Wednesday, September 14, 2011

You Can Manipulate a Back, but You Can't Manipulate Reality

On Twitter, I like to try to keep my followers informed of outbreaks of diseases like measles and pertussis. Some may need to get up to date on boosters for themselves or their children. Some may not be able to receive a vaccine due to a medical condition and so need to take precautions if they are in an area affected by an outbreak. To help me in this, I have some alerts set up to forward news articles to me. For the most part, they are sane, reality-based articles discussing the diseases or the vaccines without spin. Occasionally, something like this article comes along.

Titled "Effectiveness of vaccines needs to be re-examined," it is an opinion piece, so I shouldn't really expect it to be as rigorous as an actual news story should be. However, I would, at the very least, like to see some measure of scholarship, especially considering the author, Ammitai Worob, has at least a college level education (degree in psychology from Hunter College, according to his bio). Why do I say this? Because he trots out a good number of anti-vaccine talking points that have been trounced numerous times over the years.

He begins by asking what seems a reasonable question:
The first question, and one that has become taboo to even ask, is whether childhood vaccines are actually effective.

Now, in the science-based community, merely asking this question is not taboo. It is perfectly fine to ask this question, and it is doubly important to ask it of brand new vaccines. Where he goes awry is this:
The Journal of the American Medical Association published a study in 1998 noting that pertussis was common in the vaccinated population. Shouldn't an effective vaccine prevent contraction of the disease? If parents are to relinquish health care choices for their families, effectiveness must be clearly established even before we discuss safety.
First, it would be nice if he actually provided the title of the study to which he's referring so we can look it up ourselves, especially to find out just how "common" it was in 1998. Perhaps, though, he should have referred to more recent information on efficacy, like the CDC Pink Book chapter on pertussis (PDF), which lists the currently licensed vaccines as about 80%-85% effective. Or, he might have referred to a 2011 Cochrane review, "Acellular vaccines for preventing whooping cough in children," which found that multi-component pertussis vaccines were about "84% to 85% in preventing typical whooping cough, and from 71% to 78% in preventing mild pertussis disease." He should also have avoided invoking the Nirvana fallacy, presenting the false dichotomy of "either it's effective or it isn't," instead of the more rational and logical conclusion that for the most part, the vaccine is effective.

What about other common tropes among ill-informed anti-vaccine screeds? Pharma Shill gambit? Check. Calling for unethical studies? Yep:
Most vaccine studies compare adverse events of children vaccinated with a previously approved vaccine versus those exposed to the newer vaccine. There is no control group of unvaccinated children to compare against. All this tells us is which vaccine has a higher or more varied incidence of adverse events.
Dr. Worob (more on the "Dr." title below), when a company develops a new medical product for the treatment of a disease or condition for which there is already an approved, safe and effective treatment available, a clinical trial comparing the new product against placebo is a no-no. The reason is the ethical concept of justice or equitable share of burdens and benefits. Now, if a company makes a vaccines for a disease for which there are no alternatives, then, as occurred with rotavirus and HPV vaccines, use of a placebo control is not only acceptable but vitally important. I am just a lay person. Certainly, someone who completed a full course in a scientific discipline should know the basics of study design and ethics.

He also trots out the "too many, too soon" nonsense and the aluminum portion of the toxin gambit. And of course he plugs Dr. Robert Sears' (though he says "Dr. William Sears") alternate vaccination schedule, which, as everyone knows is based on a close and careful evaluation of the scientific evidence to ensure that the schedule is both safe and does not reduce the effectiveness of vaccination. Or, wait. That's the CDC/AAP recommended schedule. Dr. Sears' schedule is based on hunches and opinions.

Finally, Dr. Worob brings up the Vaccine Court, which has, rightfully, paid damages to claimants who suffered rare injuries following vaccination. Like many anti-vaccine advocates, he asserts that vaccine manufacturers cannot be sued at all, ever, if a patient suffers injury. However, that is not the case, as reading and actually comprehending the Supreme Court decision (PDF) earlier this year would reveal. Basically, a claim for "design defects" must go through the Vaccine Court first, rather than going directly to a tort claim against the manufacturer in the regular courts. That said, the ruling of the Vaccine Court can be rejected by the petitioner and a tort claim can then be filed against the company, where they must prove not only that the vaccine caused the injury (which, for some injuries, is assumed under the VICP system), but also that the fault lay with the company.

With the level of misinformation and ignorance shown in Dr. Worob's post, I certainly hope the clients of his chiropractic practice go elsewhere for their medical advice, at least on the topic of immunization. As one commenter said:
Chiropractors are trained in manipulating the back. From reading this article, some chiropractors are also good at manipulating the facts.

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