Several of the journals I receive alerts from are in the AltMed domain and I sometimes wonder why I bother looking through them at all. The mix is usually some proportion of “Survey of x population using y alternative modality” often merely chronicling the depressing rise of AltMed/CAM in general use (either actual or claimed depending on your definition of CAM).

The rest are often boringly conventional in their attempt to be scientific having titles like “Effects of vitamin E suplementation on renal non-enzymatic antioxidants in young rats submitted to exhaustive exercise stress“. These I don’t bother with. I just don’t have the expertise to parse them with any reliability.

Then there are the odd gems, either for comedic value or because they offer an alternative perspective on alternative medicine.

Recently one of the later came down the intertubes and into my in-box. Published in BioMed Central’s journal “Chiropractic & Manual Therapies”, the article is entitled “The Five Eras of Chiropractic & the future of chiropractic as seen through the eyes of a participant observer”.

The paper starts with a potted history of Chiropractic and the environment that it was founded and grew up in to the present. The early days could be seen as Chiropractic’s first opportunity to start down the science based path. In 1910 the “Flexner Report” on medical education was published and with it’s acceptance by the medical educational community came legitimation to those who abided by it’s recommendations. As well as:

“…generous funding via the Rockefeller Foundation while schools that did not assent, simply ceased operation due to lack of funding. The result was that, by 1930, only 76 of the 168 medical schools remained.“

The impact on Chiropractic is characterised thusly:

“In part because of the rejection of science by a significant element within the chiropractic profession, and in part because the Flexner Report dismissed the chiropractors as “unconscionable quacks who should be dealt with by the public prosecutor and the grand jury”, the chiropractic profession bypassed the era of educational reform.“

The early twentieth century therefore saw a great deal of animosity towards the nascent Chiropractic practice and the emerging scientific medicine of the time. Indeed the author argues that this conflict essentially shaped Chiropractic as we know it today. In order to defend Chiropractic from the legal attacks being made on it it was necessary to develop a definition of Chiropractic that would insulate it from charges of practising medicine without a licence, charges that were common against Chiropractors of the time.

This is related as involving four simple concepts:

“1. Chiropractic is not medicine; chiropractic has a “separate and distinct philosophy and practice”.
2. Chiropractors do not diagnose, but analyze the spine for the  cause of dis-ease.
3. Chiropractors do not “treat,” but adjust the spine for the cause of dis-ease.
4. The Chiropractic profession has been built upon success in cases where medical doctors failed.“

Putting aside the obvious sophistry in these concepts (how might we define the difference between diagnosis and “analyz[ing] … for the  cause of dis-ease” or between treatment and “adjust[ing] the spine for the cause of dis-ease“?) it is argued then that the very fact of opposition by the medical establishment helped to solidify the tenets and practice of Chiropractic:

“During this journey, the chiropractic community developed and embraced a distinct lexicon and rationale toward health and its maintenance in order to emphasise the difference between medicine and chiropractic. Thus the “philosophy of chiropractic” became “an unyielding dogma”.“

With this legal history at it’s back Chiropractic moved into the next period of it’s history where it was the focus of a co-ordinated and sustained attack by the medical establishment in the form of the AMA.

Carrying out the opposition to Chiropractic was the “Committee on Quackery”:

“The Committee on Quackery was well funded, and operated a highly successful campaign that was centred on three main strategies:
1. An ethics based boycott, which deemed it unethical for AMA members to have professional dealings with chiropractors;
2. Convincing other organizations to adopt or adapt the AMA’s anti-chiropractic policy; and
3. Instituting a comprehensive political campaign to thwart chiropractic progress on several fronts, including but not limited to education, research and insurance funding.“

This campaign was put to an end in 1987 thanks to a permanent injunction ordered against the AMA, after a lawsuit was levelled against it by a number of Chiropractors. At this point it’s difficult not to see the Chiropractic as a beleaguered philosophy deserving of empathy on behalf of it’s persecuted adherents.

Emerging from this legal victory Chiropractic has been slowly edging it’s way into mainstream acceptance with the development of Chiropractic based courses in universities and a surge in chiropractic research. Unfortunately the steadfast refusal of many Chiropractors to relinquish the unscientific concepts of old has meant that as a profession they are still looked upon with disdain:

“Chiropractic’s problem is that subluxation based chiropractors are not only deluding themselves, they are indoctrinating patients into believing in a purportedly dangerous mythical entity, and that without regular adjustments, patients will not only fail to reach their full potential, they will likely suffer serious health problems.

Some authors have suggested that this may be a threat to public health . And this, at a time when the profession has just entered The Era of Chiropractic Opportunity.”

The opportunity discussed is that of the ever growing need for specialists in musculoskeletal care. As the worlds population ages the demand for providers who are proficient in the treatment of pack pain/musculoskeletal disorders will only increase.

It is into this world that the Chiropractic profession must be re-born as the evidence based providers of musculoskeletal care that are needed. The problem is that if Chiropractic insists on holding onto the non-scientific notions of DD Palmer then it voluntarily relegates itself to the back waters of medical practice.

This then is the proper focus of the article: where Chiropractic will go from here.

Least attractive to the author is the prospect that the practice will stay on it’s current trajectory, keeping the outdated concepts that it was founded upon and denying the very science that would confer upon them the legitimacy they crave.

Two options are given as alternatives to this “Status Quo” approach: one is to definitively split the profession into those that follow the traditional method of chiropractic practice, so-called “Straight Chiropractic”, and those who are willing to discard tradition and step into the light of science and evidence based practice.

The second and preferred option is to move forward with a united front, ditching along the way those parts of Chiropractic that are unsound and unproven. This is also recognised as the most difficult route for the profession, requiring near superhuman commitment from the individuals and organisations that make up the world’s Chiropractic profession:

“Escaping from the dogma house will require extraordinary cooperation amongst all aspects of the profession. Organizations such as the World Federation of Chiropractic and all major chiropractic associations will need to agree upon and adopt a position statement identifying the chiropractic subluxation as an historical construct that remains a hypothesis, which cannot form the basis for patient care until and unless there is a body of scientific evidence to support it.“

“If the profession is to gain the trust of the consuming public it must, of necessity, become truly self-policing.

Only in this way will chiropractic generate the cultural authority required for recognition as a group worthy of the title “Profession”.

No longer can we cast a blind eye. By our silence we are giving consent.“

Should Chiropractic refuse to move properly into the 21st Century then the consequences for it as a whole may be dire, leaving it’s future as a force in medical practice in doubt.

“The chiropractic profession can choose to be illiterate, but it will do so at its peril. It is realized that thinking is hard and that those who are unaccustomed to thinking may even find it unpleasant. On the other hand, thinkers have always found it rather fun and there are no confirmed reports of anyone dying or being seriously injured by thinking. Thinking may necessitate changing our minds – which may not be a bad thing. At the very least the profession owes it to its patients.“

Related articles

• Subluxation Theory: A Belief System That Continues to Define the Practice of Chiropractic (sciencebasedmedicine.org)

New Zealand follows Canada in the #1 spot relegating the US to #3. HA.

What’s the deal? Why are we so over represented?

I’d like to say it’s because our population is just highly educated and naturally receptive to the sceptical mind set.

Any suggestions?

Page Views of "Skepticblog" per million Ranked by Country

Previously Alison kicked us off by looking at the use of medicinal leeches, as did  Siouxsie, and Michael took on Ayurvedic Medicine.

The latest round concerns something called Thai Yoga Massage or Nuad (Nuat) Boran. Essentially the practice consists of the massaged party adopting a series of yoga positions while the massager applies pressure to the body’s “Sen” lines. Those familiar with acupuncture’s “Meridians” can replace Miridian with Sen and get the general idea.

From an article describing the practice:

“The theoretical basis for traditional Thai healing is rooted in the belief  that all forms of life are sustained by a vital force (lom) that is carried  along invisible energy pathways (sen) running through our bodies.  This energy force is extracted from air, water, and food, and it is  believed that disease and dysfunction come about when energy  becomes blocked along these pathways. Accordingly, Thai massage’s  intent is to free this trapped energy, stimulate the natural flow of life  force, and maintain a general balance of wellness.”

Thus Nuad Boran is a system of energy medicine based on pre-scientific notions of “Vital Force” or “Life Energy”, blockages in which are the cause of disease (though exactly what disease seems to be harder to pin down). It is also claimed to be based partly on Ayurvedic medicine.

