Let me start with the conclusion, because Peter Doshi’s article can be a little dry if you let it. I don’t want you to miss the point…
In the end, yes, CDC and vaccine manufacturers are out there paying for pushers of vaccines to push vaccines on the population. But we’re talking about vaccines and not heroin. Independent agencies (like local and state health departments, academic institutions, and competing pharmaceutical companies) all continue to validate the need for vaccination as a life-saving public health intervention. That is the difference between this kind of “pushing” of a “pharmaceutical” and pushing something that truly harms. We don’t need Peter Doshi or Sharyl Attkisson or Age of Autism to be the watchdogs because their anti-vaccine intentions are, in our opinion, very clear. For truly making sure that vaccines do far more good than any harm, we have the dedicated healthcare providers, epidemiologists, biostatisticians, and other public health workers who look at the evidence (observational and experimental) and continue to promote vaccination against all the hate and vitriol of the anti-vaccine cult.
And now, the meat of this blog post…
You remember Peter Doshi, don’t you? He’s the dude who wrote a “shocking” report about the influenza vaccine and how it supposedly didn’t work. As it turns out, the report wasn’t all that shocking. As Dr. Salzberg wrote:
“First, as Snopes.com has already pointed out, Doshi is not a virologist or an epidemiologist, but rather an anthropologist who studies comparative effectiveness research. He never conducted influenza research at Hopkins. (He’s now an Assistant Professor at the University of Maryland’s School of Pharmacy.) Second, Doshi’s 2013 article was an opinion piece (a “feature”), not an original research article, and it did not report any new findings. Third, it is highly misleading to suggest (as the anti-vax article’s title does) that Doshi somehow represents Johns Hopkins University. At Johns Hopkins Hospital, the flu vaccine is required of all personnel who have contact with patients, as a good-practices effort to minimize the risk that a patient will catch the flu from a caregiver.”
People who ask me about Peter Doshi get one simple warning from me: Be careful with his writings because he’s very good at manipulating language. Dr. Salzberg’s article continued:
“Doshi uses this sleight-of-hand to suggest that the vaccine may not be beneficial at all. He never says this outright—instead, he just questions, again and again, whether the precise percentages reported in published studies are accurate. For example, he makes a big deal of a CDC announcement in 2013 that the vaccine’s effectiveness was only 62%. He casts doubt with phrases like
“the 62% reduction statistic almost certainly does not hold true for all subpopulations”
That is almost certainly true, but is meaningless from the point of view of public health. Of course the vaccine doesn’t have the same effectiveness in everyone. The point is that it works most of the time.”
Earlier this year, Peter Doshi was at it again with “just asking questions” (aka JAQ-ing off) about the Vaccine Adverse Events Reporting System (VAERS). There was a technical glitch on the VAERS system that prevented some users from being able to access it. He made a big deal about it, and he never clarified that it was a technical glitch which was correctable and certainly not part of some big conspiracy to keep people from reporting vaccine adverse events. The VAERS site has since been updated, and it is working well, but Peter Doshi will probably not tell you that.
Well, now Peter Doshi is at it again. This time, it’s those horrible pro-vaccine organizations who get all sorts of funding from all sorts of horrible pro-vaccine agencies in the federal government (i.e. the Centers for Disease Control and Prevention [CDC]). He’s written an opinion piece that is chock-full of nuts. And, as I’ve warned you, he uses language to obfuscate the issue.
So let’s dissect it, shall we? He begins:
“Vaccination programs have long been a centerpiece of public health activity. But policies of compulsion have always been controversial. Against a backdrop of recent measles outbreaks, France and Italy moved this year to mandate certain vaccines for school entry. There’s even a renewed push for mandates in the UK, where public health leaders have long resisted compulsory vaccination on the grounds that it undermines the trust between the public and healthcare professionals and is ultimately counterproductive.”
The policies requiring vaccine are controversial not because vaccines are bad but because people keep spreading the idea that vaccines are some sort of poison. People don’t want to be poisoned, and they certainly don’t want their tax money to go toward poisoning others. That is how anti-vaccine groups are born. They’re born out of an idea that is flawed from the beginning. (Like the idea that HIV doesn’t cause AIDS, which we’ll talk about some more later since we’re talking about Peter Doshi.)
Let’s see some language manipulation:
“The debate is also alive in the US. Although all states require vaccination as a condition for entry to school, most also allow exemptions for families with non-medical philosophical or religious objections. Overall, childhood vaccination levels remain at or near historically high levels, with under 1% of toddlers receiving no vaccines. But beneath the broad national trends there is geographic variation in coverage, and survey data have documented that parental concerns over vaccination safety and timing are common, even among those whose children receive all recommended vaccines.”
Note that Peter Doshi doesn’t mention what a slight drop in vaccine coverage can do. For example, when it comes to the MMR vaccine against Measles, Mumps and Rubella, even a tiny drop in vaccine coverage can lead to an outbreak. So, yeah, it might be good that we’re at under 1% of toddlers, but if that number doubles, or if it reaches 5% in the pockets where anti-vaccine sentiment is high, we can be in for some expensive public health responses.
Peter Doshi continues:
“In 2015, a US federal advisory committee warned that public confidence in vaccines cannot be taken for granted, and some prominent vaccine advocacy organizations are pushing for greater compulsion. But are these groups—which present themselves as reliable sources of information—providing the public with independent information?”
