Just Missing the Mark Again, Katie Couric Airs HPV Followup Segment

Back on December 4, award-winning journalist Katie Couric aired a mindnumbingly bad episode of her show Katie. Throwing her credibility and journalistic ethics to the wind, she made her show a platform for the anti-vaccine organization SaneVax, which promotes the erroneous belief that Gardasil, among others, is horribly dangerous and is killing our kids, going so far as to make available a guide on how to blame the vaccine if anything bad happens to your child at some point after they receive it. The episode featured two women, one (Emily Tarsell, National Vaccine Information Center's Director of Gardasil Network Development) who blamed Gardasil for the death of her daughter, and one (Rosemary Mathis, Founder and Director of SaneVax) who blamed a wide range of non-specific maladies that her daughter experienced. Both guests have a vested interest in scaring people away from the vaccine. In addition, one of the primary investigators of the Gardasil (Merck) and Cervarix (GlaxoSmithKline) clinical trials, Dr. Diane Harper, appeared on the show to downplay the effectiveness of the vaccines, stating they only lasted 5 years, while overselling pap smears in such a way that it made the vaccine seem pointless. For the science and reality side of the "conversation", Couric included Dr. Mallika Marshall. Dr. Marshall did her best to point out the facts of the vaccines, but when the entire show was framed to generate fear and mistrust of the vaccine, she had a very difficult time of it.

While others focused on the myriad flaws and errors in the episode, I focused on the ethics, though I did include links to a number of other articles lambasting the show. As a journalist, Couric had a number of responsibilities to her viewers to seek out the truth and report it. Unfortunately, she and her producers opted for ratings. The Friday after the episode aired, someone at the show put up a lukewarm justification for how they opted to do the show. It did not offer any apologies, nor did it correct any of the misinformation from the episode. More criticism popped up, and Couric herself penned a "mea culpa" of sorts on the Huffington Post. It was a step in the right direction, but Couric still didn't go far enough to correct the errors and damage done by her December 4 show. She addressed some, but not all, of the problems the others pointed out, but she skipped over some very important points. To make matters worse, she did it in the wrong venue. Rather than devoting time on her show to the corrections, which would have been seen by the same audience as her original episode, she opted to address a completely different audience: the ones who were criticizing her and already knew what the problems were.

Well, it seems that the well-earned criticism has finally filtered through...kind of. This past Friday, December 13, Couric devoted her "Follow Up Friday" segment to HPV and the vaccines that prevent it.

Followup: Katie Couric Addresses the Criticism...Sort Of

Last week, Katie Couric, award wining reporter and host of her own talk show, Katie, threw journalistic ethics to the wind. She hosted a show on the HPV vaccines, engaging in false balance by propping up two anti-vaccine anecdotes as being not only valid, but equivalent to the scientific evidence supporting the safety and efficacy of the vaccine. The backlash from science bloggers, journalists and the public was fast and brutal, pointing out all the things Ms. Couric (and her producers) did wrong.

When lukewarm justification for the way the show was done appeared on the Katie web site, it was not an apology. It did not correct any of the errors of the show. In short, it failed the ethical obligation to "admit mistakes and correct them promptly". Today, Katie Couric posted an article on the Huffington Post titled Furthering the Conversation on the HPV Vaccine. While it goes part of the way toward correcting things, it isn't quite enough.

Katie Couric Chooses Ratings Over Ethics

The blogosphere, Twitter, even mainstream news outlets have been abuzz about a recent episode of Katie Couric's show Katie. The episode, which aired December 4, 2013, was on the HPV vaccine, a vaccine that prevents infection with a virus that causes cervical cancer, head and neck cancers, warts and so forth. To give you an idea of how Couric and her producers were going to frame the discussion, here's what the teaser said:

The HPV vaccine is considered a life-saving cancer preventer … but is it a potentially deadly dose for girls? Meet a mom who claims her daughter died after getting the HPV vaccine, and hear all sides of the HPV vaccine controversy.

This blurb could have been written by the National Vaccine Information Center. Just like NVIC's recent anti-flu vaccine ad and more generic anti-vaccine billboards, the topic is framed to emphasize fear and distrust of the vaccine. And after watching the show, I agree with the numerous critiques that have been levied at Couric and her producers. The flaws with the show have all been stated very capably, so I'm not going to bother repeating them. Nor will I go into detail about the human papillomavirus or the vaccines that prevent infection. If you are interested in learning any of that, take a look at the links down at the bottom of this post.

Instead, I want to talk about the effect that Couric's show may have, not to mention some of the ethical implications involved.

VAERS a Few Things We Need to Discuss

I've been remiss. There's a topic that I've written about in passing, but I have yet to devote an entire post to it. In all this time writing about different vaccines, studies about vaccines and anti-vaccine claims, there's a subject about which I have neglected to write more about than a paragraph here or there. I'm speaking, of course, about the Vaccine Adverse Event Reporting System, or VAERS. The handful of times I have written anything about VAERS (here, here, here and here), it's mainly been a very brief overview of what it is and how anti-vaccine activists like to abuse it (except that last link, which included a study using VAERS data).