So what exactly does this “Alternative Therapy” treat? From the same article quoted above:

“The result of a full-body Thai session is often an exciting and powerful mind/body experience, bringing both the recipient and the practitioner to greater states of physical and mental well-being.”

But that’s kind of vague, what else?

Like many alternative treatments and especially the ones covered by the Herald this week the actual claims for Thai Massage seem to centre around improved blood flow. At least that’s the impression I got from looking at the listed clinical research on this page.

But apparently in the medical literature Thai Massage is mainly focused on pain relief, though there is this one hopeful study trying to use it as a treatment for Autism (the current trendy target for alternative therapies where nothing is too insane to try including chemical castration). Though a brief look at the abstract implies to me that they took one implausible treatment added a second implausible treatment and decided that Implausible² = Success.

Pain is a good candidate for effective use of Thai Massage; the end point is subjective and massage involves close contact which humans generally find inherently soothing. Hopefully any successes in the pain arena will not be parlayed into evidence that the treatment “works” for any other condition.

The main issue I have with all the literature I’ve been able to dig up so far is that only Thai Massage was included in the studys. The specific reason for using Thai Massage (at least traditionally) is the claims regarding redirecting and unblocking life energy. Remove that unscientific aspect and why wouldn’t any massage work just as well?

I’m perfectly sanguine about the possibility that Thai Massage may be beneficial for perception of pain and reliving stress for the reasons given above. Should we be saddled with the extra hypothesis about life force, with the implication that there is something mystical and magical going on; giving the added justification that the therapy could be of use beyond pain and stress (and whatever else massage is good for)?

I don’t think so.

As Michael pointed out in his post, even the Herald reporters aren’t approaching these “therapies” as medical treatments but more as a relaxing massage/spa  session (except for the leeches, but perhaps there are those out there who would consider this relaxing).

Frankly, after the above it should be “’nuff said”. But how does the Herald approach this wellspring of traditional medical wisdom?

Well, possibly this article is the most honest so far, explicitly calling the technique a “relaxation therapy”. The life force concept is only briefly and obliquely referenced and the main emphasis is that this is simply a massage.

Even so, there are vague hints that the procedure is beneficial to your health is way that go beyond simple massage.

Passages like:

“…the yoga-like stretches help to stimulate and move air through the body.

“Every vital part of the human body, from the heart to the lungs, needs good air flow to function well, and Thai massage is aimed at stimulating these air vessels in the body,” said Nucharee Weerawan”

Do subtly imply that the massage will not only relax you but will help your body to “function well” whatever that might mean in this context. Which in turn may lead people to be more open to the idea that the massage could be used to treat more serious ailments. Or maybe the population will actually think things through for themselves and see through more extravagant claims.

I’m hoping for the later.

Though reading further into the description of the massage given, it doesn’t sound especially pleasant. Despite the attempt at a positive spin in the last line.

Sometimes it’s someone pointing out how stupid I am, many times I’m being used as a resource on some forum discussing AltMed. Today I found I was being linked to by a site called the Webwhisperer.

The Webwhisperer is a blog run by a UK doctor who is attempting to create a resource of reliable medical information, mainly for the doctor’s own family to access it seems but I think it has wider appeal and application.

Since the beginning of the year the Webwhisperer has been running a series on infant teething, the fifth and latest post is a link to my own article on Amber Teething Beads with a favourable intro. Ok, so I’m referred to as a mother but I’ll let that go (mainly because comments are disallowed and I can’t see any other way to contact the author. But also because I’m secure in my masculinity. Mostly).

Teething is something that can be quite distressing for new parents and is a topic that that every family member has an opinion on the best way to handle. A medical resource that gives factual information can be invaluable. So check it out.

There are many, many other topics covered on the site from allergies and alopecia to breast implants and pregnancy. I plan to browse it regularly. You should too.

Keplerites aside, I decided to look up the report from UMR Research about the beliefs of my fellow citizens.

The report makes for interesting reading (if somewhat disconcerting in places) and I’ll be looking for the follow-up reports around Maori culture and Herbal remedies. The first thing to note is that this was an on-line survey, so right off we should be wary about how representative these findings are of the general population. In that vein there was some attempt to make the results as representative as possible with quotas and weighting of responses. I couldn’t find details of how this was carried out so with that in mind do take the results with a grain of salt.

One of the first things that jumped out at me was how uncertain people were regarding their answers. The questions seems to have 4 possible answers for both the affirmative and negative, from Absolutely Certain through Fairly Certain, Not Too Certain and Not At All Certain.

So while 61% believe “That there is a God or some sort of universal spirit” only 28% are absolutely certain of this. If we lump in the fairly certains then it goes to 41% (from now on I’ll consider both groups to make up the “Certain” category). Compared to 38% who don’t believe (27% of who are certain-ish). 38% non-believers in NZ. It’s difficult to compare data sets but this appears to be up somewhat from ~34% (depending on how you count) religiously unaffiliated at the 2006 Census.

57% of us believe that there is life after death. 32% are certain. 31% are certain this isn’t the case. 55% of us believe in psychic powers, 27% are certain; 27% are certain that they don’t exist.

Now we get to the headline grabbing UFO question. 33% believe we have been or are being visited. How many are certain? 11%.

That’s a bit of a relief.

Then there’s Astrology. 24% think there is something to that malarkey. Only 6% are certain though. Whew…That’s lucky. Still, those horoscopes are everywhere.

It seems that the hardcore believers tend to only make up a minority of the population, even for the mainstream beliefs. With the more mainstream the belief the more evenly spilt the believers and non-believers. i call that interesting. As well as somewhat heartening.

The report breaks down the results further into gender and ethnic responses but I’m happy with looking at the top level stuff here. Check it out to see how women answered differently than men and how ethnicities are split between the different questions.

Related articles

• You CAN be good with God! (openparachute.wordpress.com)

Moxibustion is the practice of burning ground up mugwort and applying the smouldering plant indirectly or directly to the skin to alleviate illness. In the indirect method acupuncture needles are inserted and the burning mugwort is used to heat either the skin or the needle. Direct methods are exactly what it sounds like, the mugwort is burned while sitting on the skin and your skin burns too. The amount of skin burning can vary – from minor to burns that will leave scars. On purpose.

Why would you want to subject yourself to this? Beats me.

But people do, and others study what it might be good for and publish papers about it. One of these turned up in my in-box this morning courtesy of BioMed Central Complementary and Alternative Medicine. With a title like “The effectiveness of moxibustion for the treatment of functional constipation: a randomized, sham-controlled, patient blinded, pilot clinical trial” how could I ignore it?

Reading the study I was transported to a place where the underlying physical process of disease matters not a whit and where the sweat, facial features, , body energy, duration of disease, and pulse type are methods of determining treatment. To be fair other measures were also used, including stomach pain, stuffiness and duration of disease.

No indication was given of how “body energy” was measured. Stuffiness was not defined – I’m sure these are standard things that every doctor knows about.

Frankly, if you are using a magical treatment to unblock your magical life energy then this is the type of thing you should expect to be important.

The study itself was quite small, as the title suggests, only 25 participants. 12 in the treatment arm and 13 in the sham moxibustion arm. Now, how do you do sham moxibustion? Apparently, as it is the heat from burning the mugwart that is important, you just introduce an insulator to stop that heat reaching the patient.

Luckily the procedure used was the indirect acupuncture type, so those in the sham group didn’t wonder why no third degree burns where in evidence.

This approach leaves all the burny, smokey goodness of the mugwort though. Given the negative outcome of the study I suspected this would come up in the discussion. I was not disappointed.

We’ll get to that in a bit. First I want to cover how the patients were divided into “deficiency syndromes” and “excess syndromes”. Constipation in traditional Chinese and Korean medicine is apparently due to either a deficiency or excess of qi (chi), you know, the life energy. This is where checking out people’s faces and sweating etc comes in.

I’ll quote directly from the paper at this point:

“A patient with a deficiency syndrome has sunken, weak pulse, whereas a patient with an excess syndrome has superficial and broad pulse. The patients having symptoms such as a pale face, heavy sweat, and depression were considered to have a deficiency syndrome; the patients having symptoms such as a swollen face, little sweat, and chest pressure were considered to have an excess syndrome. Syndrome pattern differentiation was conducted by an OMD before randomization.”

