Someone wasted their time in biostats class

There have been many times when I’m standing before master of public health (MPH) students, giving them a presentation on epidemiology, and I wonder how any of them can even put on their shoes in the morning. Don’t get me wrong; they’re bright students. Many of them have graduated from college with impressive grades and great projects. They wouldn’t be in these top-notch universities if they were not bright. (Or if their benefactors didn’t see brightness in them.) Still, I’m not surprised when I see many of those kids getting an MPH in epidemiology and not become epidemiologist.

Being an epidemiologist is tough. It requires you to be able to think critically and analyze a problem from different sides and different points of view. Most public health problems requiring epidemiological analysis are big, huge puzzles with many working parts. Just being book smart is not enough. Being street smart is not enough. Being charismatic is not enough. Having an MPH in epidemiology or otherwise is not enough.

Like many people, I have issues completely comprehending biostatistical analyses. Biostats is tough. Few people get through it and continue to take classes in it. In fact, I look at the biostats crew at my job and shake my head in amazement. They can slice and dice data in ways I can’t even dream of. So I go to them with questions about biostats. It was one of them, a PhD-level young lady, who explained to me why the paper by Dr. BS Hooker was full of, well, BS.

I have never claimed to be all-knowledgeable on things like epidemiology and biostats. I just know what I know, and I know when to ask for help. I don’t like to pound my chest and say that I’m the best epidemiologist out there. I’m not.

So who wasted their time in a biostats class? Who else, the kid. What leads me to that opinion? First, some background.

In epidemiological studies, there is a hierarchy of what studies contribute the most evidence. At the very bottom is professional opinion. Surely, you would not guide public health policy based on what I or any other person would write on their blog or in an op-ed, or in a letter to the editor. Right above professional opinion are cross-sectional studies. Cross-sectional studies are basically surveys. You survey the population to get an idea as to what is going on before you move on to bigger, better-designed studies, like case-control and cohort studies. After case-control and cohort studies come randomized trials, where issues of confounding and bias are better addressed, and the results have a lot more weight on how to go about solving a public health problem. At the very top of the hierarchy are meta analyses and systematic reviews, where you take all the data from different studies and weigh all the evidence to separate the wheat from the chaff.

Did you notice how I bolded where cross-sectional studies lie on the hierarchy? Why would I do that? Again, some more background.

The paper by BS Hooker took the data from the DeStefano study and treated those data as a cohort study. That right there was one of many flaws in the BS Hooker paper. You don’t take case-control data (which was how the DeStefano study was conducted) and treat it as cohort data. You just don’t.

When the kid tried to defend the findings of the BS Hooker paper as if his life depended on it, using only a screenshot from a video published by Andrew Jeremy Wakefield (and nothing more), someone pointed out to him (again) the flaws in the BS Hooker approach:

“Hooker didn’t crunch the data as a case-control; he crunched it as a cohort study and without knowing temporality of MMR vaccination with ASD diagnosis, it’s dead in the water.”

The kid took exception to this and made what I believe to be the epidemiological and biostatistical mistake of the year:

“No, he crunched it as cross-sectional.”

I spat my coffee all over my desk when I read this. Not only did BS Hooker torture data, his protege is now saying that BS Hooker downgraded the way he treated the data. Remember where cross-sectional studies rank in the hierarchy? I mean, holy sh!t. I knew the kid wasn’t that good at epidemiology, but this confirms how bad he is with biostats.

The same commenter tried to correct the kid (again):

“Anyone looking at how he modelled the data can see that it was a cohort design and if that wasn’t enough, Hooker explicitely states that, “In this paper, we present the results of a cohort study using the same data from the Destefano et al. [14] analysis.” Taking a tumble down the hierarchy of study-design strength, particularly when the dataset available to him was sufficient to conduct a case-control is a bizarre strategy to salvage Hooker’s miscalculated results.”

But the kid can’t be wrong, not even in this case:

“He should have said cross-sectional in that sentence, but it doesn’t change the validity of his results. Relative risk would be more meaningful to the average person than odds ratios and this is an issue which effects (sic) everybody, so I would imagine that is why Brian Hooker conducted it that way.”

