Sunday, November 27, 2011

How should we meet baseline energy demand?

For over two decades, I have held the firm conviction that the best way to meet baseline energy demand - the amount of electricity that is always needed, before any spikes (such as during a particularly hot summer day) - is with nuclear energy. Other means of generating electricity can be used to meet additional energy needs - perhaps a combination of natural gas (because it's relativity easy to increase or decrease the energy generated to meet demand) and solar (because the biggest spikes in energy demand tend to be during those times when the sun is shining). But the base load? The answer is clearly nuclear.

I have heard many arguments against nuclear energy, and found none of them compelling. 
  • Nuclear energy is the same as / supplies the raw materials for / implies support for nuclear weapons. This is simply false. Canada's CANDU reactors use natural uranium. US, French, and Japanese reactors require uranium to be enriched to approximately 3% of a more fissile isotope. Uranium needs to be enriched to contain over 90% for a nuclear bomb. And though there are small amounts of other elements (such as plutonium) in the waste products of some nuclear plants, there are (unfortunately) several easier methods of getting hold of weapons-grade nuclear materials. No one intent on building a bomb will bother dumpster diving outside a nuclear plant. One can both favour nuclear energy and strongly advocate against nuclear weapons.
  • Three Mile Island demonstrated the inherent dangers of nuclear energy. I have always found this argument curious. Yes, something went wrong at the Three Mile Island plant and the operators there made mistakes that compounded the problem. But the automatic safety systems kicked in exactly as they should have. The containment structure was never breached (and was only filled with hydrogen, which could have made a loud noise if ignited but little else). No radiation was ever released to the public. You could have been standing right outside the plant at the time and nothing would have happened to you. It was a black eye for the industry from a public relations perspective, but nothing transpired that ever threatened the health of a single human being. 
  • Chernobyl proved that the fallout from a meltdown far outweigh any potential benefits. I agree that Chernobyl was a disaster, and only the heroic efforts of the Ukrainian, Russian, and international engineers that erected an improvised containment building prevented it from being much worse. Chernobyl clearly showed that the Soviet design principles of the RBMK reactor were fatally flawed. RBMK reactors have a combustible graphite core.When there was insufficient water in the core to cool the graphite, it got hotter and hotter until there was an explosion and full meltdown. In western designs, the coolant also serves as a catalyst - if all the coolant instantly disappeared, the reaction could not continue. I am certainly in favour of shutting down all existing RBMK reactors (none with this design will be built again). Without minimizing the scale of the Chernobyl disaster and its aftermath, I find it to be a credible argument against the RBMK design, not nuclear energy in general.
  • Uranium mines despoil natural habitats and pollute water sources. Strictly speaking, this is accurate. As with all mining activities, some mines / companies do better than others, but most or all have nontrivial environmental effects, and uranium mines are no exception. But consider the environmental impact of coal mines, natural gas extraction (especially the increasing use of the technique known as hydraulic fracturing (fracking), which injects "hundreds of millions of gallons of hazardous or carcinogenic chemicals" into the water table), hydroelectric dams (with the massive tracts of land that are flooded), or oil (especially Canada's Albertan tar sands). In any fair comparison, uranium mines are not pristine but come out looking pretty good - if for no other reason than much less uranium needs to be extracted from the earth to keep a 1,000 MW nuclear reactor running than coal or gas for the same power output.
  • Nuclear waste is dangerous for [tens or hundreds of] thousands of years, and we have no way of safely storing or managing anything over these timescales. The byproducts of nuclear energy, when compared to other sources of generating electricity, are one of the strongest arguments in its favour. Yes, there is some toxic stuff, but most of it is dangerous only if ingested or inhaled. The material that is very hazardous also doesn't last long. Look at it this way - the more radioactive a substance is, the more harmful it is to humans, but also the faster it decays into something else. The stuff that lasts for a long time isn't very radioactive and isn't nearly as hazardous to human health. There is so little waste from a nuclear plant that it's relatively easy to manage. With coal, there are enormous quantities of ash. This is a real waste problem. For example, in December 2008 a retaining wall failed in Tennessee and over 1 billion gallons of coal fly ash (contaminated with extremely toxic heavy metals such as lead and thallium - just watch the scale of it in this video) escaped into tributaries of the Tennessee River. This stuff isn't harmful for hundreds of thousands or millions of years - it's poisonous forever.
  • Nuclear energy is more expensive than hydro, coal, oil, or gas. This is generally true historically, though the large price fluctuations in recent years for oil and gas leaves it open to question whether this will continue to be the case. But overall, the economic case against nuclear energy is cogent and accurate. There are two things to consider about the cost of nuclear energy: it produces energy under far more stringent conditions than any other energy source (coal plants emit 100 times more radiation into the environment than nuclear stations), which naturally drives up costs; and perhaps it is worthwhile to pay more for an energy source that, when compared to any other, is essentially non-polluting (especially since we are cooking the planet with our carbon dioxide emissions).
Thus, for many years I have been quite comfortable holding the opinion that nuclear energy was the best way to meet our baseline energy needs.

All that started to change in March 2011, with the earthquake and tsunami that hit Japan. Over the past several months I have had to reevaluate an opinion I have staunchly held for many years.

The Fukushima plant was constructed to withstand an earthquake up to 7.9 on the Richter scale. The quake in March was 9.0, or over ten times the maximum design threshold. The seawall was 5.7 metres high, far less than the 14 metre height of the tsunami that followed. Though the severity of these events was surprising, the result (given how far they exceeded the design thresholds) at Fukushima was not: there was major damage to the plant, which resulted in a meltdown.

Unlike Three Mile Island, this was a serious event (according to an October 2011 paper in Nature, the radiation emitted from Fukushima is now half that of Chernobyl). And unlike Chernobyl, Japanese plant designs are just as rigorously safety oriented as their western European and North American counterparts. Japanese nuclear physicists, engineers, scientists and construction workers are world-class. In other words, if a meltdown can happen in Japan, it can happen anywhere.

What happens in Canada or the US when an earthquake, flood, or hurricane of unprecedented magnitude strikes in an area with a nuclear plant?

In 2010, a nuclear plant in Nebraska failed a safety inspection due to insufficient flood defenses. In response, the operator improved them to be effective for a high water level of 1,010 feet. In June 2011, an unprecedented flood peaked at 1,008 feet. Though the surrounding terrain was flooded, there was no damage to the plant. But it could have turned out quite differently with a single additional heavy rainstorm.

If this year's floods had occurred even months earlier, the plant itself would have been at least partially under water. The mandated improvements to the facility's flood preparedness enabled it to make it through June 2011 undamaged.

It's a happy ending, but illustrates a key requirement for nuclear safety: the existence of a strong, truly independent regulator to enforce the rules. Otherwise, safety inevitably gets compromised. Not operational safety, necessarily; but it requires a firm enforcement agency to get a power company to build (as in the Nebraska example) expensive flood barriers in areas not prone to them. Or to ensure numerous secondary and tertiary independent backup systems are continually checked and monitored so that they will perform as expected should primary systems suddenly fail for any reason.

The U.S. federal Nuclear Regulatory Commission behaved commendably in Nebraska in 2010. Its action likely prevented significant damage to a major power generating facility. But I am unconvinced that enforcing objective rules independent of industry influence is typical of this US regulatory body, especially after reading this four part series by the Associated Press. 

The situation is no better in Canada. In November 2007, Linda Keen, the president of Canadian Nuclear Safety Commission followed the law and refused to allow the Chalk River nuclear plant to restart after a planned shutdown until two coolant pumps were connected to backup power systems that could withstand a major earthquake. In December, the Canadian Parliament overruled this decision and ordered the facility to restart operations. In January 2008, Ms. Keen was fired.

(In May 2009, the reactor had be shut down again due to safety concerns. It did not re-open until July 2010.)

If Canadian nuclear plants consistently pass safety inspections and their operating permits are regularly renewed, is this due to the industry taking safety seriously and meeting or exceeding all guidelines? Possibly. Or perhaps no inspector, remembering Ms. Keen, wants to lose his or her job. Her dismissal was not an erosion of the traditional independence of the nuclear regulator - this act destroyed it with one brazen decision.

Beyond these examples, and many allegations of a cozy relationship between TEPCO (which operated the plants at Fukushima) and JNISA (the Japanese national nuclear safety regulator), I have one more reason to doubt the long-term independence of any nuclear regulator.