Further on:

“Five participants were diagnosed with an excess syndrome, and twenty-one participants were diagnosed with a deficiency syndrome. In this study, the most prevalent symptoms for an excess syndrome were a strong body energy and superficial pulse; for a deficiency syndrome the symptoms were a long duration of disease and weak body energy.”

Given that “body energy” plays such a part in dividing the patients I was hoping at this point it would be defined and a method to assess it given. Alas, I was out of luck. Obviously it’s too basic to explain here.

To the results!

I already gave the game away: moxibustion was no different than sham moxibustion when it comes to improving symptoms of constipation. To their credit the authors admitted this could be because moxibustion is, in fact, ineffective. But then, maybe they chose the wrong acupuncture points (never mind that large well designed studies show that where you stick the needles has no effect on outcomes). Or perhaps the sample size was too small – I’ll give them this one, though if there was a significant effect then even a small sample should have shown it.

Then the inevitable, perhaps the sham moxibustion was effective after all. Because, you know, the smoke and stuff. And, oh yeah, the patients actually had “excess-cold” syndromes when normally you’d expect excesses to be warm – so maybe that has something to do with it…

Can you say “rationalising”?

The authors also note that while a number of adverse events have been reported for moxibustion, the patients in this group only experienced redness. Another quote:

“Previously reported adverse events related to moxibustion treatment include burns [no kidding, I thought that was a feature - not a bug], an itching sensation, infection, allergy and xerophthalmia [dry eyeballs]“

Dry eyeballs…. hmmm, better than a punctured lung.

The paper concludes with the obligatory call for larger more rigorous studies, despite the fact that this is an implausible treatment based on magical thinking. Oh well, such is the way of things nowadays.
———————————————-
Park JE, Sul JU, Kang K, Shin BC, Hong KE, & Choi SM (2011). The effectiveness of moxibustion for the treatment of functional constipation: a randomized, sham-controlled, patient blinded, pilot clinical trial. BMC complementary and alternative medicine, 11 (1) PMID: 22132755

The focus is on conducting and reading research and determining good research study practice but I think there is value in everyone knowing what confounding variables are.  So what are they?

Well, read that post……

Ok, good.

Another example that I got in my stats class (many moons ago) was the correlation of matches with cancer. Those people who tend to carry boxes of matches in their pockets also have a higher risk of cancer.

As in the Murder vs Ice-cream example given at the link above, there is no direct link between matches and cancer (though it’s obviously related), the most probable explanation is that those who carry matches are more likely to be those who smoke and it is the smoking that relates to cancer.

Smoking can then be said to be the confounding variable – the variable that explains both of the explicitly stated variables and either ties them together with a causal mechanism (Matches -> Cancer) or shows that there is no direct relation (Ice-cream -/-> Murder).

A similar effect may be seen with something like surveys, the manner in which a survey is carried out may introduce confounding variables (say a phone or internet survey which pre-selects participants by their access to said communication methods) or the questions asked may smuggle in assumptions that do not separate out confounding variables.

For example a survey may ask “Are you Religious” and “Are you Happy” (as many have). The Religious question smuggles in a number of extra factors that may contribute to a person’s level of happiness eg religions usually come with a feeling of belonging to a community, social interaction, social support networks or guilt over actions and feelings. Each of which may more directly impact happiness that religion per se.

Other areas may also suffer from the confounding variable problem, alternative medicine springs to mind. Say you suffer from a cold, you soldier through it until you can’t take it any more and start downing some homeopathic remedy. In a day or two your symptoms resolve and you feel better. Did the remedy work?

In this case the confounding variable could be the natural history of the disease. Colds don’t last for ever (it is “self limiting”), it could be that you took the remedy right before the cold would have resolved itself anyhow. If this is so the conclusion that the remedy “cured” your cold would be invalid, there would not be a causal connection between the remedy and the cold symptoms going away.

The natural history of the disease would explain the reason you took the remedy when you did (symptoms had reached a climax) and why the remedy appeared to work (the cold would have resolved anyway).

When we examine issues closely we can see that confounding variables crop up, and should be carefully considered, every time we try to determine a causal connection between two events or phenomena. This is the reason that skeptics chant “Correlation does not equal causation” like a mantra.

Just for fun, suggest some instances of confounding variables in the comments. The more obscure the better.

Related articles

• I Was A Skeptic, but… (sciblogs.co.nz)
• Five Signs You Might Be Wrong (sciblogs.co.nz)
• Amber Teething Beads a Few Points to Consider (sciblogs.co.nz)

It uses a cool functionality of Scoop.it to collect posts which are then “curated” by a real person (hate those obviously fully automated ones that often ping my posts).

Vaxfax monitor is a Scoop.it site, which means the curator specifies keywords and the software trawls Twitter, Google, Digg and Youtube to generate content that matches the keywords. Once this is done the output is offered to the curator to vet. The posts that are retained through this process are published to the main site while those that don’t make the cut are discarded.

The curator of this feed is a poster who goes by the handle anarchic_teapot. Regarding anarchic’s chosen Nym I took this from the about page:

“My handle was chosen entirely at random, so don’t read anything political, social or ironic into it. I have no connection with the Anarchist Teapot Collective, or the coder using the handle anarchic.teapot (with a period, not a hyphen). I’m pretty certain I used the name first, though.”

I contacted anarchic_teapot to get a bit more information about the process involved in putting this feed together and to get a feel about the person behind the page and for why this resource is important.

[Scepticon] Where abouts in the world are you based?

[anarchic_teapot] I live in France, surrounded by sunshine, wine and cheese. And lots of other stuff that’s bad for my diet.

[Scepticon] The agregator uses keywords to collect content, is there any way to get random stuff you’ve noticed into it?

[anarchic_teapot] It’s also possible to scoop stories directly off the Internet, using a browser widget. In fact, the 3 main aggregators I use: paper.li, scoop.it and newsvine now all offer this service.

[Scepticon] What’s the difference between those services?

[anarchic_teapot] Scoop.it will publish each article immediately it’s validated. You choose any tags and which sites you’re going to publish to. It’s useful for getting breaking news out the door, but does require a lot of time curating. Another drawback is that it can mean a lot of tweets going out, and I don’t like flooding the intertubes, out of respect for my long-suffering readers. I want to keep them!

Paper.li does quite a good job of finding keywords, and you can pick the regularity at which it’s updated. At most, you’ll have two tweets a day.
The (big) disadvantage is that you can’t remove unwanted content until after an update.

Newsvine doesn’t send out tweets, although I suppose it would be easy to send your personal RSS feed through a service like Twitterfeed for that. On the other hand, it does allow comments, so you can get a discussion going. You can also write quite a lengthy post about the article you’ve seeded, as they call it. However, you have to go find your content for yourself; it won’t go looking for you. Although you *will* be warned if Newsvine thinks someone has already seeded the same story.

[Scepticon] Once the stories are gathered what happens?

[anarchic_teapot] Every time I check the feed, I have up to 100 stories that I can either discard, block the source (porn sites, bots, or other minor noise) or decide to publish. I try to keep Scoops recent (past 2-3 days) and from reliable sources. I also try to keep repetition down.

[Scepticon] Why did you feel the need to create such a resource, what do you see as the goal of aggregating all this stuff in one place?

[anarchic_teapot] I suppose the need comes from not having enough time to check major news sources regularly, and nobody to do it for me. I’ve always been one to let the computers do the spadework. Putting it all in one place gives me the chance to spend more time sifting through the dross. There is a lot of dross. I have some absolute doozies lined up for future blogging.

At the same time, to see so much quackery being sold so hard scares me.
It keeps me motivated, and I understand why others are so implicated in the struggle for science too.

[Scepticon] What is the criteria for inclusion, do you simply include those things you already agree with?

[anarchic_teapot] Well, it’s all a bit subjective, as things have to be when you’re playing editor (I hate the word curator, that’s for museums) to any sort of publication. As a rule of thumb, I try to keep to stuff that’s informative, not too technical – I’m not the health professional in the family – and of immediate use. I had to think about announcements of potential breakthroughs (HIV and malaria are currently doing the rounds) but decided it would be quite enough to deal with currently available vaccines.

[Scepticon] What is the main focus, news stories that demonstrate harm of anti-vaccine views or information about vaccines themselves?

