, a guy named [redacted] got on the case. He’s an epidemiologist with the Maryland Department of Health, but he gets antsy when introduced that way, so we’re quoting him here strictly ex officio! Anyway, [he] found Jennings’ case report in the “Vaccine Adverse Event Reporting System,” which tracks this kind of thing. Her VAERS report reads in part, “The admitting neurologist felt that there was a strong psychogenic component to the symptomology, and made a final diagnosis of weakness.””

(This is what [redacted] wrote about that case.)

Things were not all that they seemed about that young lady, who was supported by the man in question and his organization. When asked about that whole thing by “Frontline”, this is how he answered:

“[Interviewer] Talk about the viral spread of an image over the Internet, like [Redskins cheerleader] Desiree Jennings’ flu shot story, for example.[Man] It’s remarkably powerful what an image or an idea can do in today’s day and age, and for a group of parents who feel completely outmatched — because think for a moment about who our enemy is; our enemies are the largest pharmaceutical companies on the planet, making billions of dollars in net profit a year — you’d think that we could never compete with that. But an idea can transmit itself powerfully and very cheaply for millions to see. So in the case of Desiree, here you have an image of this beautiful woman who’s been severely disabled that literally tens of millions of people view overnight, and imagine the chilling effect that has on a flu vaccine that she attributes as the cause of her condition. It’s remarkably powerful.
[Interviewer] Does it matter whether it’s true or not?[Man] Truth always bears out in the end, so I’m a firm believer in that. Are there moments in time where truth is exaggerated or expanded? Absolutely. But truth bears out in the end. …”

“Are there moments when the truth is exaggerated or expanded? Absolutely” Wow. That’s an understatement. Myself and other bloggers, journalists, writers, and, let alone, scientists have documented time and again the misinformation and outright lies from anti-vaccine groups and their members. Everything from conspiracy theories about multinational parties and even extraterrestrial invasions has been discussed and revealed for what it all is: lies and misinformation.

“But truth bears out in the end.” I guess, if the waves of anti-vaccine-induced panic don’t bring about “the end” to people who didn’t know better but to listen to anti-vaccine propaganda.

But the man in question is just being a reasonable, concerned parent. From that same interview on “Frontline”:

[Interviewer] Once you connected with these groups, you started to play a role in the organization?
[Man] If you saw The Matrix, it’s like all of a sudden you’re looking behind the matrix as to everything that’s going on. We’ve got 1 in 6 kids with learning disability, 1 in 12 with ADHD [attention deficit hyperactivity disorder], 1 in 110 with autism. What’s happening to our children is insane, and once my wife and I were pulled behind the matrix to see what was going on, we felt compelled to act, not only on behalf and in honor of our own son, but on behalf of all these other kids, too.”

It’s all about the children. But I have the sneaky suspicion that it is about something else, too. No, I’m not talking about money. The man has more than enough money to cover the media blitzes against vaccines, supporting his efforts to bring the U.S. vaccine program “to its knees”. I’m talking about an ideology.

An ideology is a way of looking at the world. Ideologies shape our actions and dictate our goals. It is neither good nor bad to have an ideology. It’s just one of those things about being a thinking human being. (Thinking does not equal rational, by the way. Not in this context.) From what I gather in the man’s blog posts and interviews, his ideology is one that vaccines cause autism, period. And, like any good ideologue, he seems to have his champion.

Who is this champion worthy of the man saying the following about him?

“To our community, Andrew Wakefield is Nelson Mandela and Jesus Christ rolled up into one… He’s a symbol of how all of us feel.”

A discredited physician-researcher who was struck off the medical register in the UK and found to have committed fraud in his MMR-autism “study” is, to the man, the equivalent of a freedom and equality fighter AND The Son of God.

Do I really need to write more?

I do and I don’t. The hardcore anti-vaccine types have probably already skipped to the comments section and started writing something full of vitriol that I won’t publish (because it’s full of vitriol). Or they clicked away to the anti-vaccine echo chamber, their hearts festering with hate for me. For those people, I don’t need to continue writing.

For the pro-science, truly reasonable person who accepts the evidence, compares it to what we already know, and follows the science wherever it leads us, this whole thing is nothing they have not heard already. They probably already moved on.

This is for those of you who are on the fence about vaccines, autism, and science in general. I want to reach out to you if you have just discovered that your child is autistic and you’re wondering if it was the vaccines that caused it. Despite what this man and his ideology, his blogs, his celebrity friends, and his fellow ideologues tell you about vaccines, here is the wheat separated from the chaff:

  • We have looked at the biological process by which vaccines protect us from infectious diseases by activating our immune system. This process does not lead to autism. Not in humans. Not in lower primates. Not in mice. Not in a computer simulation.
  • We have taken groups of children with autism and groups of children without autism and compared their vaccination records. Their vaccination records are the same. Being vaccinated or not has no bearing on the risk of autism.
  • We have looked at countries that provide lesser numbers of vaccine doses or overall vaccines. Their rates of autism are comparable to the United States. The reason they may be different in some cases is that they have a different definition of autism or no way to track it, or both.
  • We have looked at the risks of reactions from vaccines and determined that those reactions occur at a frequency in orders of magnitude less than if the person gets the infection itself. That is, you’re more likely to be injured by a vaccine-preventable disease than by a vaccine. Heck, you’re more likely to die driving to the doctor to get your vaccine than to get any reaction from a vaccine.
  • Reactions to vaccines can and will occur, but, as stated above, they are less frequent and less severe than the diseases themselves. Not vaccinating opens an avenue for those disease to come back and really do a number of the lives and wellbeing of children everywhere, not just yours.