Nuclear energy is not just about scientific research, defense in depth engineering design, and precision construction. It is a business. With tens of billions of dollars at stake, considerable time, expertise, and expense will be dedicated to regulatory capture. We've seen this happen in numerous other industries, such as telecommunications and finance. Regulatory bodies have occasionally provided the mandated oversight of their assigned industry but more often have lobbied on their behalf. Nothing I have seen makes me think that nuclear regulatory bodies are immune to the pressures and corrupting influences that their peers have succumbed to, time and again, all around the world.

If I have my doubts about nuclear energy, how do we meet our current and future demands for energy? I don't like any of the major alternatives. 
  • Coal is cheap and plentiful. It is also highly polluting, with emissions of high amounts of particulate matter (leading to smog and respiratory ailments), sulphur (leading to acid rain), and carbon dioxide. Coal mining is literally changing the landscape in many areas, as entire mountains are flattened for the coal they contain. The scale of some coal mining operations is staggering. 
  • Natural gas is cleaner than coal, though it too generates a lot of carbon dioxide emissions. There is an increasing environmental cost of extracting gas from remote or hostile areas from beds with ever lower concentrations. Also, there are serious allegations that fracking has led to an increase in the number and severity of earthquakes in Oklahoma and England.
  • Oil has numerous issues associated with it: implicit support for regimes with horrendous humans rights records (Saudi Arabia and Iran spring to mind immediately); accepting the enormous environmental costs associated with oil extraction (think of any number of breached tankers, Canada's tar sands, or the Deepwater Horizon oil spill in 2010); or ignoring the simple fact that there is a finite amount of oil in the ground, and we should be planning to meet our ongoing energy needs with a source that is not at risk of being depleted in our lifetime.
  • Hydro: My understanding is that most of the attractive sites in North America have already been exploited for their hydro potential. There may be a few good locations remaining, but I question whether we should place much effort in developing the marginal sites given the fiscal and environmental costs of damming and flooding large, fast-moving waters.
  • Renewable sources: I think investment to obtain greater efficiencies from solar, wind, geothermal, and tidal sources is worthwhile. Every bit helps, and placing a greater emphasis on reducing demand from large central electricity generating plants by meeting needs locally is a good idea. But each of these also require nontrivial amounts of water, concrete, steel, and rare earth metals if they are to produce a meaningful contribution to our energy supply. Putting these issues aside, and even granting significantly higher energy conversion rates and much lower costs of production, renewables can only contribute a small percentage of our energy demand - perhaps enough to build one less large coal, gas, or nuclear plant (which typically produce 800-1000 MW). This is fine as far as it goes, but the overall question remains.
It is clear to me that a multi-pronged approach is called for. We should make a serious effort to decrease the growth of our energy consumption needs (install high efficiency furnaces in new or renovated homes, replace expired incandescent bulbs with equivalent CFL or LEDs, turn up the thermostat in the summer and down in the winter, etc.). We should reduce energy waste (such as with high efficiency power lines and better insulation - especially in large, older buildings). But according to a column in Nature, even if we could replace all "cars, appliances, boilers, buildings and power plants with today's state-of-the art technology, replace and expand current electricity generation with non-emitting sources and produce as much biofuel as possible by 2050," California's greenhouse gas emissions would be reduced by 60% from 1990 levels, well below its stated target of 80%.

We (as a country, and as a species) will only need more and more energy. If the trend to hybrid / electric cars continues it will reduce smog, but also increase electricity demand substanitally. We cannot have heated homes, personal computers, and other conveniences of our modern existence without an energy-intensive infrastructure, nor can we alter this dependency without a significant impairment to our quality of life. Do we sacrifice some of our creature comforts? If so, which ones? Do we take steps to limit the global population? If so, how would we accomplish this is an ethical and humane manner?

On this topic, I no longer have a strong opinion - only many questions. So I turn to you: how should we meet baseline energy demand?

Wednesday, November 23, 2011

Vaccine Safety Manual review: response and rebuttal

This will be my final post on the topic of national vaccination programs. As with my other posts, these have been lightly edited for clarity.

My review of the Vaccine Safety Manual prompted this response:
My bottom line: I agree with almost everything that you said. Our only difference is that you don't seem (in my opinion) to be as critical of the other side. I think the medical model, scientific community, and big pharma are just as biased and play just as many games with the numbers.  Let's use your Mike Moore example, which I think is as perfect as a metaphor can be.

I don't think he is that talented (except for Canadian Bacon :-). I do agree that his works are more propaganda than journalism. He is popular because of the absolute failure of the mainstream news to do its job - especially with the Iraq war. Even the Canadian media did a lousy job with the Weapons of Mass Destruction/Deception issue. His success is only a result of failure. In order to prove his point and present his data he has to move all the way to the left. In our discussion the "scientific/peer review" community is the media. They are controlled and have an agenda just like everyone else. Do I need to expand this point or is it clear? I'm not sure.

I have absolutely no problem with someone saying that I "think" or I "believe" vaccines are better then non vaccinated. I do have a problem with anyone saying the it is clear, they are sure, it is proven, or like the original Penn and Teller anyone who doesn't is a  moron or something like that.
  • There has never been a double blind study
  • There has never been a proper control study
  • There has never been a study comparing a vaccinated vs. a non-vaccinated group
  • There has NEVER NEVER NEVER been a study of the vaccine schedule
  • There has never been a proper (by peer review standards) study of just the preservatives
  • There has never been an adequate long term study of the effects of the vaccines across the life span
  • There is no data using today's environment for the effects of the diseases in question (proper heating in homes, access to immediate medical attention, antibiotics etc.., clean water, sanitation, dentistry (cavities causing infection to go straight to the blood stream))
  • etc.....

So when you made the argument that with vaccines some people may get sick but without lots of "people will die", I don't know how you are coming to that conclusion. Look at SARS. In China lots of people died. In Toronto, not so much, and no vaccine was necessary.

Of course there are lots of arguments of why this can or can't be done, but without them, in my mind, it cannot be claimed that the full scientific model /testing was used. Therefore the full level of scientific certainty cannot be invoked. As I said previously, but never expanded upon, I also believe that the ideological model of human health and the immune system needs to be updated.

Finally, of course the book is one sided. It was written to be. As is every study that is published and paid for by a drug company. As is every news report from Fox news, CBC, BBC or any other source. Its like reading any book or "peer reviewed" paper. There is an agenda! The better you know it, the better you can interpret the data. Wouldn't it be nice to read a pro-vaccine article and have them provide disclaimers on how many tests they ran that showed no responses that weren't published? Or how much pressure the authors were under due to the publish or perish environment?

Bottom line, I agree with how critically you read the book, but I think that just as much criticism is need on the pro-vaccine side as well.
 My rebuttal:

We agree that the US (and, to a lesser extent, Canada) has major, structural, fundamental problems with its media. These are not the same problems facing the scientific community. Peer review is not perfect - it usually cannot detect outright fraud and sometimes misses flaws reviewers should have spotted - but it is far better than anything else we've tried.

That the media inaccurately report on scientific findings does not mean that scientists have learned nothing. It's a media issue, not a scientific one.

In any argument, if your premises (starting points) are false, everything that follows cannot be trusted.

With vaccines, your premises are false.

"There has never been a double blind study" - false. I typed "double blind vaccination study" into a Google search box. The very first result (of 900,000) was a double blind immunization study. Limiting the search to just scholarly publications, there are over 60,000 hits.

"There has never been a proper control study" - false. Without getting into the details of each one, I am sure that many of the 60,000 double blind vaccination studies found in a scholarly publications have proper controls (there are probably some with methodological issues as well).

"There has never been a study comparing a vaccinated vs. non-vaccinated group" - false. A quick search of article titles reveals several with randomized placebo control groups. That is exactly what you are looking for. This HAS been done.

"There has NEVER NEVER NEVER been a study of the vaccine schedule" - false. Go to Google, and type "vaccine schedule study" in the search box. The very first result links to this article, which describes the precise type of study you claim has never been conducted. Furthermore, do you honestly believe that the national health bodies of Canada, the US, Sweden, Britain, Japan, etc. (to say nothing of the various states, provinces, and territories they contain) have come up with (slightly different) recommendations without a single study being completed? Have you asked anyone who might know? Do you agree that your position stretches credibility way beyond the breaking point?  

"There has never been a proper (by peer review standards) study of just the preservatives" - false. A quick Google search on "double blind vaccine preservative study" revealed this study as the third hit. Have you verified *any* of your assumptions?

"There has never been an adequate long term study of the effects of the vaccines across the life span" - impossible to evaluate without a definition of "adequate". People who get immunized are protected from that disease for years, decades, or a lifetime (this is measured both by observing that these people don't get the disease and by directly testing their blood for the relevant antibodies). People who aren't immunized often contract the disease, are ill for days or weeks, and some are permanently disabled or die. What more do you need?