[anarchic_teapot] Both, really. For reasons of space, I try to avoid localised reports, unless the story is of wider relevance (e.g. a clinic offering free shots probably won’t make it, but an outbreak of mumps may). I occasionally throw in some of the nastier antivax stuff, well flagged as such, in the hope that someone better qualified than me will pick it up and pillory them.

The teapot also admitted to using the generated content prior to publishing as a means of keeping an eye on the shall-we-say “less reasoned” content out there. I believe the term used was “Stupidity detector”, turning these gems into the bases of blog posts.

One of the things that I am grateful the anarchic for is the attempt to keep the feed from turning into an agglomeration of random crap.As noted earlier, I often get pingbacks from sites that have linked to my posts (and sometimes published portions of them) that when I check are simply grabbing everything with a keyword with in filtering, even to the point that the main purpose of a page is 180^o opposed to what I’ve written but presents my content as if it’s in line with the site’s philosophies.

According to the teapot:

“The nice thing about Scoop.it is that you don’t *have* to publish anything.”

Ah, how refreshing.

Related articles

• Vaccines and Autism – Media Report Card Expanded (sciblogs.co.nz)
• Anti-Vaccine Charities – Is there any Quality control on Charities? (sciblogs.co.nz)
• IAS Complaint Part 1: Thimerosal in Your Vaccine? No. (sciblogs.co.nz)
• IAS Complaint Part 2: Gardasil Horrors – Horrific Reasoning (sciblogs.co.nz)
• IAS Complaint Part 3: Vaccine Ingredients: Not So Bad Really (sciblogs.co.nz)
• IAS Complaint Part 4: Anti-Vaccine Impact in New zealand (sciblogs.co.nz)
• Defending The Term “Anti-Vaccine” (sciblogs.co.nz)
• The Legitimate Risks of Vaccines (sciblogs.co.nz)

Those who advocate vaccine use are often portrayed as denying any harm from vaccines and arguing that vaccines are completely safe, even that everyone should be given vaccines. This I think is an example of projection. Those in the anti-vaccine camp may become convinced of the absolute evil of vaccines, they then project the mirror image of this certainty onto vaccine supporters, warping the reasoned position taken into some sort of ideologically driven madness.

No-one I know who supports vaccine use argues that vaccines are completely safe, we realise that total safety is a naive concept, one that undermines the real discussion we must undertake based on relative safety and risk vs benefit.

I mentioned a few risks that can reasonably be discussed in this previous post. I’ll cover a few more here but must point out that the overall risks associated with vaccines are still lower than those associated with the diseases immunised against.

The first risk I’ll cover is intussusception with rotavirus vaccines. In the late 1990s a rotavirus vaccine RotaShield® was put into use, within months it was found that there was an increase in intussusception associated with the vaccine. Intussusception is a form of bowel obstruction that consists of the bowel folding in on itself. An investigation of the vaccine determined that this bowel obstruction was up to thirty times more likely in infants that had received the vaccine. On the back of this information the manufacturer voluntarily withdrew the vaccine from use.

As a result of this new Rotavirus vaccines are closely monitored for intussusception risk. The current Rotavirus vaccine used in New Zealand, Rotarix®, has been monitored and found to have a low risk of intussusception translating to between 0 and 4 extra cases of intussusception per 100,000 infants. It is noted that these are “extra” cases of intussusception as the background level has been found to be approximately 34 cases per 100,000 infants per year (ie the total number of cases would go from 34 to 38 per 100,000).

I found a paper published just prior to 2000 that estimated that the incidence of hospitalisation due to rotavirus was approximately 315 to 362/100,000 annually in New Zealand. A report from 2002 estimated that deaths from intussusception in developed countries (specifically the USA) might be approximately 4 deaths per 100,000 live births. Given this the risks associated with the vaccine are considered to be lower than the risks of the disease.

Moving on, MMRV vaccine is considered to come with an increased risk of febrile convulsions compared with the separate MMR and varicella (note the MMRV vaccine is not currently available in New Zealand). Febrile convulsions (or seizures) are seizures caused by high temperatures and are quite common in childhood. I have not been able to find any information that indicates febrile convulsions per se are a danger, normally these are caused by infections and it is the infection that is considered the dangerous component. As these infections are what are aimed to be prevented by the vaccine then it can be reasonably concluded that the risk from the vaccine is much less than that of the prevented diseases.

A recent interesting case of a vaccine side-effect was the increase in narcolepsy incidence in Finland for the H1N1 vaccine Pandemrix. A press release from the Finland National Narcolepsy Taskforce was recently released and noted:

“In all the cases examined, narcolepsy associated with Pandemrix vaccination has been identified in persons who carry a genetic risk factor for narcolepsy. Because of this very strong association with the genetic risk factor which regulates immune responses, narcolepsy is considered an immune-mediated disease”

and:

“In addition to Finland, Sweden is so far the only other country which by using epidemiological research has confirmed an increase in narcolepsy cases associated with pandemic vaccination. In Sweden, too, the increased risk of narcolepsy has been observed specifically in children and adolescents. The added risk associated with vaccination was about three cases of narcolepsy in every 100 000 persons vaccinated.”

Finally and importantly:

“During the influenza season 2010–2011, 52 persons were treated in intensive care, and 13 succumbed. Most of these were unvaccinated. Combining the data on morbidity and mortality with data on vaccinations in the 2009–2010 pandemic season indicate that a swine flu vaccination taken in the pandemic season had  provided 75–88 per cent protection against the swine flu virus in winter 2010–2011. Based on these figures, it has been estimated that during the second wave, the swine flu vaccine prevented approximately 40 000 cases of swine flu.

The Task Force concurs with the European Medicines Agency’s estimate that, despite the unforeseen and deeply regrettable cases of narcolepsy, the overall benefit-risk balance remains positive.”

This is an important point to remember. Medicine is a risk benefit analysis, virtually all interventions carry an element of risk and we must use the available information to determine if the benefits outweigh those risks. In the case of this vaccine it was determined that the benefits were great enough.

Finally, there is a risk to immunodeficient individuals who receive live virus vaccines. This is seen in the case of the oral polio vaccine (OPV). It has been estimated that the risk of developing vaccine-associated paralytic poliomyelitis (VAPP) in the general population is approximately 1 in 2.4 – 13 million oral polio vaccine doses. As the vaccine is multi-dose this breaks down to a 1 in 750,000 risk after the first dose. Immunodeficient individuals are at a much greater risk, possibly as high as 1 in 100-200.

As noted previously, this information allows us to make a determination of the risks of the vaccine under each situation. As such the OPV is no longer recommended in areas where polio is under control and the population will not come into contact with the wild strain and immunodeficient patients are not given the vaccine.

A recurrent theme here is the evaluation of both the risks and the benefits of vaccines. One cannot be properly assessed without the other, over-emphasis of one side of the equation will lead to a biased conclusion and decisions that may be costly in terms of human life. I must stress however that this attempt at a balanced what occurs all the time in science, new information is always coming in and must be incorporated into the existing body of knowledge.

In some cases this results in the removal of vaccines from use (eg RotaShield®) or the restriction of their use (OPV). The charge that science is blind to the potential drawbacks of vaccines and vaccination programmes is simply false.

Related articles

• Vaccines: The real issue in vaccine safety (nature.com)
• Vaccines and Autism – Media Report Card Expanded (sciblogs.co.nz)
• Anti-Vaccine Charities – Is there any Quality control on Charities? (sciblogs.co.nz)
• IAS Complaint Part 1: Thimerosal in Your Vaccine? No. (sciblogs.co.nz)
• IAS Complaint Part 2: Gardasil Horrors – Horrific Reasoning (sciblogs.co.nz)
• IAS Complaint Part 3: Vaccine ingredients – Not so bad really (scepticon.wordpress.com)
• IAS Complaint Part 4: Anti-Vaccine Impact in New zealand (sciblogs.co.nz)
• Defending The Term “Anti-Vaccine” (sciblogs.co.nz)

Well, nobody really. I can’t read their minds, although if I could would that change anything? All anyone can do is examine their output, and that of others, and try to make a determination as to whether it is more consistent with an impartial, or simply safety concious, approach to vaccines and vaccination or an anti-vaccine stance.

I hope that my previous posts have demonstrated that the IAS in particular produces anti-vaccine rather than balanced vaccine safety material.  The mission of the IAS is to cast doubt on the safety and efficacy of vaccines not to educate responsibly about the real concerns and limitations of vaccine use. If this was their aim they could do a much better job. Look at the articles produced on their website and you will see many that promote the “dangers” of vaccinations, try to discredit health campaigns and generally aim to undermine public confidence in vaccines.