HOLY SH!T. He thinks that cross-sectional analyses are better than cohort, and better than case-control as well!!! Even worse, he thinks people are effected, not affected. So call the grammar police!

Of course, to the uninitiated, this doesn’t matter. To the true believer antivaxxer, the kid is an authority on epidemiology and biostatistics. God help anyone who places their faith on him for analysis of scientific evidence. But thank God that, although my comments are not being allowed through by the kid, he allows comments from other people who can see through his, well, BS.

If you have some minutes to waste, and you want to have a good laugh, go read the comments section of the kid’s blog post. It’s comedy gold. If you know epidemiology and biostatistics, you’ll have a good laugh at the errors in logic and reasoning that are pervasive throughout his commentary and his readers’ comments.

This was the eighth post that has nothing to do with vaccines, for the most part.

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Just in case there was any doubt

Ren wrote a great post on his blog the other day on what makes an epidemiologist. He didn’t mention The Kid (a.k.a. Jake Crosby) by name, but I’m pretty sure that’s who Ren was talking about. It seems that Jake Crosby, on account of having earned a Master of Public Health degree from the George Washington University, fancies himself an epidemiologist. I agree with Ren that people like Jake Crosby are not and never will be epidemiologists. Jake Crosby is not an epidemiologist because he does not work as one — to the best of my knowledge — and, most importantly, he is not an epidemiologist because he believes that vaccines should be eliminated altogether. Anyone with an ounce of decency and common sense in their bodies would not call for the end of something that has saved countless lives.

Just in case there was any doubt of his stance on vaccines, on his blog, this is what Jake Crosby wrote when one of his readers suggested that we (humanity) vaccinate no more:

end_vaccines_comment

The book in question is a new book by RFK Jr. about vaccines and neurodevelopmental disorders. As you can see, Jake Crosby and his reader appear to have developed a macropapular rash when the book is quoted as lauding vaccines for the “achievement in medical science” that they are. “That ingredient” is thimerosal, a compound that contains mercury but is touted as being nothing but mercury by people like Jake Crosby and others. Jake Crosby is apparently angry because one of his (apparently former) idols, Robert Kennedy Jr., is promoting a book about thimerosal causing, among other things, autism but doesn’t go as far as to call for the end of vaccines.

There was a time, way back when, when I would have given Jake Crosby the benefit of the doubt and chalked his anti-vaccine screeds to him just being fed anti-vaccine lies by his friends at Age of Autism. Today, Jake Crosby is an adult who has attended a four-year college and a two-year master’s degree, has been given all the tools of epidemiology to use, has been given all the evidence when it comes to vaccines, and he still calls for the elimination of the vaccine program. How he can classify himself as an epidemiologist after writing those things is beyond me, and beyond reason.

I think Ren went lightly on Jake Crosby’s antics. Me? Not so much. Jake Crosby will never be an epidemiologist because epidemiologists read the evidence and come to the reasonable and proper conclusions. They don’t see monsters under the bed or chase windmills. They don’t call for the elimination of the vaccine program and thus, in essence, call for the return of diseases that would kill thousands upon thousands of children worldwide every day. It’s par for the course for anti-vaccine types, however.

Spitting on the graves of children lost to influenza

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

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

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

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

Continue reading

Influenza is here, it’s bad, and it’s killing people

Contrary to the opinions of people like Peter Doshi, PhD, and others that influenza is not that bad, influenza is pretty bad. Just ask the family of this woman in Texas how bad it is. Or ask the family of this girl. Influenza is being reported from all over the lower 48, Canada, and Mexico. Many public health agencies are now recommending the influenza vaccine as a countermeasure to the increase in cases. As an epidemiologist, I join other epidemiologists in saying that the vaccine is not a good countermeasure, and it shouldn’t be used as the lone countermeasure. It takes a while for it to confer immunity, so it may be too late now that the season is fully underway.