SARS in China and Canada: What possible relevance does this have? It is completely unrelated. The only way to connect SARS to this discussion that I can conceive of is that you believe (or think I advocate) that vaccines represent the sum total of medical practice and innovation. (I admit it's a stretch, but the alternative is that you have nothing of merit relevant to say so you're just tossing out a bunch of red herrings and straw men.) True, vaccines have had nothing to do with vast improvements in surgical techniques, treating stroke victims, managing diabetes, and numerous other health issues. So what? Truly: why do you mention SARS at all?

But, for the sake of completeness, let's look at SARS. In China, the government reaction was to deny there was a problem, crack down on bloggers and text messages that tried to communicate the fact that many people were getting sick, and took no precautions to protect its citizens. The disease spread. In Canada, the government was on the front lines communicating how people could get sick, people suspected of SARS were informally quarantined, health workers took extensive precautions (though some still died from SARS), and [tens or hundreds of] thousands of people wore face masks in public. The disease was largely contained. Yes, vaccines had nothing to do with it. What is your point?

"It can not be claimed that the full scientific model /testing was used." Wrong. Flat out wrong. It can be claimed. It has been claimed. Furthermore, it has be DONE.

"I also believe that the ideological model of human health and the immune system needs to be updated." Wow. You have a problem with Penn and Teller telling folks that they're morons for ignoring the overwhelming scientific consensus that places their children at risk for lifelong disability or death. But you have no problem with demeaning the education, ethics, and practices of the entire medical community by describing their understanding of the human body as "ideological" and (presumably) not rooted in reality. Do you have even a basic understanding of human health and the immune system? If so, how? (I certainly don't.) If not, on what basis can you believe that our current understanding needs to be updated?

I'm relieved to note that you agree Miller is a propagandist, and not interested in a reasonable discussion. But you are wrong when you state: "It's like reading any book or "peer reviewed" paper." No. With a book, one can state anything, regardless of the evidence. No one is checking. With peer review, though imperfect, someone does check.

"I think just as much criticism is need on the pro-vaccine side as well." At some point, evidence counts. I don't argue in favour of vaccines because I get paid by drug companies, because I think doctors are perfect, or I have some irrational emotional commitment to them. I think they are beneficial because the data clearly show that vaccinated kids don't die from certain diseases. And I think that's a good thing.

Read some of the scientific papers. They are filled with the disclaimers you are looking for (how many tested, limitations on interpreting the data, other avenues of recommended research to further verify the assumptions or [in]validate the data, etc.). True, the media skips over those bits. Coverage of science topics in the media is lousy. Agreed. That does not mean that the scientific discoveries they describe are without merit. Anyone who truly disproved the effectiveness of vaccines would be heralded as a hero – that’s how science works. People who carp on pet theories when they have no evidence and cannot even demonstrate how their position could be true in principle are derided. That’s also how science works.

In summary: over the past few months, each argument you have provided - all of them - every single one - was either logically incoherent or radically disconnected from reality.

On this topic, you have shown yourself impervious to fact. Logic has had no impact on your stance. Truth seems to matter little, if at all. If one line of defense of your position collapses, you come up with another, until it seems you are desperately grasping at straws that have no bearing on the topic at hand (SARS).

So: I am done discussing this topic with you. I will no longer try to understand why you think vaccines do not have a net benefit for society. I will not try to convince you that the earth is (mostly) spherical. I will not try to convince you that Barack Obama was born in the United States. I will not try to convince you that the earth revolves around the sun. When reason, knowledge, and science have no effect (and over the past few months this has been demonstrated repeatedly), I must (regrettably) walk away from the conversation.

Thursday, November 17, 2011

Book review: Vaccine Safety Manual

A friend of mine, during a lengthy discussion about the safety and effectiveness of vaccines, sent me a book called Vaccine Safety Manual. I read the Introduction and two chapters and wrote the following review in a personal email to explain why I found the heavily footnoted arguments made in the text unpersuasive. The letter has been lightly edited to remove personal references and clarify certain arguments not clear outside the context of the broader discussion.

To [my friend],

Thank you for sending me the Vaccine Safety Manual. I can see that it is the source of many of your concerns about vaccination.

I have read the Introduction, Measles, and MMR sections, and wanted to share my thoughts with you. (All quotations and page references are from the second edition, published in 2010. All italics are in the original text.)

But first, a little context.

I am not a scientist - I studied mathematics, computers, drama, and business, none of which are particularly relevant to the topic of vaccinations. I have a basic understanding of science, but within that biology is easily my weakest subject area. I have taken only one course in it (Biology 101 or its equivalent) so I am in no way an expert. I am skilled at logical inference but must defer to experts I trust on the details of any biological or medical issue.

The key word in the previous sentence is trust. Because my knowledge is only cursory, it would not be difficult for someone who has a deep understanding of biology to bamboozle me. If someone bluntly claimed humans didn't need oxygen to survive, I would walk away from the conversation knowing that person was a crank. But I probably could not refute a similar argument that got into the details of how the lungs extract only oxygen from air that contains mostly nitrogen, the chemical pathways of how that oxygen is converted into energy for our muscles to use, and a substitute substance that under certain circumstances replace oxygen as fuel during respiration.

My concern is that I may not be able to distinguish between a sophisticated, coherent, and accurate argument that should change my opinion about vaccinations, and a sophisticated, coherent, and fallacious argument that managed to mask its flaws (to my amateur eyes).

So I need to trust that whatever source I read has intellectual integrity.

Intellectual integrity does not simply mean that a person does not lie. It means that the proper context is established to give as complete and accurate a description of an event, process, or issue as humanly possible, with the relevant pros and cons, with each factor given the appropriate weight.

Let me give a completely non-medical example.

Michael Moore is a skilled and often entertaining filmmaker. His recent works are called documentaries, but I think they would be more accurately classified as propaganda (whether you agree with his take on issues or not). In Fahrenheit 9/11, there is one scene where he is interviewing a US Senator or Congressman. The elected official says something along the lines of, "If my constituents ever want to talk to me, they can call my 1-800 number and be connected directly to my office."

Just after he says that, there are some added subtitles: "Senator X doesn't have a 1-800 number. But you can call his office at (123)456-7890."

Assuming that Michael Moore was not lying in the subtitled text, this is a great Gotcha! moment. The Republican guy was caught fibbing on camera!

Except he wasn't. Not really. He had a toll-free number that started with 1-888. So while, technically, Michael Moore was not lying (the politician did not have a 1-800 number - though he did have a toll free number), he certainly was not presenting a portrait this person with any form of intellectual integrity.

The key point is: you would never know about this sleight-of-hand tactic if your sole source of information was Fahrenheit 9/11. In order to have an accurate understanding of the situation, you need to have more knowledge than was presented in Michael Moore's polemic.

I fear I must conclude that, in a similar fashion, Neil Z. Miller lacks the intellectual integrity for me to trust him. I will assume from the outset that Mr. Miller does not lie outright. In fact, I find him refreshingly forthcoming. On page 17, he writes, "I never intended to ratify traditional beliefs regarding vaccine safety and efficacy." On page 26, he writes, with considerable understatement, "this book does not emphasize vaccine benefits." I do not have access to many of the studies he quotes or summarizes, and even if I did, I do not have the time to follow up every reference. But here, on the first and last pages of the Introduction, he bluntly states that he did not conduct his research with an open mind and let the weight of evidence determine his conclusion. He had an agenda, which he explicitly sets out, and would report on whatever he could find that matches his already fixed decision. And having read three sections of the book, I conclude he writes about ONLY those things that support his predetermined viewpoint.

The book may be many things, but it is certainly not a fair, dispassionate, objective, or reliable guide to the risks of vaccinations (according to Mr. Miller, there are few if any benefits).