An organisation concerned about vaccine safety and promoting responsible use of vaccines might write about reducing wide-scale vaccination in favour of targeted vaccination of at risk populations. Perhaps They would also try to work with health authorities to examine ways in which vaccine production can be improved (better production techniques might avoid allergy issues mentioned below), or ways in which the distribution of vaccines can be made more effective and thereby reducing the need to preservatives that are thought by them to be harmful.

It is important to note that someone can be concerned about the safety of vaccines while not being anti-vaccine at the same time. I alluded to this above, but there are legitimate safety issues surrounding vaccine use and vaccines should indeed be closely scrutinised prior to mass roll-out via safety and efficacy trials and post roll-out via surveillance systems and doctors reports. It is a valid complaint that procedures are not always carried out effectively.

Sometimes though they are carried out quite effectively and in a follow-up post I will look at a couple of examples of this. The trouble is that often when a “danger” of vaccines is reported more coverage is given to the sensationalistic claims than the eventual explanation. Also (perhaps because of this) these claims have a tendency to hang around and affect public sentiment long after the coast is clear from a safety standpoint.

As I mentioned there are real risks associated with vaccine use, there are known side effects that can have implications for the health of a small number of vaccine recipients. One of the more obvious being allergic reactions to the vaccine ingredients. Those with egg allergies are urged to use vaccines cultured via chicken embryos with caution and may be unable to receive the vaccine at all. There can be other serious and not so serious or transitory side effects for specific vaccines and effects that are general to vaccines (such as redness, soreness, syncope etc).

As such there are a variety of non-histrionic ways that vaccine safety can be discussed, without impugning the general safety of vaccines. Likewise reasonable conversations may be had regarding relative efficacy of vaccine preparations against the myriad of infectious agents that we are exposed to as well as discussions about cost effectiveness of mass vaccination for low incidence infections.

Serotype replacement (or replacement disease) is another issue that can be raised. As infectious strains are targeted by vaccines there is the possibility that other strains that were less important in the pathology of disease become more prominent once the “Top Dog” has been removed.

Encouraging the production and research into more effective vaccines that give better or more long lasting protection could also be a fruitful line of approach. Perhaps we could focus on immunogenicity, better adjuvants would give a vaccine the ability to provoke a stronger immune response, possibly with fewer antigens – as has already been achieved with modern vaccines. If vaccines are improved in this way then there will likely be more local reactions with the inclusion better adjuvants. This again is a reasonable discussion to have.

The lack of large RCTs on all vaccines and the challenges of working around this (for example ethics prohibit withdrawing a measles vaccines then trying a new one against a placebo). The types of studies required or currently used to give us the appropriate information to act upon is something that we can all try to resolve together.

All these things are such that reasonable people may disagree and we should be able to marshal evidence based (rather than emotive) arguments to discover the optimal us of vaccines in society. To my reading of the IAS, their output appears limited to vitriolic and divisive attacks on health authorities and other informational agencies, vilification of pharmaceutical companies, fearmongering over the alleged dangers of vaccination and downplaying the risks of infectious diseases.

Where we start treading into anti-vaccination territory is when we start to become entrenched in a view that sees vaccination as an evil unto itself, perpetrated in the name of profits by immoral pharmaceutical companies and carried out by unethical doctors who are either ignorant dups or willing accomplices. Those who take this stance may make all of the reasonable arguments that I outline above but also be resistant to evidence that contradicts their views and committed to a general non-vaccine outlook.

In discussing this it is very difficult to convey the range of views that may be represented. Obviously we all exist on a spectrum – from fully pro-vaccine to recalcitrant anti-vaccine. It can also be very difficult to determine the views of people in conversation. I prefer to err on the side of caution and assume people are generally well intentioned and open to evidence until proven otherwise.

One of the defining characteristics of the anti-vaccination crowd, it seems to me, is the hyping of dangers far beyond what the evidence supports. As can be seen in some of the attacks on vaccine ingredients, lists of ingredients are given and scary information accompanies them with the toxicological effects of these compounds on living organisms. In these cases  though the dose is often ignored. Dose response is one of the corner stones of medicine and the dose makes the poison. Drink large quantities of formaldehyde and you’re in trouble, but in the tiny doses found in vaccines your body can easily handle it. as noted in a previous post our bodies actually make formaldehyde as part of normal metabolism and the amount found in vaccines is far smaller than that made by the normal process of living.

When it comes down to the bottom line – Vaccines work, and they actually perform that holy grail of CAM, “boosting” the immune system and allowing the body to heal itself. Not in some vague, feel good alternative medicine way but in real objectively measurable and observable ways. Your immune system is primed to react to infectious agents in such a way as to reduce the amount of time that it takes for an effective immune response to be mounted against the pathogen.

With this priming your body can fight off infections much more efficiently and this translates into keeping us healthy, or reducing the severity of diseases. While we can debate the finer points of vaccine safety and efficacy in the end we have a system that works and has saved many lives. I see that as a win.

[for more on this topic see this post from David Gorski of Science-Based Medicine published last year]

Related articles

• Vaccines and Autism – Media Report Card (sciblogs.co.nz/skepticon)

Impact of Anti-Vaccinationist Misinformation in New Zealand

Maintaining a high level of vaccine coverage is important for reducing the probability of disease outbreaks and to limit the spread of disease in the community. Diseases (often) spread due to contact between infected and uninfected individuals. If the uninfected individual has partial protection from the disease due to immunisation then the disease will spread with more difficulty. This is often referred to as “Herd Immunity”.

Herd immunity does rest on several assumptions, one of which is that immunised individuals are spread evenly throughout the population. If pockets of unvaccinated individuals develop then diseases can gain a foothold in that part of the population and spread outward – even to vaccinated individuals. If parents in a community are convinced by the IAS information not to vaccinate their children then an in-road for disease is created and outbreaks can occur. As such this would constitute a detriment to both children and the wider community – in direct contradiction to the IAS stated charitable aims.

New Zealand has struggled to reach recommended vaccination levels in the past with the coverage rate in 2005 being only 77% at two years of age¹. With such low rates of vaccine uptake in the population there is a risk of vaccine preventable disease outbreaks occurring in the population and putting children’s lives at risk. In fact this is happening now with the measles outbreak in Auckland. Health officials have linked this outbreak to lowered vaccine uptake attributable to anti-vaccine misinformation².

Vaccine coverage for a disease such as measles needs to be at approximately 90% or greater in infant populations to prevent epidemics³. Despite a focus on increasing coverage since earlier this century and improving coverage since the 2005 survey New Zealand still only sees an average of 85% vaccination coverage in this age group, with some areas dropping as low as 75%⁴.

In 2004, just prior to the Vaccine Coverage survey, a study was performed to see what reasons parents gave for not vaccinating their children⁵. The results of the study found that many of the parents interviewed made a decision not to vaccinate based on perceived risk of the vaccines. The risks cited were common anti-vaccinationist misunderstandings, including linking vaccines to autism and the belief that children’s immune systems are weakened by immunisations.

While almost all of the study participants consulted their GP for vaccination information, this source was seen as biased. In fact many of the “Pro-vaccine” sources were considered biased and parents expressed interest in information provided by groups outside the “medical establishment” indicating distrust of medical advice on this topic in general. The Immunisation Awareness Society was explicitly listed as a source of information by 76% of survey respondents, along with Naturopaths and Homeopaths (43% and 48% of respondents respectively).

The Immunisation Advisory Centre is sufficiently concerned about misleading anti-vaccination claims that they have included a page dedicated to rebutting this information on their website⁶.

Conclusion

The IAS dispute that they are “anti-vaccine” both in their Charity “Rules” (3. Beliefs, subsection C⁷ and through comments on their website. This claim rings hollow though when the actual content of their writings is examined. Therefore it is important to look at the effective output of the ideologies, philosophies and stance of the charity rather than their explicit statements.

In regard to IAS staff and members, belief that they are acting in the public interest, belief that their materials constitute an educational resource and belief that they are in fact doing the right thing are not enough. I have no doubt that the founding members, the officers and members of IAS sincerely think that they are provide a public service and that their interpretation of the scientific facts is the correct one. This however only affords them the right to be respected as individuals and for their views to be given fair hearing, it does not constitute a right to charitable status and does not exempt their views from criticism.

