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.

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