On page 18, he writes, "one-third of highly cited original clinical research studies were eventually contradicted by subsequent studies." The clear implication is that the conclusions of highly cited studies are suspect. There are a few reasons why this is misleading: 
  1. This means that two-thirds of such studies have withstood the test (and re-test) of time.
  2. The paper had nothing to do with vaccinations. It was written by Dr. Ioannidis, who was profiled in a November 2010 Atlantic article (about which I wrote: "“It has been said that democracy is the worst form of government except all those other forms that have been tried from time to time.” - Winston Churchill, 1947. Could the same be said for double-blind studies and medical science? Kudos to the medical community for welcoming his Dr. Ioannidis' research and results - but its implications are staggering.").
  3. This is roughly what one would expect with scientific progress. We learn more; we get better; previous results/theories/methods are refined, or in some cases, rejected. Either Miller doesn't understand this basic principle of science, which makes me wonder whether there are other fundamental gaps in his knowledge, or he does understand this, but is happy to deliberately mislead his readers, which does not make me inclined to trust him.
  4. I had hoped that Miller would apply a similar standard of excellence to the studies he cites that initially supported his position, if any of them were contradicted by later research. He does not, as we'll see below. 
Also on page 18, he writes, "The media is loathe to publish anything that challenges the sacrosanct vaccine program." This made me laugh. Does Miller live in an alternate universe where Jenny McCarthy, Oprah Winfrey, and many others are not given plenty of air time and print space? The purported vaccine -> autism link has been given enormous media attention. He's not accurately representing reality.

Page 19: "3 percent of all children six months to one year of age who received the vaccine ended up in the hospital with respiratory problems!" 3% may be bad, but perhaps not. What is the rate for infants who didn't receive the vaccine? One percent? 10%? We don't know, because Miller doesn't tell us. And because it is supplied in isolation, absent the relevant context, the 3% figure is useless.

Page 19: "A whopping 62 percent [...] had systemic reactions," which could be any of a long list of symptoms including headaches and muscle aches. It's clear that Miller is implying that vaccines cause "systemic reactions" in a majority of people. But that's not fair. When I get a needle in the arm, it aches for a couple days, no matter what it contained (including when the needle contains nothing, such as when I donate blood). The needle itself causes some discomfort. Given the muscle ache criterion, I'm surprised the number was below two-thirds. Plus, vaccines are often weakened viruses. So a mild reaction is often to be expected. That's probably why doctors consider it "normal," not because (as Miller implies) doctors are all part of a vast vaccine conspiracy. Miller does not mention that a getting a headache might be preferable to contracting meningitis.

Page 21: "The pure and innocent baby is overdosed with 38 vaccine-drugs". There is just so much wrong with this sentence. The opening is clearly inflammatory language - "pure and innocent" is not there to convey information, it's there to provoke a strong positive emotional reaction, to contrast with the damage one must be doing by subjecting this beautiful being to an "overdose". There is no explanation of "overdose" - why is 38 (over the course of a year and a half) an overdose? Would 3 be an overdose? Why or why not? Would 300? I don't know, and if Mr. Miller knows, he isn't sharing. Note too the invented hyphenated compound word "vaccine-drugs", because one associates overdosing on drugs, not on vaccines. This isn't honest writing - it's pure propaganda.

Here's the analogy in the text, all he provides by way of explanation (referring to the combined Measles, Mumps, and Rubella (MMR) vaccine): "If you pour three separate glasses of whiskey, gin, and rum into one bottle, you're still ingesting three alcoholic drinks with all of the expected effects." Well, yes. If this wasn't the case, then consolidating separate measles, mumps, and rubella vaccines into a single injection would rather defeat the purpose, wouldn't it? Miller takes an argument that favours current immunization practices and tries to spin it to sound negative.

Page 21: "The United States is the most vaccinated country in the world, yet it has a poor infant mortality rate." The latter is definitely true, and I will assume the former is as well. But what are the most relevant factors determining infant mortality? I would propose that childhood poverty or the tens of millions of people/families/children without health insurance (who therefore have limited access to health services) are far more responsible for the poor showing of the US in this regard. I would guess that Canada or Sweden have a similar vaccination rates as the US, but very different infant mortality rates. The argument is a red herring.

Page 21: "There is evidence that when children are young and exposed to disease naturally, and then recover, the immune system is stimulated and strengthened." True. The immune system is also stimulated and strengthened when children are young and exposed to attenuated versions of diseases via an immunization program. And with immunization, you have far fewer children that are exposed to the disease and do NOT recover. Which is better for a society? Once again, Mr. Miller does not lie. But he guides the reader to a false conclusion that he does not explicitly state. I cannot characterize his writing on page 21 as honest.

Page 23: Miller here argues, curiously, that vaccines work. He accurately says that when you vaccinate a population for one strain (of six) haemophilus influenzae, the other five are more prevalent in those who get the flu. Similarly, he argues that preventing seven strains (of 90) of pneumococcal disease is *worse* than preventing none. The logical extension would be that until vaccines have been developed for every strain of every disease, they are somehow bad. I truly do not follow his argument here at all. What is he trying to say? (He applies the same bizarre logic to the HPV vaccine in Figure 81 on page 257.)

Page 24: "Sadly, our lawmakers are impotent to effect meaningful change." Baloney. See my media comment above. Mr. Miller seems to confuse "unable" with "unwilling" - lawmakers, with some exceptions, do not want to see a vast increase in preventable childhood disease.

Page 26: "I never give advice." HAHAHAHA! I thought he had to be joking, but apparently he's earnest. What does he call the previous nine pages?

Miller lists a large number of horrible side effects, up to and including death, on page 114 and in Figure 30 on page 115 that have "linked to" the measles vaccine. If the vaccine caused these side effects, I'm reasonably confident Mr. Miller would have said so. So what does "linked to" mean? I don't know, and Mr. Miller doesn't define the term.  He also doesn't give any indication of how many people experience adverse reactions. It is one in ten million? One per hundred thousand vaccinated? One in ten? The book doesn't say. Mr. Miller omits crucial information that could greatly strengthen his argument or render it utterly moot (he does so again in Figures 48, 60, and 79). One cannot possibly make an informed decision based solely on the data provided in this book.

On page 117 and again on page 149, Miller refers to Wakefield's discredited 1998 Lancet paper. This book was published in 2010, so I don't expect the book to contain references to the fact that Wakefield lost his medical license in May 2010 and that the paper was formally retracted in February of that year. But he writes on page 149 (and uses the identical phrase on page 158), "Wakefield and his world-class team of medical experts" without mentioning that 10 of the 12 authors retracted their names from the paper in 2004 - six years before this edition of the book was published. Either he knew that over 80% of this "world-class team" denounced the paper's findings and did not disclose this information, or he was not aware of a major change to a landmark study that received considerable publicity at the time. Either way, Miller is highly irresponsible.

Page 159: Miller approvingly repeats Wakefield's contention that "thirty-one children is too small a number" to draw any conclusions. Yet Miller refers to the 1998 Lancet paper at least twice, in glowing terms, without mentioning that it studied only 12 children. The double standard is glaring, and galling.

On page 160, Miller refers to an *interim* report from the Immunization Review Committee, quoting "models linking MMR vaccination to autism spectrum disorders, although far from established, are nevertheless not disproved." Two things: It is nearly impossible to prove a negative. The committee was stating a truth, but Miller invests it with far greater weight than is warranted. But the final report, issued in 2004, stated clearly that the "evidence favors rejection of a causal relationship between the MMR vaccine and autism." This is known as quote-mining - selecting quotations out of context to make it appear the author is supporting a stance other than intended to support your own argument - and I strongly suspect that this is not the sole instance of this practice in the Vaccine Safety Manual.

At this point I deemed Miller's credibility to be irreparably damaged.

Doctors and the medical profession do not automatically and blindly condemn and ostracize those that criticize the profession. Look at the example of Dr. Ioannidis. The medical community embraces his stinging critique of the gold standard of medical research. On the other hand, Wakefield is not persecuted because he dared to stand up to the establishment. Wakefield is persecuted because he abused children in his care and committed multiple counts of fraud. Medical professionals are highly critical and disdainful (quite rightly, in my view) of shoddy research methods, lax methodology, gross conflicts of interest, and bad science.

Miller assuredly makes many claims that I have not refuted here; but I hope I have demonstrated why I do not trust that Miller is intellectually honest - that is, that I can take him at his word that he is portraying the risks of vaccinations accurately. As Miller himself states, he is only interested in presenting one side of the argument.

For a more balanced view, read the Immunization Review Committee report where they describe their approach: "The committee begins from a position of neutrality regarding the specific immunization safety hypothesis under review. That is, there is no presumption that a specific vaccine (or vaccine component) does or does not cause the adverse event in question. The weight of the available clinical and epidemiologic evidence determines whether it is possible to shift from that neutral position to a finding for causality (“the evidence favors acceptance of a causal relationship”) or against causality (“the evidence favors rejection of a causal relationship”)."

That's how science should be done - allow the evidence to determine your conclusion. Miller had already decided what his conclusion was, and sought the evidence to back it up. The difference is crucial. And that is why I will trust the Immunization Review Committee report, but not the Vaccine Safety Manual.