The IAS has shown through their materials that, despite protestations to the contrary, their views are anti-vaccine. This entails that their views are factually and scientifically incorrect, that they have an agenda to reduce or stop vaccinations being performed and that through this their actions may translate into serious harm for individuals, the community and the public at large. The IAS currently enjoys charitable status, as such they are exempt from taxation on their income. This amounts to a government subsidy of anti-scientific and potentially harmful views.

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One last point, I am pretty clear to paint the IAS as anti-vaccine. They themselves deny this label, as mentioned above. But then I have a bias don’t I? Well, heres a link to a website that has the opposite bias, they list the IAS as on of their “100+ Great Anti-Vaccination Information Links“, I’d say that;s telling.

Footnotes:
1. NZ Vaccine coverage survey 2005
http://www.moh.govt.nz/moh.nsf/pagesmh/6028/$File/national-childhood-immunisation-coverage-survey2005.pdf
found on:
http://www.moh.govt.nz/moh.nsf/indexmh/national-childhood-immunisation-survey-2005

2. Stories covering the Aucland Measles outbreak:
http://www.stuff.co.nz/marlborough-express/news/5220199/Immunisation-rate-of-refusal-growing
http://www.nzherald.co.nz/immunisations/news/article.cfm?c_id=461&objectid=10553617
http://www.stuff.co.nz/national/health/5222511/Measles-outbreak-likely-to-spread

3. Predictive model for Measles Outbreaks. Coverage at 15months should be >90%
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2810912/pdf/10813154.pdf

4. Immunisation Coverage report 2010:
http://www.immune.org.nz/site_resources/Professionals/Research/2010_Immunisation_coverage_report.pdf
Found Here:
http://www.immune.org.nz/?t=603

5. Study looking at reasons NZ parents give for not vaccinating:
http://www.nzma.org.nz/journal/117-1189/768/

6. IMAC website with anti-vaccination rebuttals:
http://www.immune.org.nz/?T=938

7. Charities Register page for IAS:
http://www.register.charities.govt.nz/CharitiesRegister/CharitySummary.aspx?id=17c102eb-e79c-de11-9604-0015c5f3da29

The following example was posted as a look at vaccine ingredients in two parts. I will not be so lenient – Both in one for you.

Vaccine Ingredients – Part 1
posted May 6, 2011

This post contains a number of misunderstandings and falsehoods both explicitly stated and implied. The post lists the type of cell culture lines that viruses are cultivated in in order to create vaccines and then implies that the cells from these cultures are still found in the final vaccine product that is injected, including the emotive claim that we are injecting aborted foetal tissue into our children with the vaccine.

[Quote]
“I bought Sue Claridge’s fantastic book “Investigate Before You Vaccinate,” and turned to page 44 which states: “The cell cultures used to grow the viruses and bacteria include monkey kidney (vero cells), foetal calf serum, chick embryo fluid, yeast and human diploid cells (cells from aborted human foetuses). WHAT?! You mean to tell me that we are injecting aborted human fetal cells into our babies?!”

This is incorrect.

While it is true that there are some cell lines used to culture viruses used in vaccines, it is inaccurate to say that we are injecting these cells into children. Once again precision in language is important, there are currently existing cell lines that were originally cultured using aborted foetal tissue. These cell lines used originated in the 1960s¹, meaning that the cultures used now many cell replication generations removed from the original tissue and are now are simply cells grown for medical use – not foetuses.

The only vaccine in the New Zealand schedule to be developed using cell lines derived in this fashion is the MMR vaccine, due to the inability to grow Rubella virus in any other type of cell line². Vaccines must also be purified before use in order to remove these cells prior to injection^3,4. Following purification the cells of the original culture are no longer present.

The article then proceeds to give a laundry list of possible vaccine ingredients, with the implication that the levels of these compounds are harmful at the doses provided in the vaccine.

[Quote]
“…formaldehyde (an embalming fluid). SERIOUSLY?! Oh, it gets better!!! Some vaccines also contain mercury, aluminium, preservatives, stabilisers, lactose, sorbitol, sodium chloride, sucrose, sodium borate, magnesium chloride, sodium phosphate, hydrolised gelatine, neomycin, gentimicin, streptomycin and human albumin…”

This dose insensitivity of the anti-vaccine rhetoric is recurrent and important. All chemicals have a threshold above which they can have detrimental effects on human physiology, the question is whether this threshold is exceeded by vaccine ingredients. The medical community is in agreement that the answer to this question is “no”. At this point the anti-vaccine community does not need to provide proof that the levels of compounds found in vaccines are harmful, the only goal is to raise questions about safety.

The United States CDC website has a page dedicated to vaccine ingredients and countering anti-vaccine questions about them⁵. The IAS article highlights that formaldehyde is used in vaccines and points out that this is used as an embalming fluid. The CDC website answers this question and it is telling that the IAS article does not mention that formaldehyde is also made in the body during normal metabolism. In fact it is calculated that a baby (depending on size) would have more than 50 times the amount of formaldehyde in its body naturally than it would get from a vaccine dose.

Most of the rest of the ingredients listed are stabilisers and preservatives of the vaccine components. Several such as sodium chloride (table salt) and sucrose (sugar) would not be considered harmful by most reasonable people. As such I will point out a small selection that would seem to be concerning and give the actual facts behind their use.

The first that would seem worrying is amorphous aluminum hydroxyphosphate sulfate. The approximate amount of this compound used in vaccines is 225 μg. Used as an adjuvant (a vaccine additive that modifies its effects) this ingredient actually makes the vaccine more potent by enhancing the body’s immune response to the vaccine. As such it has an 80 year track record of safety in vaccines⁶. Also, dietary sources of aluminium are not insignificant, estimated at 1.6-13 mg per day⁷ or 7-60 times that in the vaccine, even though bioavailability of chemicals is affected by the method of introduction to the body (oral vs injection) it’s hard to see how this minuscule amount would make any difference.

Another potentially scary sounding chemical in vaccines is sodium borate, the approximate dose per injection of vaccine is 35 μg. This is used to balance the pH. The LD50 (a measure of toxicity) for this compound is 2-3 g/kg in mammals⁸ and as such is actually slightly less toxic than table salt (~3 g/kg⁹), the 35 μg in the vaccine if given to a 50kg individual equals a 0.7 μg/kg dose, this isn’t even close to a dose high enough to cause even a minor problem.

The article goes on to make a specious assertion that we were “created perfect as we are” and that we shouldn’t need to inject “formaldehyde and monkey cells” into our bodies to make our immune systems work, if we did we would be “born with it”.

[Quote]
“Weren’t we created perfect as we are? Do we really need to be “fixed” or “made better” by injecting these substances into our bodies? If we were meant to have formaldehyde and monkey cells in our bodies in order for our immune systems to work, wouldn’t we have been born with it?”

Aside from the unintended irony that we actually were born with formaldehyde in our bodies this claim is poor reasoning. By this criteria some of us would have also been “born with” glasses or contact lenses or hearing aids. This article also would appear to refute the utility of acquired immunity – if we needed foreign bodies in our system to make our immune systems work then we would have been born with them.

Finally the question is asked “If we’re all suddenly going to get sick or die if we don’t get these vaccines, then how did we survive for tens of thousands of years without these ingredients inside us?” ignoring for the moment that it is not the vaccine ingredients themselves that we need but rather the antigens in the vaccine that the rest of the ingredients stabilise and preserve, the simple answer to this question is “millions of us didn’t survive”.

Vaccine Ingredients – Part 2
Posted May 9 2011

This post appears to be one long argument attempting to cast doubt on the level of knowledge we have regarding the operation of our immune system. By quoting from an anatomy and physiology text book¹⁰ and emphasising tentative sounding words such as “appears”, “may” and “apparently” the author is attempting to show that the entire field on immunology is in doubt.

[Quote]
“On page 778, after talking about T cell maturation, it mentions that “less is known about the factors that control B cell maturation in humans” i.e. they haven’t quite figured out how B cells mature in our bodies yet. Another classic is on page 792, when they try to explain why the immune cells sometimes attack foreign human cells when a patient has received a graft. Their explanation is that “apparently, [emphasis mine] the cytotoxic T cells sometimes ‘see’ the foreign class I MHC antigens as a combination of self class I MHC protein bound to foreign antigen” i.e. they don’t actually [emphasis mine] know how it works, but this is their best guess.”