By “we”, I mean scientists, epidemiologists, physicians, researchers… People who have done a lot of studying at accredited institutions of higher learning, who have written peer-reviewed papers, and whose evidence has stood the test of everything. “We” are those of us whose ideology can best be summed up as “that’s interesting, let’s see what the science says” when it comes to issues such as these.

By “we”, I do not mean celebrities who saw a coincidence and ran with it to sell you their story.

I certainly do not mean a man who has taken it upon himself to destroy the one thing that keeps the story being told in “The Poxes” from being a reality.

Oh, ye who have ears and yet won’t listen

There is a hilarious thread going on on Facebook right now between an anti-vaxer and a pro-vaxer. (Yes, I checked in with a few comments and explanations, but mine are just a small fraction of the comments.) Go over and check it out before it gets deleted by the anti-vaxer.

If you don’t want to go over and read, I’ll give you the long and short of it:

The anti-vaxer calls herself “Vaccine Skeptic Society” and a “non-profit organization”. Mind you, she is just one person, an at-home medical coder (per some conversations of hers on Facebook), and someone who is totally ignorant of science. Okay, maybe not totally ignorant, but she does come off as knowing nothing, absolutely nothing about science.

(She should also be careful because calling yourself a non-profit without being one is a crime, and I have been so far unable to find her registered as a non-profit anywhere.)

The anti-vaxer began claiming that the influenza season is a result of influenza vaccination. That is, she postulated that the flu vaccine — and shedding from the vaccine, which is incredibly improbable with the nasal vaccine and impossible with the injected vaccine — causes the yearly epidemics that we see in the northern and southern hemispheres. I’m not kidding. Check this out:

And Easter eggs cause Easter

Those 150 comments are her and a couple of science-oriented people, myself included, trying to set her straight. But then she just goes off on a tangent. This is a later post of hers, in which she alleges that H. influenzae (a bacteria) is what really caused the pandemic:

Because something believed in 1918 is so true today

Now, I would try to explain to her why she’s wrong and why that was just what scientists believed at the time, but it would be pointless. (Viruses as such were theorized before 1918, but it wasn’t until the invention of the scanning electron micrograph that they were visualized and later isolated. Shortly after that, we had a vaccine. In between the SEM and the vaccine, we were able to isolate antibodies. Later, we’d isolate the virus from corpses of people who died in the pandemic, but no H. influenzae.)

It would be pointless to argue because she is a germ theory denialist.

Anyway, if you want to have a good laugh at someone who is rabidly anti-vaccine and wants to come off as a scientist, go over to her page. Chuckle as you read her write over and over that she’s “just asking questions” and wants to have a “balanced” debate.

There are bigger, more important reasons why I’m pointing out her stupidity. I’m pointing out her stupidity because it is classic of most anti-science and anti-vaccine people. They know very little to nothing about the sciences of microbiology and immunology, yet they pretend that they do. They then go and google for any science article that sort of kind of confirms their beliefs and post it on their own echo chambers to show to their followers how smart they are. (Their followers are just as clueless about science as they are, by the way.)

This brings to the forefront the need for better science education at the elementary and secondary school levels. We really can’t get more people like the idiot above get out into the public, create Facebook pages alleging to be non-profit organizations (a crime) and “just ask questions” that lie and deceive unknowing people out of a safe and effective way to prevent deadly communicable diseases. Because, soon enough, some poor new parent is going to stumble onto her rants and get the wrong idea about vaccines, refuse to vaccinate their child, and lose or have that child injured by a vaccine-preventable disease.

Oh, yes, it’s that important to learn science early and often.

The Anti-Vaccine Reality Distortion Field

There used to be a time when diseases that are now vaccine-preventable used to be, well, non-preventable because there were no vaccines for them. Because we made it far as a species, it is the sincerely held belief from some anti-vaccine people that we don’t need vaccines. That, or they think that vaccine-preventable diseases are not deadly.

Take, for example, chicken pox (varicella). Before the vaccine was introduced in 1995, about 100 people or so died form it, and over 11,000 were hospitalized per year from chickenpox. In a country of several hundred million, 100 deaths don’t seem like a lot. You probably wouldn’t call chickenpox “deadly” at that rate. But try telling that to those 100 families. See if they agree with you.

Since the introduction of the chickenpox vaccine, the number of deaths per year from it in the United States has dropped to less than 5. Let that sink in for a little bit. Each year, 95 people who would have otherwise died from chickenpox are alive to be productive in society, to hug and love and be with those who love them. Let THAT sink in a little.
Ah, but no! Anti-vaccine advocates will go as far as organize chickenpox parties to expose their children to the virus. Willingly or not, they want to “up” that number from 5 to 10 or 20 or, why the [expletive] not, all the way back to status quo at 100 if we do away with the vaccine altogether. I think they do it because they are not the ones explaining to those 100 families why their loved ones died FROM A PREVENTABLE DISEASE.

That is, IF they believed that chickenpox kills. Perhaps because chickenpox deaths are rare, there are those in the anti-vaccine camp who believe that chickenpox doesn’t kill.

Exhibit A

The person on top was trying to show the person on the bottom that, yes, in fact, chickenpox does kill. It killed before, and it can kill again if we stop vaccinating. The person on the bottom would have none of it. The person on the bottom questioned the mental health of the other person for even suggesting that chickenpox kills. That, ladies and gentlemen, is the degree of denial that people who have swallowed anti-vaccine tropes hook, line, and sinker will go to.

In their version of reality, chickenpox doesn’t kill.

In the rest of the world’s version of reality, chickenpox not only kills. It can leave a child with all sorts of complications. It’s even worse for adults, causing swelling of the brain and other problems. In their version of reality, vaccines didn’t cause the >95% reduction in the number of deaths. In the real world, however, study after study, observational and experimental, has shown that the vaccine is nothing short of a gift from God.

In the real world, we had to explain to this family why chickenpox took their child.