I took notes and wrote all of the above to demonstrate that I have not rejected Miller's arguments lightly. I am not a doctor, have no firm grounding in biology, and only the most cursory knowledge of how vaccines work. But even so I am convinced that the Vaccine Safety Manual, supposedly an authoritative tome on questioning the wisdom and efficacy of vaccinating a nation's children, is (at best) misleading. One cannot trust the author to honestly inform the reader on significant points. Rather than using evidence to build a rational justification for questioning the efficacy of vaccines, Mr. Miller engages in half-truths, misleading arguments, and emotionally laden language to advocate for his ideological position.

Tuesday, November 15, 2011

Vaccination conversation, Part 5

The conversation on vaccines continues. Indented text is written by others. All text has been lightly edited for clarity and to remove personal references.
In our last discussion I tried to point out several flaws in the research methodology methods that were being used. You stuck to your guns 100%. Once upon a time, all the studies said that smoking was fine. Doctors even recommended it. It was only those with, as you put it, no biological or medical knowledge, minus a few, that were most vocal.
When you posted that article, I was curious how it affected your 100%, no doubt (except for maybe the flu shot) attitude. You answered my question quite clearly. It didn't. It may apply to other areas of science, and maybe even some medical disciplines. But not vaccines. Okay. Once again I can't imagine anything I could possibly say.
As for the Vaccine Safety Manual: no, I can't summarize it. It is like a text book. It goes  through the history of every vaccine, the corresponding disease, and is filled with a multitude of peer review articles. It is extremely well researched and very thorough. I ordered you a copy. Enjoy it as research, fairly tales or as a booster chair for one of your kids. Your call.
As for Wakefield: to be honest, as I stated before, I am not sure how anyone can understand anything about the entire controversy. I have seen so much propaganda, fluff and hate from both sides that I have no idea how you came to the conclusion you did. What little I read on this issue showed no blatant fraud or lies. Serious problems with methodology and ethics, yes, but that's it. It doesn't matter very much as I have never used him as a reference.
I was very excited about a study that he was about to publish about a year ago. He took two groups of primates, gave one group the regular US vaccine schedule and gave the other, the control group, nothing. Preliminary results showed delayed neurological and survival instincts in the test group. As the paper was about to be published, the Lancet suddenly decided after something like 10 years to retract his original article. Also, at the same time the UK medical board decided to suspend and eventually revoke his medical license. If that wasn't enough, there was then a giant media smear campaign against him. It seemed like very interesting timing to me. Bottom line: I didn't believe any of it. Both sides are little more than sensationalism, propaganda, and fear mongering. And both sides have financial motivations to argue as they do.
Listen to this lecture or don't. I don't really care. [Ed note: I have been unable to find a video or transcript of this lecture. The original link now redirects to a blog post about autism and iPads.] What I say still stands. During his lecture to European Parliament in 2010 after he lost is medical license, he quotes several peer reviewed studies to support his claims. I didn't have a pen and paper handy to write them all down for you. You asked for "help" in understanding how intelligent people have the ideas / beliefs that vaccines are not worth the risk and I thought this was a useful resource.
What about evolution? One of the points I wanted to bring up earlier is the evolutionary significance of some diseases. We don't know what the long term effects of not having certain diseases in our environment really are. They have been around as long as we have, most likely longer. To assume that we have been living with them for thousands of years but they serve no useful purpose or benefit is a little odd, no? To think that we can just eradicate entities that we have been cohabiting the planet with for the entire life span of our species, and not have some kind of detrimental effects, is a little arrogant. This is a very long and separate argument, but I wanted to mention it here for you to think about. It's all part of the greater package that I see as totally untested and untestable.
Finally, my entire overview is based on a medical model that differs from the standard view. It is based on science and research, but it is not the standardized approach to wellness / sickness. I am not sure if I am capable of writing about it. I think I could do a so-so job of presenting it orally. 
I will not repeat what I have already written, but refer to my previous responses.

Double-blind peer reviewed research is not perfect , and the article indicated that greater caution is warranted when using a single study or only this method to argue a point. Like democracy, it has its flaws – but it’s the best we have. What would you replace it with?

You asked why I think vaccinations are safe. I provided a robust response. Studies were one pillar on which my argument rested; that pillar may not be as strong as I had previously thought, but the other arguments are unchanged. On what foundation does your argument rest? I still don’t understand.

You claim that all the research that has concluded that, on balance, vaccines are safe and effective are flawed by methodological problems, self-interest, corruption, and/or failing to account for long-term effects. You have provided no credible evidence to back that up. Let’s assume the contents of the Vaccine Safety Manual make a good argument – I will look at it when it arrives. But given your radical skepticism about medical findings, how CAN it be convincing? Through research? Studies? Why is the research done by your authors true and accurate, but the research done by hospitals and governments (among others) around the world for decades invalid?

The tobacco analogy is fatally flawed. See my previous posts for a list of various institutions that have conducted various types of vaccine research. Drug companies are included, but only as a small part of that list.

The whole point of vaccination is to develop long lasting or lifetime antibodies without getting the disease. We inject dead or attenuated versions of the disease to trigger an immune response. And it works (not 100% of the time, but enough that it makes a HUGE impact on incidence and mortality – we eliminated smallpox entirely due to a decades-long comprehensive global vaccination program). To claim otherwise is to deny reality.

Do you think that surviving a disease is better than getting vaccinated for it? Let’s follow this line of reasoning. If nobody is vaccinated, lots of people get sick and many die from disease X. If everyone is vaccinated, few people get sick and a very small number die from disease X. How is the first scenario superior to the second? I am baffled.

I think you misunderstand evolution. Any complex and successful organism will suffer from parasites who want a free ride. You are claiming that diseases (let’s say hepatitis) benefit us. I think you’re out of your mind to say such a thing. In principle, there may be some esoteric benefit to a broad range of diseases running rampant in the human population. But the cost in human lives and misery is enormous – are you really claiming it’s worth it? Who is arrogant here? Life before modern sanitation, technology, and medicine was nasty, brutish, and short.

The argument that we cannot understand the long term (or if we do, the very long term, or the very very long term) effects of an intervention can be applied to just about any advance in human society or technology – surgery is unnatural, as is any form of representative government, as is birth control. I think that all these are good things. Don’t you? We evolved into our current form long before any of these innovations. To be consistent, why are you so against vaccinations but not, say, cell phones? Or electricity in our homes?

Every argument you have provided so far against vaccinations – every single one – is either a) false or wildly improbable (all positive vaccine studies are corrupt or lax), b) scientifically incoherent (avian RNA), c) irrelevant (toxic additives), d) data-free (nut allergies), e) allusions without explanations (Vaccine Safety Manual), or f) actually in favour of routine vaccinations (Australia). You have not acknowledged an error or retracted a single claim throughout this entire discussion. I hope you’ll forgive me for being unconvinced by the arguments and evidence against vaccination presented thus far.

I was a little disturbed by your response to the Wakefield clip. I guessed how you felt about him and thought I presented it properly. Put that aside and listen to his sources - everything he cites is done by others.
For the record, I am using electricity right now, I use antibiotics for the kids, and the Vaccine Safety Manual is filled with peer reviewed studies, so I am not sure how I led you to believe that I was against and fundamentally rejected all of these things.
I want to say three things that have had a big influence on my view of the medical model.
1) Gould's Mismeasure of Man. He and others like him step back, and look at the situation as a whole. In this book he didn't say that intelligence testing was not the best that they had when they did it. He broke from the system and tried to give an objective view from today's perspective. I wish it was mandatory reading for people who preform the actual IQ test. I wish there was an equivalent for the medical model, and the experimental model.
2) Once [someone I knew] was waiting for his chemotherapy treatment, and there was a major delay -  literally hours. Keep in mind that chemo is like battery acid being injected into one's bloodstream. After a few hours he started cracking up laughing. Everyone started looking at him, and he said, "Can you imagine what people in the future are going to say about us? Something like, 'Not only did they inject themselves with raw poison, but the idiots actually stood in line and waited for it. What morons!'" It was an interesting reality check for me. I am sure bloodletting worked to some degree but when we look back... There is no reason to think that same won't be said about us and all of our current practices, regardless of how right we think we are today - especially if we don't update the model, or how our thinking is structured.
3) You once wrote, "In theory, theory and practice are the same. In practice, they're not." Funny and profound, and very true. All the research in the world is, at best, theoretical. This doesn't mean that research isn't helpful or that it doesn't need to be continued. It just means that that's all it was. Research. A study, a statistic, an average. Practice is not the same as theory.
Wakefield violated just about every ethical and professional standard in his now retracted study. The man is indirectly responsible for thousands of children falling ill and hundreds of deaths from easily preventable diseases. Independent investigations have now concluded that he also guilty of fraud. He attributes every criticism of his work to reputational hit men and pharmaceutical company conspiracies. He is vile.