The fact that the text is dealing with minutia of the immune system down to the level of cell generation and activity seems to not persuade the author that in fact there is a great deal currently known about immunity and how our immune system works. To the point that it is considered feasible (by the author) that future text books will recall the use of vaccines and their “toxic ingredients” as complete folly.

The level of argument here is such that similar reasoning could be used to show that since the fluid dynamics at the edges of aircraft wing tips is not completely worked out, in the future we may discover that airplanes cannot fly after all. The point of this parody is to show that the author is confusing knowledge of mechanism with knowledge of efficacy. We know vaccines work, study upon study of new and old vaccines verify this fact every day. The inability of science to answer every minute facet of why they work does not invalidate this data. Once again the only goal here is to plant a seed of doubt about the safety and effectiveness of vaccine in the minds of the public. As such the IAS once again demonstrates the education is not the desired outcome of their operation.

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Footnotes:
1. Cell lines

http://www.viromed.com/services/product/wi38.htmhttp://www.viromed.com/services/product/mrc5.htm

2. Vaccine Manufacture

http://www.immunizationinfo.org/issues/vaccine-components/human-fetal-links-some-vaccines

3. Vaccine Purification:

http://www.cuno.com/healthcare/pdfs/application_briefs/vaccine_production.pdf

4. Vaccine requirements(Section III, sub section B.5. paragraph 2):

http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Vaccines/ucm074801.htm

5. CDC Vaccine ingredients page:

http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/ucm187810.htm

6. Aluminium track record:

http://www.webmd.com/parenting/news/20040129/aluminum-in-vaccines-poses-no-harm

&

http://www.chop.edu/service/vaccine-education-center/hot-topics/aluminum.html

7. Dietary aluminium:

http://www.efsa.europa.eu/en/efsajournal/pub/754.htm

8. Sodium Borate MSDS:

http://www.anachemia.com/msds/english/f880%28vcr%29.pdf

9. Safety sheet for NaCl

http://msds.chem.ox.ac.uk/SO/sodium_chloride.html

10. The Text book that appears to be written about:

http://www.campusbooks.ac.nz/product/21980-HumanAnatomyandPhysiology-9780321584199

Gardasil Horrors
Posted April 6, 2011

First, the very title of this entry is calculated to be sensationalist and to undermine trust in a vaccine that has so far had an exemplary safety  record¹.

The post is copied from the proceedings of an FDA advisory committee and is not representative of the full content of the meeting². The content is the submission of Roberta Boyce founder of the anti-Gardasil website  truthaboutgardasil.org. The submission contains misleading information,  misunderstandings and errors of fact as well as unsupported assertions; all aimed at undermining the vaccine.

The submission starts out by alleging that the Gardasil vaccine causes vitamin deficiencies in the girls who receive it, specifically niacin.

[Quote]
“…I presented information last September against the vaccine at a similar FDA meeting when you were considering extending the vaccine to boys and older women.  At that time I told the advisory panel that many of the Gardasil girls were showing symptoms of severe vitamin deficiencies, specifically niacin.”

This  appears to be based on the submitter’s personal experience as the medical literature does not seem to back-up such a claim³. A charitable  interpretation might assume that the medical literature has not yet caught  up with a reaction that has been observed by parents and medical  professionals. To this end the VAERS database⁴ was queried by myself in  an attempt to verify whether vitamin deficiency is indeed a reaction seen in “many of the Gardasil girls” as claimed in the submission. The VAERS database did not list niacin as a filtering criterion, in this case then all criteria that where related to vitamin deficiency or decreased vitamin levels were used.

The data for worldwide events was searched, a total of 44 events were found. Given that by now millions of doses of Gardasil have been administered⁵ 44 events (of which 11 were considered “non-serious”) seems minimal. Certainly far from the “many” quoted above. When it is factored in that the VAERS database does not show causal connections but is merely for reporting events that occur in close temporal proximity to the vaccine there is no reason to determine that these events are anything more than normal occurrences within a population.

Part of the submission references the May 2006 FDA VRBPAC report on the clinical results for the development of Gardasil as a prevention of HPV in women⁶.

[Quote]
“Already the May 2006 FDA VRBPAC reports that if a woman has HPV and receives Gardasil, her chances of getting cervical cancer increase by 44.6 percent after inoculation. “

The submission reference is at best a misreading of the report and at worst cherry-picks facts out of context in order to support a specific conclusion. It is alleged that women already infected with HPV strains targeted by the vaccine experience an increased risk of cancer of 44.6%. This is incorrect on two counts; first, the possible increase is in CIN 2/3. This refers to Cervical Intraepithelial Neoplasia, generally regarded as “pre-cancer”⁷. This may appear to be hair splitting but in science precise terminology is used for a reason.

Second, the data referred to is made up of small numbers and is a sub-group of the main study population. As such, further in the report it is suggested that the observed increased risk is actually due to slight imbalances between the intervention and placebo groups. This conclusion is reached after additional information about the sub-groups and data using larger sample numbers is provided by the study authors. In conclusion, it is likely that this result is simply noise and the use of it without context amounts to cherry-picking.

The submission continues with further medical misunderstandings and eventually devolves into what appear to be paranoid theories about drug companies targeting girls with a particular genetic make-up for sterilisation using the Gardasil vaccine.

[Quote]
“My daughter recently tested sterile at age 21, although she is still getting a relatively normal period.  Could it be that Merck intentionally developed this vaccine thinking it would affect a small number of individuals with PK deficiencies?  Is this what their intent was when they developed their recently approved fertility drug Aleva, which was just passed for European use?  I wonder if Merck and other big pharmas have intentionally taken advantage of genetic deficiencies.  I believe they have, and I believe this is what has happened many, many times over.  In fact today’s presentation by Dr. Garner clearly stated that DNA extractions were performed in their tests.”

As corroborating evidence the submitter refers to a previous presentation during the committee that referred to DNA extractions, once again ignoring the context in which this was stated – clearly in reference to looking for evidence of HPV DNA in subjects, not screening the genetic profile of the subjects themselves.

Finally the submitter implies that the Gardasil vaccine is a self-manufactured curse from God for Christians because they have not adequately spread God’s word. Beliefs such as this may motivate some people but they do not constitute a valid argument when it comes to health and science. Evidence is required and the evidence provided, such as it is, is not adequate.

The appearance of this submission on the IAS website implies an endorsement of its views and that it is considered information worthy of inclusion about the safety and efficacy of the Gardasil vaccine. As it is based almost entirely on personal experience, assumptions and misunderstandings its inclusion on a website run by an organisation that ostensibly is concerned with providing accurate information to parents is completely inappropriate.

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Footnotes:
1. Gardasil Postlicenture safety Surveilence report:
http://jama.ama-assn.org/content/302/7/750.full.pdf+html

CDC Safety information:
http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/ucm179549.htm

2. Full FDA Advisory committee Meeting muinutes:
http://www.fda.gov/AdvisoryCommittees/CommitteesMeetingMaterials/BloodVaccinesandOtherBiologics/VaccinesandRelatedBiologicalProductsAdvisoryCommittee/ucm241266.htm

3. Literature search was carried out using the PubMed database found here:
http://www.ncbi.nlm.nih.gov/pubmed

4. Vaccine Adverse Event Reporting System. Data from which may be accessed here:
http://wonder.cdc.gov/vaers.html

5. Gardasil Doses
http://www.bestshot.co.nz/Gardasil%20Q-A.pdf pg11

6. FDA VRBPAC report:
http://www.fda.gov/ohrms/dockets/ac/06/briefing/2006-4222B3.pdf

7. Information on Cervical intraepithelial neoplasia:
http://www.thehpvtest.com/about-hpv/cervical-dysplasia-faqs/

So, what is wrong, exactly, with this article?

Well, the author starts out by saying there is a “vaccinate at any cost” mentality among the pro-vax. This is what is called a strawman as it is a caricature of the actual position, no-one actually holds that we must vaccinate at any price. The real situation is more nuanced than that (which the author admits later) the point is to perform a risk/benefit analysis with regard to vaccination and decide how high the risks of vaccinating against the risks of not vaccinating.

When this is done objectively it turns out that the risks of getting a disease and the complications that arise from this is higher than the risks from the vaccines. No-one is saying that vaccines are 100% safe, but they are safer than the diseases.