He is now beginning with the JAQ-ing off, and it’s a question that seems to imply that non-independent information is bad. He continues with the example of Senate Bill 277 in California, a bill that became law and removed personal and religious exemptions from vaccine requirement. Instead of saying that their personal belief or their religion prevented them from vaccinating, anti-vaccine people had to find “vaccine friendly” physicians (like noted Douchebag Dr. Bob Sears) who would acquiesce to their fears and allow them to be exempt from vaccination “for medical reasons.” Organizations that were involved in the promotion of that bill’s passage was Every Child By Two (ECBT), the American Academy of Pediatrics (AAP) and the Immunization Action Coalition (IAC). And they were correct to do so because vaccines save lives. But, Peter Doshi writes:
“IAC, ECBT, and AAP have a few things in common. They are all non-profit organizations with large online presences that promote themselves as sources of reliable information on vaccines. They also receive funding from both vaccine manufacturers and the Centers for Disease Control and Prevention.”
Oh, noes! CDC promoting a public health intervention with a great track record of working? What shall we do? Vaccine manufacturers promoting their safe and effective products against deadly diseases? Say it ain’t so.
He finishes that section with a mention of his old nemesis, the influenza vaccine:
“And, in their advocacy for compulsory vaccination, they all have in common a goal that pushes beyond official governmental policy and, in the case of influenza vaccines, the evidence.”
The rest of the article has several more questions for us to consider. “Education or lobbying?” is one of the questions because these organizations dared lobby for a public health bill that has probably saved several lives by now (and all without causing autism, to boot!). “Did ECBT and AAP’s support of the California bill cross a line for the CDC?” Peter Doshi asks. He asks this because there is regulation against CDC using money for lobbying pro or against pending legislation. This is a grey area when it comes to vaccines because CDC’s mandate is to protect health and save lives. For that, vaccines are needed. So support of a bill that has increased vaccine uptake in California fulfills the mission of the agency. Then Peter Doshi goes after the influenza vaccine again:
“One of the non-profit’s use of evidence is also questionable. Multiple reviews have found insufficient evidence that mandatory influenza vaccination for healthcare workers has benefits for patients. As one team of systematic reviewers put it, “evidence from observational studies suggests that a vaccine mandate increases vaccination rates, but evidence on clinical outcomes is lacking.””
I told you the vaccine was his nemesis. Peter Doshi can’t seem to get off of it. Or, rather, he seems to get off on not getting off of it? (I’m just asking.)
The questions keep on coming from Peter Doshi:
“In broad terms, the CDC and vaccine advocacy non-profits share a common goal of increasing vaccination rates. But when it comes to the details—which vaccines, when, for whom, and how to achieve those goals—is there a need for independent sources of information on vaccination policy?”
“But do advocacy organizations with financial ties to the CDC and vaccine manufacturers have sufficient distance to offer such a service?”
What? No questioning of Dr. Paul Offit’s intentions? Shame on you, Peter. Shame on you.
As far as originality, I have to say that this anti-vaccine article is not very original. (It is anti-vaccine, Peter, because you seem to be questioning the need for vaccine mandates, vaccine information to the public, use of the influenza vaccine, and promotion of the use of vaccines, over and over and over again without a single mention of the good that vaccines have done.)
It’s a lot like this blog post by Age of Autism whose thesis was that ECBT got a lot of pharma money and thus vaccines cause autism, or something. And this other blog post by the same cesspool of so-called reporters which contends that the Immunization Action Coalition got a lot of sweet, sweet cash from CDC.
Noted anti-vaccine activist and conspiracy theory loon, Sharyl Attkisson asked the same questions (or did the same JAQ-ing off) as Peter Doshi did, except that she did it in 2008. (Little late to the party, Peter.) Sharyl wrote:
“There’s nothing illegal about the financial relationships, but to critics, they pose a serious risk for conflicts of interest. As one member of Congress put it, money from the pharmaceutical industry can shape the practices of those who hold themselves out to be “independent.”
The American Academy of Pediatrics, Every Child By Two and Dr. Offit would not agree to interviews, but all told us they’re up front about the money they receive, and it doesn’t sway their opinions.”
So I wonder where Peter Doshi got his inspiration for his latest anti-vaccine post?
Let’s quickly go back to what Dr. Steven Salzberg wrote about Peter Doshi, because it reveals something troubling about Peter’s view of the world:
“Perhaps even more disturbing is that Doshi signed a petition arguing that the HIV virus is not the cause of AIDS, joining the ranks of HIV denialists. He signed this statement while still a graduate student, so I contacted him to ask if he still doubted the link between HIV and AIDS. I also asked him if he supports flu vaccination, if he agrees with the anti-vaccine movement’s use of his statements, and if he believes the flu is a serious public health threat.
On the question of signing the HIV/AIDS petition, Doshi responded that “Seeing how my name was published and people have misconstrued this as some kind of endorsement, I have written the list owner and asked for my name to be removed.” He declined to state directly that he agrees that the HIV virus causes AIDS—though I gave him ample opportunity.”
It seems to me that Peter Doshi has a conspiratorial view of how the world of science works. If 99% of scientists say that HIV causes AIDS, it seems that Peter Doshi (a young Peter Doshi, a graduate student Peter Doshi) rebelled against that. If 99% of scientists and physicians and epidemiologists say that the flu vaccine is a good idea at a population level to mitigate the effects of the seasonal epidemics, it seems that Peter Doshi rebelled against that. Now, if 99% of pediatricians, epidemiologists, and public health authorities are finding ways to counter anti-vaccine nut jobs who are convinced that vaccines are poison and that they can endanger us all, it seems that Peter Doshi rebells agains that.
It would all be fine and well if he wasn’t an associate editor at the BMJ, a highly-respected journal. It makes me fear that articles submitted for review that shed a positive light toward vaccines, or toward the HIV-AIDS causal pathway, are not being accepted, or that hey may be stonewalled. Of course, I have no evidence of this, and pushing that idea without evidence would make me no different than Peter Doshi and Sharyl Attkisson and the bunch of weirdos at Age of Autism. But, still, I can’t help but wonder… And shudder.