He is also clever. He could make up research results or inaccurately portray the results (perhaps by enumerating all risks but no benefits); he could quote them out of context (by not differentiating between a one in ten risk and a one in a billion); he could attribute conclusions to papers that the authors never intended. I do not want to verify every one of his claims. The bottom line is, I do not trust Wakefield, and don’t want to waste my time on him. If there is good research supporting his claims, there should be plenty of more trustworthy people defending the anti-vaccination viewpoint.

1) I also read Gould’s Mismeasure of Man. So let’s look at the big picture. No vaccinations – hundreds of thousands or millions ill, tens of thousands of deaths in North America every year. Everyone vaccinated – hundreds OR thousands ill, tens of (perhaps a hundred) deaths. The rest is details.

2) Chemotherapy is horribly primitive. Its basic premise is to kill the person slightly slower than the disease. It is also, for now, the best option for many people afflicted with cancer. I look forward to the day when we have techniques that render it (and its cousin, radiation treatments) obsolete. The answer lies in more research: better understanding of the disease, devising new avenues to attack it, demonstrating that the new methods work as they should, tweaking and improving them, etc.

3) Studies are not all done with test tubes in a lab. Many are observational – looking at what happens in the real world to real people. When dealing with hundreds of millions of people, statistics are required. That’s why you need a mix of theory (does this make sense in principle?) and practice (does it actually work in the way we expect in the real world?) Different types of studies can provide both. See 1) above.

I don’t necessarily disagree with any of these points, but utterly fail to see any connection between them and your position on vaccination. As always, I am not looking to convince you, but to understand the basis for your position. And I am as baffled as ever.
Hey there. Please read this article. There's no need to discuss or debate; I'm just addressing the peer review issue and the "scientist" and "scientific method" on both sides.
This article is a summary of ways some people have guessed that vaccines might cause harm over the decades. Many of these have been debunked. So the author states (presumably correctly), "No one has proven that this vaccine component doesn't cause autism." If someone studies this vaccine component and finds no harm of any kind to any people, will another possible danger from some other ingredient arise from the mist? Is this discussion the debate equivalent of whack-a-mole? Please remember that no one has ever shown that any component causes autism in any way.

How about some evidence that any such proposed harm has, in fact, transpired? (The only argument I found in the article is one of correlation - and you have probably heard the aphorism "Correlation does not imply causation.")

This paper is little more than data-free guessing. It is a repetition of the unsupported (or demonstrated to be false) claims of others over the past several decades. There is no information to connect any statement in the paper to reality - it's just repeating what someone else once said. And so all of my previous comments stand.

A quick search on the paper title revealed an impassioned rebuttal (heavily cross-linked) of this paper by a pro-vaccine surgeon that may or may not be of interest to you.

You once again make the assertion that vaccines are not nearly as safe as I (and most people, and virtually all medical professionals) think they are. But you have not presented one shred, not one iota, not a single tidbit of evidence to back up that claim. Nothing. Not one thing. Not a single piece, in all the messages we've traded over the course of the many months this conversation has been going on.

Look at it this way. There are at least two possible reasons for the utter lack of studies showing a link between vaccines and significant detrimental effects:
  • There are no links. Any submissions to journals that purport to show them had major issues, so they were filtered out during peer review (or withdrawn after publication). When methodological problems were corrected, the negative effects they described disappeared.
  • There are such effects, but a wide-ranging conspiracy between drug companies, hospitals, journal editors, researchers, doctors, and medical bodies around the world suppress any mention of them in the published literature. 
Obviously, I lean toward the first explanation.

If you think the second one is more accurate, why doesn't Ratajczak mention any anti-vaccine results in her paper, now that she's free from the chains and constraints of her former bosses?

At this point, the Vaccine Safety Manual arrived. I took extensive notes on selected chapters. My review of the book will be the content of the next post.

Saturday, November 12, 2011

Vaccination conversation, Part 4

The conversation on vaccines continues. As with previous parts, indented text was written by others (with only light editing for clarity and to remove personal references).
How do you apply this article to the vaccine debate? Given the immense uproar of this debate of the last few years, especially with H1N1 do you find it interesting that vaccines were not mentioned once in this article as a possible issue?
We use double-blind studies because they are the best tools we have, not because they're perfect. Whereas I view the fact that no reasonable studies challenge the consensus view on vaccines as evidence that they are generally safe and effective, you view the same fact as evidence that no one is willing to dispute the status quo (or at least publish a critique).

If the efficacy of vaccines were demonstrated with a single study, no matter how large, I think skepticism about its admittedly grandiose claims would be warranted. But vaccine studies have been replicated globally, across decades, with similar findings. (Plus some easily observable trends like measles and mumps making a comeback today in communities with low vaccination rates.) That's as close to proof in medicine as we're likely to see.

I think the H1N1 scare was wildly over-hyped in the media (as I mentioned before) - but to my mind that's far more a mass media than a scientific issue, and therefore largely irrelevant to the overall vaccination debate.
Did you read the article that I posted a few days ago? Again I am not talking about my position, proofs, or beliefs in anyway. I am asking when you read the article that you posted, and the article that I posted how do you apply this to the vaccine debate. Do you not have any questions or doubts? Perhaps I am not articulating my question properly. I find it very funny that your article doesn't bring up one of the most contentious medical issue of the present day. I also find it very interesting that the article describes how a  mother is vaccinated for something and her doctors have no idea how the infant got the same disease a few days later, as he has had "no exposure". Anyhow, I don't really want to get in to the actual debate, but more the application of Religiosity of Medicine and Science. Specifically on this issue.
 The article you linked to is interesting - the whooping cough bacterium has mutated, rendering the standard vaccine (partially?) ineffective. That this has happened is news; that it could happen is not. I don't think it changes the debate in any fundamental way. It's too bad we didn't eliminate pertussis (like we did smallpox) when we had the chance - we were close.

I'm not sure what you mean by the Religiosity of Medicine and Science. If you are equating basing one's beliefs and behaviours on the best knowledge of the human body and the universe that we (humans) have available with what was written on a piece of parchment a few hundred or thousand years ago, I disagree strenuously. But you may mean something completely different.

I would also dispute that vaccinations are one of the most contentious issues in medicine today. There's no shortage of such issues - the best methods of AIDS prevention / treatment, whether and where male circumcision should be standard practice, preparation procedures for future epidemics, how quickly to adopt new technology vs. the costs and potential risks involved, and on and on - but I have yet to see any peer reviewed articles that seriously question the proposition that vaccination benefits are far, far greater than its costs and risks. The debate can certainly become contentious between partisans on either side, but the medical community seems to have come to consensus (with ample documentation and proof) that routine vaccinations are an enormous benefit to the overall health and well-being of a country.
It is surprising that you don't consider it "one of" the most contentious issues. I can't really argue about opinions but it certainly seems so to me. The main difference with all of the issues that you brought up is that they are not backed by law. There is not a huge corporation lobbying governments, funding research, and paying for ads, and refusing entry to schools for non-compliance.
As for peer review, you posted an article which both of us praised highly that criticized all aspects of the peer review process. So I asked you how this applies to your view on vaccines. And you said "but I have yet to see any peer reviewed articles that seriously questions the proposition that vaccination benefits are far, far greater than its costs and risks." I don't know where to go with this.
As for actual peer reviewed studies, I believe I have given you a few, specifically the book called Vaccine Safety Manual which is extremely well researched and sourced. [Ed note: A review of the Vaccine Safety Manual will be the content of a future blog post.] So again, I am not sure what to say. You asked for sources, and I have provided them to you.
I know that Wakefield has a pretty bad reputation and as you know I have only quoted him once. I just listened to this speech last night. [Ed note: There was a link provided to this speech which now redirects to a blog post about autism and iPads. I have been unable to find a video or transcript of the address online.] I tried to find the transcript for you but I was unable to find it. He quotes numerous "peer reviewed" studies NOT DONE BY HIM to support his arguments. If you are truly interested in these studies take the 30 minutes to listen to him and follow the sources that he gives.
To be fair, I am not an expert on what the medical community considers contentious - I am a generalist, do not follow medicine particularly closely. But everything I've read leads me to conclude that the benefits of vaccination are among the least contentious issues in medicine - it is overwhelmingly people who have little or no biological or medical knowledge, training, or experience that are most vocal. (Palevsky is the one exception I am aware of. My point is not that there is perfect unanimity, but that there is a consensus among the vast majority of experts.)