Next she goes on to say that the vaccines lead to autism thing is a viable conclusion ‘cos the courts say so. I’m afraid courts are not the arbiter of scientific consensus, science is. Also the burden of evidence in these cases is quite low, much lower than in science, and rightly so. We do not want the court process to have such a high burden of proof that suffering families have no hope. But with this must come the acceptance that the court room is not where science should be decided.

The author then decides the vaccines cause autism is acceptable because we have incomplete knowledge about the causes of autism. This is true but incomplete knowledge does not mean anything goes, we know enough that vaccines can be ruled out as a significant contributing factor (see the Related articles below).

Next the author appeals to anecdote to make the vaccines -> autism point. She does this by asserting that a family member has autism because of vaccines. This is what we call begging the question, she has assumed the truth of the vaccines cause autism in her premise and uses the premise to support her conclusion. Something of a no-no if you want your argument to be taken seriously.

The author also appeals to “toxins” in the vaccines as the boogie man (ie look at the ingredients). This despite most of the ingredients being in use and showing safety for years (decades even in some cases) before the “Autism epidemic” was an issue.

She simplifies the risk/benefit assessment again by arguing that pro-vax people see vaccine injury as an “acceptable risk”, she also implies that we callously disregard those who might be harmed, quite offensive actually. In reality we simply recognised that greater numbers of individuals will be saved through use of vaccines than without them. To say that this is equivalent to turning our backs on those harmed by vaccines is a cheap shot.

She re-iterates a talking point of the anti-vax crowd that the method of vaccine introduction into the body is “unnatural” and therefore possibly harmful in itself. Obviously these people have never had a scratch, nor stepped on a nail.

She also implies that parents who assert that their children have been harmed by vaccines are the “canaries in the coal mine” and we should listen to them on that basis. Well, guess what, scientists did listen and investigated the link between vaccines and autism. Turned out there wasn’t any. Should we keep listening beyond the time that the hypothesis is a viable one?

The good points of the article I thought were that she recognised that discussion should be respectful and not a degenerate mud-slinging match. I agree. She mentioned being for the dispersal of information on this topic so that parents can make informed decisions. I’m behind that too. She also called for people to recognise that this is a complex issue, somewhat ironic given her massive simplifications, but I agree with that as well.

In the end I found the writer to be trying to honestly come to grips with the issue, she failed in my opinion, but she did so without outright name calling, vilification and denunciation. It’s a sad state of affairs that I consider that a win, but there we are.

Related articles

• Vaccines and Autism – Media Report Card (sciblogs.co.nz)
• Vaccine Doesn’t Cause Autism: Latest Panel (newser.com)

Thimerosal in your Vaccine?
Posted September 13, 2010

This post on the IAS website (made up of basically an uninformed question about the harmfulness of ethyl mercury and a video) insinuates that Ethyl Mercury (also known under the trade name Thimerosal)¹ is both harmful in the amount contained in vaccines and, by extension, that New Zealand vaccines contain this substance and should therefore be viewed with suspicion.

The first thing to note is that the Thimerosal post is irrelevant to New Zealand populations as Thimerosal is not present in any of the vaccines used in New Zealand². Bringing up this issue in the context of New Zealand vaccines (implied as this is a New Zealand organisation geared towards New Zealand residents) is at best ignorant and at worse disingenuous scaremongering. Even so it is useful to deconstruct the post anyway as it is indicative of the faulty reasoning and scientifically inaccurate content of the IAS website.

The post includes a link to the Material Safety Data Sheet (MSDS) for Ethyl Mercury as support for this claim³. The relevant part of the MSDS has been reproduced below to give an indication of what the post considers concerning about the use of Thimerosal in vaccines.

Quoting from the MSDS:

“Effects of Overexposure: Topical allergic dermatitis has been reported. Thimerosal contains mercury. Mercury poisoning may occur and topical hypersensitivity reactions may be seen. Early signs of mercury poisoning in adults are nervous system effects, including narrowing of the visual field and numbness in the extremities. Exposure to mercury in utero and in children may cause mild to severe mental retardation and mild to severe motor coordination impairment.”

This is used in conjunction with a video link on the page⁴ to advance the hypothesis that Thimerosal in vaccines causes  autism, despite the fact that the symptoms listed are explicitly due to overexposure, not the trace exposure that  constitutes the vaccine dose. This type of “any level is harmful” approach to medicine neglects the dose response  relationship of drugs and other chemicals in the body. This hypothesis also ignores scientific research into
mechanisms of autism, the epidemiology of the increase in autism reports and the failure of the hypothesis to account for the continued rise of autism cases after Thimerosal was removed from the majority of vaccines.

The web-based resource Science Based Medicine has a reference page containing summaries of and links to the various studies showing no link between Thimerosal in vaccines and development of autism or autism spectrum disorder (ASD)⁵. The studies in aggregate looked at the claim of a link between Thimerosal and autism in a number of ways. Several looked at large groups of individuals and attempted to find any sort of correlation between childhood exposure to Thimerosal and development of autism symptoms. All together these studies combed through the data of over 750,000 individuals in several different countries and found no evidence to support a link.

Continuing to disseminate information that implies a link between Thimerosal and autism is to be either wilfully ignorant of the current state of research, in which case claims to educational content are not accurate, or to be dismissive of the current research as being an inaccurate reflection of the facts. This second option depends on there being some sort of conspiracy within the scientific/medical community to hide the truth. No such conspiracy can be substantiated.
As an side, the MMR vaccine has also been linked to development of autism in the minds of anti-vaccine campaigners since Andrew Wakefield’s now discredited and retracted paper in the Lancet⁶. A Cochrane review of the evidence shows

“No credible evidence of an involvement of MMR with either autism or Crohn’s disease was found.”

and

“Exposure to MMR was unlikely to be associated with Crohn’s disease, ulcerative colitis, autism or aseptic meningitis…”⁷

—————————————————————————————————–

Footnotes:
1. Thimerosal clarification of chemistry:
The chemical IUPAC name of Thimerosal is actually
Ethyl(2-mercaptobenzoato-(2-)-O,S)mercurate(1-) sodium.
This breaks down to Ethyl Mercury in the body.
http://en.wikipedia.org/wiki/Thiomersal

2. Vaccine ingredients:
a. Childhood vaccine Schedule:
http://www.moh.govt.nz/moh.nsf/indexmh/immunisation-schedule-html
http://www.betterhealth.vic.gov.au/bhcv2/bhcmed.nsf/pages/wycpreve/$File/wycpreve.pdf
http://www.betterhealth.vic.gov.au/bhcv2/bhcmed.nsf/pages/gwcinfih/$File/gwcinfih.pdf
http://www.betterhealth.vic.gov.au/bhcv2/bhcmed.nsf/pages/gwcinfiv/$File/gwcinfiv.pdf
http://www.betterhealth.vic.gov.au/bhcv2/bhcmed.nsf/pages/gwchibrx/File/gwchibrx.pdf
http://www.betterhealth.vic.gov.au/bhcv2/bhcmed.nsf/pages/gwcbostv/$File/gwcbostv.pdf
http://www.betterhealth.vic.gov.au/bhcv2/bhcmed.nsf/pages/cscgarda/$File/cscgarda.pdf

b. Influenza Vaccines:
http://www.moh.govt.nz/moh.nsf/indexmh/influenza-a-h1n1-2010-faqsseasonal#safety
http://www.moh.govt.nz/moh.nsf/Files/swineflu/$file/vaxigrip.pdf
http://www.moh.govt.nz/moh.nsf/Files/swineflu/$file/Fluvax.pdf
http://www.moh.govt.nz/moh.nsf/Files/swineflu/$file/Influvac.pdf

3. MSDS cited on the IAS website:
http://www.vaccine-tlc.org/docs/Thimerosal%20Material%20Safety%20Data%20Sheet.pdf

4. Misleading video posted under the heading “Thimerosal in your Vaccine?”:

http://www.youtube.com/watch?v=m-Frdv9iR3E

5. The Science-Based Medicine resource page on Vaccines and Autism:
http://www.sciencebasedmedicine.org/reference/?p=1

6. Andrew Wakefield:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2960175-4/fulltext
http://www.bmj.com/content/342/bmj.c7452.fullhttp://www.nature.com/ajg/journal/v105/n5/full/ajg2010149a.html

7. Cochrane review:
http://www2.cochrane.org/reviews/en/ab004407.html