So I thought I should rectify that situation. What prompted this was an exchange on Twitter with a doctor by the name of Jim Meehan, who tried to argue that the HPV vaccine is confirmed to have caused deaths...144 of them, to be precise. His reasoning is that there are 144 reports of death associated with HPV vaccine in the VAERS database. Therefore, he thinks HPV causes death:

He also tried to dismiss me and others by claiming we had financial conflicts of interest on the topic. Actually, he's rather fond of attacking the people he's arguing against, like suggesting that because they don't agree with him, they would probably also deny the Holocaust. (On further perusing his Twitter feed, he appears to be a full-on anti-vaccinationist himself, citing Robert Kennedy Jr.'s nonsense, "too many, too soon", "unvaccinated are healthier" and so on. And on even more perusing, I find that Dr. Meehan admits to being anti-vaccine:

If only I'd known that when I first saw this guy. Would've saved me a lot of time and explains a lot of his behavior. Perhaps at some point in the future I'll need to revisit this fellow.)

In the meantime, though, I thought it might be helpful to talk a little bit about VAERS: what it is, how it's supposed to be used and how it's abused.

An Honest Flu Ad

Click to enlarge.

Last week, the National Vaccine (mis-)Information Center ran an ad in a New Hampshire newspaper designed to make people fear the flu vaccine. I wrote about why the NVIC ad is misleading, as did Moms Who Vax and Epidemiological. In short, the NVIC ad played to the myth that the flu vaccine makes you sick (it doesn't) and promoted the idea that the vaccine doesn't work (it does). It also played on fears of adverse reactions to the vaccine ("know the risks"), but did not so much as hint at the benefits.

At any rate, I though I'd put together a somewhat more honest ad. Here's my take on the NVIC ad. Please feel free to share this, unaltered, far and wide. I also have a higher resolution version of it that should be good to print. E-mail me (contact info's in the sidebar) if you would like a copy.

NVIC? Know the Omissions (Part 2)

Those of you who read this blog regularly know some of the common tactics that anti-vaccine activists use. They're fond of the Pharma Shill Gambit, in which they accuse those with whom they disagree as being paid by pharmaceutical companies. This allows them to blissfully dismiss anything their detractors have to say. If you're paid by pharma, after all, you're hopelessly biased and nothing you say can be taken as true or honest. Of course, it doesn't matter whether you actually get paid by pharma or not. Facts don't tend to matter much to those using the pharma shill gambit.

That brings us to another tactic: dishonest or misleading rhetoric. The less, shall we say, sophisticated anti-vaccine activists aren't all that subtle about it. They will brazenly state as truth claims that are easily shown to be wrong (e.g., the false claim that MMR has the preservative thimerosal in it, or that vaccines contain antifreeze; they don't). The more skilled among the anti-vaccine movement, however, use insinuation. They imply certain claims using language that, on the surface, is technically true or could be classified as opinion, but the unstated claim is at best misleading and at worst dangerously wrong.

The National Vaccine Information Center (a more Orwellian-named organization would be hard to find) falls into that latter category, for the most part. Take, for instance, their latest ad, placed in a local New Hampshire newspaper:

The New California Personal Belief Exemption Form Unveiled

The anti-vaccine movement is a study in contradictions. They want fewer vaccines, but advocate for actions that ensure vaccines that could be taken off the schedule aren't. They want studies done, and even get involved in their design, but then reject them when the studies produce results they don't like. And they clamor for informed consent, but then raise a stink when efforts are made at improving education and helping parents make informed choices.

That was the case last year when, in March 2012, a bill was introduced in California (AB2109) that would require parents who want to opt out of required school immunizations for their children to get information about the "benefits and risks of the immunization and the health risks of the communicable diseases listed in Section 120335 to the person and to the community" from an authorized health care provider (which was rather broadly defined). These efforts at ensuring parents make informed choices were so objectionable, that anti-vaccine pro-informed choice activists vehemently opposed the bill. Yes, in the twisted world of people like NVIC's Barbara Loe Fisher, a doctor largely responsible for a measles outbreak or certain reality-challenged celebrities, a bill that requires parents be informed tramples on parents' rights to be informed. Yeah, I don't get it either, but supposedly it makes sense to them.

At any rate, AB2109 was signed into law by Gov. Jerry Brown on September 30, 2012, but with a catch. As I wrote at the time, Gov. Brown issued a signing statement with it, stating that he would direct the Department of Public Health to allow for religious exemptions to the whole getting informed piece of the legislation, despite the fact that California does not have any religious exemptions to vaccinations. As I noted at the time, there were significant problems with this, both legal and practical.

Well, the California Department of Public Health has announced the new form and made it available here (PDF).