Peer review has its flaws, and they are far greater than I had previously thought. Hence I posted the article about Dr. Ioannidis. However, for all its faults, there is no better way I am aware of to get to an accurate understanding of how the world works. I am always open to new ideas. But the following two scenarios are NOT equal:

1) Someone has proposed a possible risk, with no supporting data and no plausible mechanism to explain how that risk could be realized;
2) A consensus of experts is reached on a given topic, backed by research, laboratory experiments, statistical analysis, and observational studies.

Yes, 2) above may not be perfect. It is also far more likely to be accurate than 1).

There are many laws regarding public safety - seat belts, bike helmets, speed limits, etc. Each infringes somewhat on absolute personal liberty. Vaccinations are a public health issue, and on these grounds certain policies have been adopted (do they have the force of law? Perhaps, but I don't know). We can see the results of low vaccination rates: diseases that have not been seen in decades are returning to communities with low vaccination rates in North America and Britain.

I have not read the Vaccine Safety Manual, so cannot comment on it. Can you summarize its arguments?

Wakefield is a fraud and a liar. He has done tremendous damage, not only to the children he abused in his "research", but also to reputation of The Lancet and medical researchers in general. I do not trust him to do research, nor to cite research done by others accurately or honestly. If there are legitimate studies supporting a contrary view, I welcome them - but I will not give Wakefield 30 seconds of my time, never mind 30 minutes.

As I said before - if I'm wrong, then either vaccinations don't have the benefit I think they do, or the costs and risks are far greater than I understand, or both.

There will be more back and forth arguments on this topic in my next blog post.

Wednesday, November 09, 2011

Vaccination conversation, Part 3

The continued dialogue between me, who is fairly certain that national immunization programs are good for society, and others who do not. Indented text has been quoted (with only light editing for clarity and to remove personal references).
Your initial post implied very strongly that vaccines had no side effects and were 100% effective, like an impenetrable glass wall. You then made the comment, "Why is vaccination so vilified by so many?"
I responded by saying "Don't you find it interesting that Australia and Finland have both banned the new flu vaccine and it is barely mentioned in North American media?" When countries start to ban certain vaccines, perhaps there is a problem.
Any national media where the wild ravings of someone like Glenn Beck (among others) are taken seriously has such fundamental problems that the coverage (or lack thereof) of vaccination policies of foreign nations are the least of its issues.

When I first heard that Australia banned flu vaccines, I initially assumed that a batch was contaminated somehow, and the Australian authorities were acting responsibly when this was discovered. Due to your prompting, I looked into it further. After several kids showed ill effects (vomiting, convulsions) following receiving the flu shot, Australia banned all flu vaccines for kids under five in April [2010]. They investigated. They found that all ill effects could be traced to a single product from a single Australian company. The US and several European nations looked at the data and banned that product. In July, Australia rescinded its ban on flu vaccines for those under five (presumably not using the implicated product).

Isn't this an example of national health agencies behaving responsibly in the face of a contaminated product? What would you change about this chain of events (aside from not having a bad batch of product in the first place - we agree that this would ideally never occur). 

Australia continues to vaccinate its population against hepatitis A and B, diphtheria, polio, rota virus, measles, mumps, rubella, chickenpox, and several others.

My question remains: why do you consider vaccination harmful? Pointing out Australia (then others) banned one type of flu vaccine is not an argument against vaccination in general. If Australia is your counter-example, why does the fact that they vaccinate for so many other diseases not convince you of its benefits?
Initially, to answer your very general question about why people would find this to be a contentious issue, I tried to convey in a nutshell what I learned about vaccines that make me question them both philosophically and in practice. Please understand that when I chimed in, I was not trying to convince you. I shared some information about polio, which you found thoroughly unconvincing and I shared my overall opinion of the safety and efficacy of vaccines based on the studies and books I have read, as well as what I have learned from doctors about how the body and the immune system work. This does not mean that I am obligated to disregard how the argument takes shape or that I owe you, on your time frame, a critique of every study I have read, and a thorough explanation of my opinion incorporating everything I have learned over the past five years.
I have tried, am trying, and will continue to try to understand the rationale of those to think the costs and risks of vaccination outweigh the benefits. Smallpox has been eliminated from the planet thanks to a comprehensive, decades long effort. Numerous other diseases (rota virus, diphtheria, measles, mumps, etc.) are almost unheard of in well-vaccinated communities. Yes, I used polio as an illustrative example early on in this thread. As I openly acknowledged earlier, many factors contribute to a decline in the death rate from several diseases - all of which are good. In my opinion, it is better never to get (say) hepatitis than for there to be a treatment that means I (probably) won't die from it. Hence I am glad for all advances in medical knowledge, but particularly grateful for national vaccination programs.

Of course, you are not under any obligation to share anything with me. I have requested that you share what you know about polio and other vaccinations several times. Should you elect not to let me know which studies and books formed the foundation of your research, you would be entirely within your rights. However, in that case I doubt I will ever understand the basis of your opinion.

The efficacy, costs, and risks of vaccination programs have been studied by many different groups, in many nations, across several decades. Taken together, I find the evidence from them compelling. You stated they were (all?) "lax". Given the diversity of funding sources, methodologies, timelines, etc., and given the overall consistency in findings, I think a request for more specifics (which I made) is entirely reasonable. Yes, undoubtedly, some studies were weaker in some areas than others. But most (or all) of them are suspect? What sources would you refer me to in their place?

In principle, one can say that the benefits of vaccination, as I understand them, are exaggerated. Or that the detrimental effects are far larger than I take them to be. Or that the risks are huge, and there is a reasonable chance that these risks could be realized. Or some combination of all these. I am still looking for a coherent argument along one or more of these lines.

You state, "what I learned about vaccines that make me question them both philosophically and in practice." What did you learn? This is precisely what I am trying to understand. Please help.
I would suggest you start with Vaccine Safety Manual by Neil Z. Miller. I would also suggest you look up Dr. Eisenstein and Dr. Palevsky for further info and resources.
A review of the Vaccine Safety Manual will be the content of a subsequent post; more discussion will follow in the next entry.

Saturday, November 05, 2011

Vaccination conversation, Part 2

The conversation between one who thinks vaccines are beneficial (me) and those who doubt their efficacy (indented text) continues. All entries have been lightly edited for clarity and to remove personal references.
Previously you gave a good list of all the things that were improving in medical science to help slow/control/contain/etc. polio prior to the vaccine. The main thing you didn't mention was sanitation. Polio is a disease that is contracted from the fecal mater of an infected person to the mouth of an uninfected person. Thus on top of all the major and wonderful medical advances the BIGGEST impact on the spread of polio was sanitation. The conclusion above was "each of these together had a major benefit but [this does not imply] vaccinations were unnecessary or unwarranted". I find this a very interesting argument. Let's turn it around. Given all of the factors that were all ready in place and already working on the problem how do you conclude with absolute certainty that it was the vaccine that made the difference?
Improving sanitation was also a contributing factor to lower death rates. It doesn't change my previous argument at all. I would much rather prevent a disease from taking hold in the first place than to be successfully treated for it.
You make strong arguments that the data is there for the vaccines. You make strong arguments for trusting the governing bodies, from doctors, to FDA, to governments, etc., that are recommending and mandating the vaccine schedule. You make strong statements that there is no reason to doubt them yet you selectively choose to only use some of the vaccines they mandate. Why? If the science is so solid, and they are all so trustworthy why aren't you vaccinating for everything under the sun? Why wouldn't you believe that H1N1 is as bad as all the doctors and governing bodies said it was?
There are three main reasons I state with confidence that vaccinations work:

1) Controlled experiments (no vaccination + exposure = high (not 100%) chance of getting sick, vaccination + exposure = low (not zero) chance of getting sick). This is not a hypothesis; this has been demonstrated, repeatedly.

2) Preventable diseases (mumps, measles, etc.) are appearing TODAY, but (in Canada, the US, and Britain) only in communities with low vaccination rates.

3) Mathematical analysis of large data sets can identify and weight (with surprising accuracy) multi-factor causes. It's not trivial, but it's not impossible - and it's been done. Vaccination is the single largest (not sole) cause of the drop in deaths due to various diseases.