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So-called epidemiologist doesn’t understand epidemiology

The kid wrote this:

“Regarding the data you speak of, I cannot publish it because I do not have access to it nor is it in my possession. We know [autism] is declining because it was discussed in email by a coauthor of then-principal investigator/now-most-wanted fugitive Poul Thorsen’s thimerosal study in email to Thorsen, his then-student and first study author Kreesten Madsen and CDC employee Diana Schendel. A much later study coauthored by Schendel was just recently published showing ASDs going down in years following thimerosal’s removal from Danish vaccines:”

He then links to this study from the University of Miami. From what he wrote above, you would expect that the paper addressed or studied a decline in the number and proportion of cases of autism in Denmark after thimerosal was removed from childhood immunizations. Did the paper address or study this? Continue reading

Reading For Comprehension

Humor me and read the following abstract of a study:

Background The GARDASIL long-term follow-up (LTFU) study is an ongoing extension of a pivotal randomised, placebo-controlled, double-blind, 4-year study to investigate the safety, immunogenicity, and effectiveness of quadrivalent Human Papillomavirus vaccine (qHPV) on the incidence of HPV 16/18-related cervical intraepithelial neoplasia (CIN) 2 or worse in 16–23-year-old women (Protocol 015).

Methods Follow-up of subjects will be accomplished in two ways: (1) registry-based follow-up for effectiveness data as well as safety data including but not limited to deaths, cancer, and hospitalisations; (2) active follow-up for blood collection for immunogenicity assessments at years 5 and 10 of the LTFU study. Effectiveness and safety analyses will occur approximately 2 years following completion of Protocol 015 and approximately every 2 years thereafter for 10 years. The current report represents the first of these efficacy and safety analyses. Cohort 1 included approximately 2700 subjects who received qHPV vaccine at the start of Protocol 015. Cohort 2 consists of approximately 2100 subjects who received placebo at the start of Protocol 015 and qHPV vaccine prior to entry into the LTFU. Vaccine effectiveness against HPV 16/18-related CIN 2 or worse was estimated by calculating the expected incidence of CIN 2/3 or worse in an unvaccinated (placebo) cohort using historical registry data. The primary analysis approach was per-protocol.

Results There were 1080 subjects that contributed to the follow-up period out of a total of 2195 eligible subjects in the per-protocol population in Cohort 1. In these subjects there were no cases of HPV 16/18-related CIN 2 or worse observed. There were also no cases of HPV 6/11/16/18-related CIN, vulvar cancer, and vaginal cancer observed. However, the follow-up time in person-years is insufficient to make a definitive statement about the effectiveness of the qHPV vaccine for the current time period.

Conclusions The qHPV vaccine shows a trend of continued protection in women who were vaccinated up to 7 years previously, although there is as yet insufficient data to confirm that protection is maintained. The qHPV vaccine continues to be generally safe and well tolerated up to 6 years following vaccination.”

You can go ahead and re-read it if you didn’t quite catch something. Continue reading

US girls decide to become less slutty, wash their hands, or get vaccinated? You tell me.

The NY Times is reporting a study published in the Journal of Infectious Diseases where it is reported that the prevalence of HPV infection in girls ages 14 to 19 is half of what it was in 2006. So what happened? Did these girls decide to be “less slutty“? Did hygiene and sanitation finally make their way to these girls’ vaginas? No.

What happened was that anti-HPV vaccines came online in 2006, and lots of girls are getting them. Lots, but not as many as we need to sustain this decrease. We’re far behind other countries in that respect. According to CDC:

“This report shows that HPV vaccine works well, and the report should be a wake-up call to our nation to protect the next generation by increasing HPV vaccination rates,” said CDC Director Tom Frieden, M.D., M.P.H.  “Unfortunately only one third of girls aged 13-17 have been fully vaccinated with HPV vaccine.  Countries such as Rwanda have vaccinated more than 80 percent of their teen girls. Our low vaccination rates represent 50,000 preventable tragedies – 50,000 girls alive today will develop cervical cancer over their lifetime that would have been prevented if we reach 80 percent vaccination rates.  For every year we delay in doing so, another 4,400 girls will develop cervical cancer in their lifetimes.”

Most of you will know that HPV vaccine continues to be demonized, against all the evidence, and anti-vaccine people keep blaming deaths and disabilities on it. A presidential candidate fueled the fire based on similar misconceptions about the vaccine. But, guess what? The evidence keeps coming in. The vaccine is safe, effective, and it is cutting infections in half. Now, we need to replicate these findings in those highly-vaccinated countries to put yet another nail in the coffin of the HPV vaccine conspiracy.