Measles, Cows and an "Oh crap!" Moment

In the history of the battle against diseases, there are only two that have been completely eliminated from the wild. Smallpox had been with us for millennia, but it wasn't until sometime around the 17th century that moderately successful attempts at preventing the disease were practiced in the form of variolation, or inoculation with pus from an infected individual. This practice, though effective, carried significant risks, such as actually causing the disease or infection with some additional disease, like syphilis. Then along came Edward Jenner, who discovered that those infected with cowpox appeared to be immune to the more dangerous smallpox. He developed the first rudimentary vaccine in the late 18th and early 19th centuries. As medical knowledge advanced, the vaccine was refined and improved, reducing (though not eliminating) the risk of adverse effects and improving its effectiveness through booster doses. In 1967, a worldwide campaign was begun to eliminate the disease from the wild, with the last known wild case of smallpox occurring in Somalia in 1977, making it the first disease eliminated through human efforts.

The second disease that we have managed to eradicate from the wild is rinderpest, a morbillivirus closely related to human measles virus. Rinderpest was once a scourge of cattle. As with smallpox, innoculation was an early attempt to control the disease. Unlike smallpox, inoculation never really caught on, partially due to lower efficacy. Jenner's successes with vaccination using cowpox led to unsuccessful attempts to use cowpox to prevent rinderpest. Vaccines using the rinderpest virus were developed in the early 1900s, yet despite the development of effective vaccines, control efforts often took the form of wholesale slaughter of livestock when outbreaks occurred. Regional efforts at eradication of the disease began in the 1920s, but coordinated global efforts wouldn't come about for several decades. Ultimately, widespread vaccination efforts led to the last confirmed case in 2001 in Kenya. Vaccination continued for several more years, as experts suspected the virus could still be circulating among wild animal populations. In 2011, with no other cases appearing, the World Organization for Animal Health declared the disease eradicated.

We know that in the right circumstances (like when a disease is limited to a single species), and with enough effort, we can eradicate diseases. But what if a disease jumps species?

Is It More Effective to Delay MMR Vaccination?

Recently, I asked the question is it safer to delay MMR vaccination?  Many of those who are opposed to the current schedule of vaccinations or have heard anti-vaccine claims and fear that vaccines somehow overwhelm an infant's immune system may put off getting their children immunized until well after the age recommended by the CDC and AAP. This decision not only leaves a child at risk of infection for a longer period, but, as I discussed in that post, new research on the MMR vaccine indicates that there is an increased risk of seizures and fever associated with delaying that vaccine. So delaying might not necessarily be safer, at least in terms of adverse reactions to the MMR vaccine. The authors of the recent paper speculated that one probable cause of this increased risk is due to a more robust immune reaction the older a child is when they receive their first dose of measles-containing vaccine.

Another recent study, Measles in Children Vaccinated With 2 Doses of MMR, by F. Defay, G. De Serres, D. M. Skowronski, N. Boulianne, M. Ouakki, M. Landry, N. Brousseau, and B. J. Ward and published online on October 21, 2013 in Pediatrics, asked a related question: does delaying the first dose of measles vaccine improve efficacy? Well, really, the question they asked was, "does age of first MMR vaccination affect vaccine efficacy in children who received 2 doses", but my paraphrase is close enough.

For Graduate Practicum, George Washington University Earns an F

Recently, news came out that Mark Geier, the man who tried to treat autistic children's autism by using a powerful drug that suppresses testosterone (essentially chemically castrating these children), the man who lost every one of his twelve state medical licenses and had a 13th denied due to his medical misconduct (to put it lightly), served as a site preceptor for a graduate student at George Washington University. Autism News Beat rightly criticized the university. That Geier was able to serve as a preceptor for a student is pretty damning, since it means that GWU did not do its due diligence to ensure that individuals who apply to be a preceptor meet certain minimum standards. Either that, or someone at GWU was actively promoting Geier's nonsense.

The problem is that a site preceptor has a number of responsibilities, according to the GW SHHS Practicum Site Preceptor Guide:

1. Visit the Practicum Website http://www.gwumc.edu/sphhs/studentres/practicum/index.cfm and Register. (See Register: for instructions)
2. Review and approve the Student’s Practicum Plan
3. Negotiate payment/stipend with Student, if applicable
4. Engage student in work and provide constructive feedback and guidance to the student
5. Provide guidance for professional conduct
6. Complete the following on the Practicum Website:
   a. Midpoint evaluation form in conjunction with the student
   b. Final site preceptor evaluation of student and practicum
7. Address student’s reports of problems, including site safety issues and/or harassment

Take note of numbers 2, 4, 5 and 6. Mark Geier is not fit to fill those responsibilities, having been stripped of his medical licenses and being found by several Special Masters of the vaccine court to lack expertise in many different areas relevant to epidemiology, biostatistics and immunology. Coupled with his lack of medical ethics, it is grossly irresponsible to allow him to serve as a site preceptor for any student. Orac and Reuben Gaines have both chimed in, as well, castigating George Washington University for allowing this to happen.

And now it looks like GWU has taken notice.