Some vaccines have been around for decades, against diseases that have been around for centuries (at least), and for which one (or at most three) inoculations are sufficient for a lifetime of protection. These tend to be part of the standard immunization programs. Influenza mutates rapidly, so even the annual flu shots represent protection not against a known disease but epidemiologists' best guesses about which strain(s) will be prevalent in the population. Furthermore, flu shots have always been targeted at vulnerable individuals in the population (which, being lucky, I am not). So I do not go out of my way to get flu shots. There is no contradiction unless you view vaccines as a monolith. I do not. Do you?
Lets leave the polio, or any specific vaccine aside for the time being. I don't want to inject chicken, cow, or monkey RNA into my kids! How do you measure the effects of that? First of all, we don't know what kind of diseases these species are carrying. More importantly, what about the actual RNA itself? What does that do to a developing immune system? How does the body get rid of that? Can it? Where does it go? How long does it stay in there? We are not talking about something that we are evolutionarily designed to deal with.
In the majority of cases polio has little to no effect. Odds are there are many people who have polio and don't even know it. Our bodies have an immune system that is built to deal with it. The RNA of a monkey floating around in there is not the same story. Bird flu, H1N1, mad cow etc... this is scary stuff. We don't need to be introducing these diseases into our system. And we don't need to be potentially altering our genetic code by injecting genetic garbage of other species in to our selves. Plus you are injecting mercury and other neurotoxic additives at the same time .
You write, "we don't need to be potentially altering our genetic code by injecting genetic garbage of other species." This is an unwarranted concern. Putting aside for the moment the amount of animal genetic material in vaccines (I have not looked it up, but I would guess that it is vanishingly small), your DNA will not be altered by ANY amount of foreign DNA. My (future) kids will not be any stronger no matter how much DNA I inject from the cast of The Expendables.

Do you eat chicken and beef? If so, you are ingesting avian and bovine DNA and RNA. This isn't a big deal. Any amounts in a vaccine are trivial in comparison.

As for "mercury and other neurotoxic additives" - this is another red herring. No mercury or mercury products are in any North American vaccines today. We can talk history if you want, but this is (again) irrelevant to the current state of vaccination in the United States and Canada.

I will ask again - do you truly doubt vaccination's benefit? Do you really think that vaccines are dangerous? Are there any substantiated reasons for doubting vaccines work or believing that they induce harm greater than their benefits? If so, please share.

Otherwise, I will continue to be mystified why so many intelligent people seem to be so passionately against a technology that has saved millions of lives.

The discussion will continue in my next post.

Wednesday, November 02, 2011

Vaccination conversation, Part 1

In August 2010 I posted a link to the video below with the following comment: "Yes, some drug companies behave badly (to put it mildly) and yes, occasionally mistakes are made that sicken some. But children used to die by the tens of thousands EVERY YEAR to smallpox and polio (never mind the occasionally fatal cases of measles, mumps, and others). Why is vaccination so vilified by so many?" This led to an extensive discussion on the merits and risks of vaccinations, which I will summarize over the course of a few posts. I would enjoy continuing the conversation with a broad audience. Please feel free to comment with questions  and opinions of your own.

All entries have been lightly edited for clarity and to remove personally identifiable references. Comments from others are indented.

I do not argue that all vaccines are needed for everyone, all the time. I only sometimes get the flu vaccine, and was a little skeptical about the extent of hysteria surrounding new strains of influenza in the past couple of years. But it's a HUGE leap from wondering whether swine flu is truly an apocalyptic disease to denouncing (say) polio vaccinations. That's what bewilders me.
It's interesting that you use the polio vaccine as your example. Many people I encounter are unaware of the fact that between the 1920s and the early 1950s (before the vaccine was introduced) the polio death rate had already decreased on its own by about 50% in most developed countries. Also, the polio epidemic ended in countries where the polio vaccine was not systematically administered. It is also important to note that when the polio vaccine was administered systematically to the US population, a very large percentage of the vaccines were contaminated with SV-40, a monkey virus which causes cancer in humans, and incidentally is passed from mother to child. There's lots more info about the polio vaccine which leads me to believe that it was a big and dangerous flop.
I did not know polio death rates decreased dramatically even prior to vaccination programs, but find it unsurprising and it in no way clears my confusion. Polio was a disease that killed or permanently maimed tens of thousands of people (mostly children) every year. Medical scientists researched the disease, discovered early detection mechanisms, devised more effective quarantine procedures to slow its spread, and invented better treatments for its victims - hence mortality rates fell. Each of these is a significant accomplishment, and taken together they had a major beneficial impact. But to say that because of this, vaccinations were unnecessary or unwarranted brings be back to bewilderment.

Of course, vaccinations do not have an immaculate history. Many doses (especially at the outset) were contaminated. Administering vaccinations often left permanent scars in decades past. We are not beyond incompetence and corruption along the chain of vaccine creation, distribution, storage, and application today. All instances of such behaviour must be investigated, exposed, punished, and (most importantly) corrected.

But let's compare where we were and where we are: Tens of thousands of children dying every year, compared with a much smaller number of people suffering with decidedly less severe conditions.

Again, I ask, thoroughly confused: while openly and freely acknowledging that no technology, including vaccination, is 100% perfect, why are so many people so passionately against vaccination?
Vaccines are cultured in monkey kidneys, chicken eggs, and nuts. This means that along with the actual "desired" substances, and neurotoxic preservatives, we are also exposing those injected with vaccines to the RNA of other species. For example since we have been culturing vaccines in nuts we have seen an unprecedented rise in lethal nut allergies in children. I am not claiming that the former causes the latter. As with all of my arguments, I am concerned that the question is being framed in a way to eliminate a large proportion of the data in favour of the pharmacology argument.
Serious allergic reactions are certainly on the rise. That this is due to vaccines is one (unproven) hypothesis. Allergies are caused by chemicals in the air and water is another hypothesis, though I suspect you continue to breathe and drink. Terminating breast feeding at an earlier age is another hypothesis. And (I'm now making this up) too much sunscreen use is another hypothesis. (Or what about radiation from radio / cell phones / wireless LAN hotspots?) Hypotheses are easy, cheap (free even), and plentiful.

One can imagine any potential harm (autism, AIDS, nut allergy, zombification) and attribute it to an arbitrary cause (in this discussion, vaccines), but hypotheses need data to be deemed valid. We have proof that vaccinations work. Is there substantial harm being done by vaccines? If so, I'd like to know - but documented harms, not potential, theoretical, or excessively vague health issues. Do arguments against vaccinations really boil down to fanciful (that is, data-free) ideas?

I asked a simple question: Given vaccination's aggregate benefit of saving millions of lives and tens of millions of permanent, crippling conditions over the past several decades, what prompts so many to be against them?

This does not imply that there is nothing on the negative side of the ledger. Vaccinations have occasional side effects, and rarely these can be non-trivial. Sometimes they don't take in a very few individuals. Sometimes doses or batches are contaminated. All freely granted.

I am still baffled: If you fairly weigh the benefits and the costs (actual and potential), why is this a contentious issue at all?
When I learned that the death rate from polio was already on the decline, I was no longer able to firmly believe that the polio vaccine was responsible for the declining death rate in the decades following the introduction of the vaccine.
To answer your question about why I feel vaccinations to be a contentious issue, I have many answers. I do not believe that a program that is designed to be "one size fits all" is good medical practice. Just the notion that everyone should get the same vaccines in the same doses regardless of age, sex, heredity etc. seems quite the opposite of good scientific practice. Also, I am not sure that vaccines are quite as effective and save as many lives as you are claiming. In my research, the safety of vaccines has yet to be determined in a sufficient enough manner, and should be determined on a case by case basis (both in terms of the possible illness and the person receiving the vaccine). And I believe (not with blind faith) that due to lax investigations into the true short and long term safety of vaccines, the way vaccines are being manufactured, the rate and method of administration and any combination thereof, that vaccines may be causing more harm than good. So yes, I understand why so many find this to be a very contentious issue indeed.
 I have two questions:

1) When dealing with entire populations (300 million+ in the USA), how do you effectively administer a program on a "case by case" basis? Without guidelines along the lines of, "Do this with all eighteen month olds unless they exhibit one or more of the following symptoms," how does a doctor come up with a "case by case" approach? (I assume you mean something more than a doctor using her/his knowledge of the specific patient and professional judgment, which absolutely should override general guidelines.)

2) There are many published, publicly available, large scale, peer reviewed studies on the efficacy, safety, and risks of vaccinations, performed by national health agencies, academic researchers, medical professionals, and (yes) drug manufacturers.What would you consider to be a sufficient level of investigation, study, research, results, and/or proof?

The conversation will continue in my next blog post.