It is ironic that the greatest barrier to the effectiveness of the vaccine program is public acceptance. Part of the problem is that very high acceptance is needed in order to achieve what is called “herd immunity” – where there is sufficient protection in the population that an infected individual will likely not cause an outbreak.

In the US the numbers are pretty good, and have remained so even through the recent increase in the anti-vaccine movement. About 68% of children complete the full routine vaccination series. Many of the individual vaccines have compliance rates in the 90s (MMR, for example, was 92.1% in 2008). The level required for herd immunity varies, but it is generally around 85-90%.

Acceptance of the flu vaccine in the US is much lower. Last year the cumulative flu vaccine use in the >6 month old population was 43%. Many people feel that the flu vaccine is not necessary, that it doesn’t work, or even that it is not safe. Uptake is slowly increasing – we  are at slightly higher levels this year compared to last year, but there is still a long way to go. The flu vaccine does have the added challenge of matching the strains covered in the vaccine to the circulating strains, so efficacy does vary from year to year, averaging about 50% effective. This year, so far, it seems that the match is a good one. We are nowhere near herd immunity levels with the flu vaccine.

Increasingly parents are opting for alternative vaccine schedule - 13% according to a recent survey.  And yet, there is no evidence that any of these alternate schedules is any safer than the standard schedule, but they are less effective – they leave children vulnerable for longer to vaccine-preventable diseases. Use of an alternate vaccine schedule, in my opinion, represents a fundamental mistrust of the medical system. The vaccine schedule is not arbitrary. It is based upon a careful review of evidence, matching the timing of each vaccine to when it is needed and when the child’s immune system is mature enough to handle it. The need for booster shots is determined by measuring antibody levels in response to vaccination. All this evidence is reviewed by panels of experts to determine the optimal schedule.

In place of this system 13% of parents would rather substitute either their own judgment or “Dr. Bob’s Alternative Vaccine Schedule.” They apparently buy into the notion that some lone maverick is better able to parse the research than panels of experts.

The historical relationship between vaccine implementation and the reduction of specific infectious diseases is very clear (which does not stop the anti-vaccinationists from denying it). Further, as pockets of vaccine denial are becoming more common, so is the recurrence of vaccine-preventable diseases. Right now Europe is in the midst of a measles outbreak, with more than 26,000 cases, 9 deaths, and 7,288 hospitalizations so far this year. MMR (measles, mumps, rubella) vaccine uptake is lower in Europe than the US. They are also dealing with many immigrant populations with lower levels of vaccine use, so it’s not all vaccine refusal.

This raises another issue with vaccine use – they are very cost effective. In case you haven’t noticed, we are in the middle of a growing health care cost crisis. The cost of health care is a complex issue I cannot get into here – but what is clear is that vaccines are extremely cost effective. In some cases they may even be cost saving – the cost of vaccine is lower than the health costs of hospitalizations they prevent.

Outbreaks of vaccine-preventable diseases are also occurring in the US. Recently there has been an outbreak of whooping cough on Long Island, for example. Whooping cough is a potentially serious illness, especially in infants. Infants are vulnerable until they are old enough to get the vaccine themselves and so depend upon herd immunity.

Often anti-vaxers point out that when such outbreaks occur it is common for most infected individuals to be among the vaccinated. They imply that vaccines therefore do not work. This is also the case with the whooping cough outbreak. This is an abuse of statistics, however.

What is important is the risk of getting the disease in the vaccinated vs unvaccinated populations. With > 90% of the population getting the vaccine the vaccinated population is much larger than the unvaccinated population. Being vaccinated greatly reduces the risk of getting the disease. Also, if someone gets the disease despite being vaccinated they are likely to have a much milder course.

It also should be noted that while overall vaccine rates are high, there are pockets of low compliance (and these are locations where outbreaks are sometimes occurring).

Anti-vaxers often cite the parents’ right to “informed consent” concerning vaccines. I agree – parents should be fully aware of the risks and benefits of vaccines. When informed with accurate information (as opposed to the misinformation from anti-vaxers) the decision to vaccinate should be an easy one.

The World Health Organization said Thursday that France had 4,937 reported cases of measles between January and March – compared with 5,090 cases during all of 2010. In all, more than 6,500 cases have been reported in 33 European nations.

That is four times the rate of 2010. I know – these reports are almost getting boring. The shock has worn off – we have come to accept that previously conquered diseases (at least reduced to minimal cases without outbreaks) have come back. The cause seems clear – outbreaks occur where herd immunity has been lost due to vaccine non-compliance. Fewer people are getting vaccinated, and not much fewer. But the numbers are falling below herd immunity levels in pockets. When vaccination rates fall below a certain level, then infectious organisms are able to spread and cause an outbreak.

The anti-vaccine movement has successfully spread unwarranted fear of vaccines, resulting in the compromise of herd immunity. There is a toll of morbidity and mortality associated with this movement.

Part of the challenge in raising public awareness about the dangers of pseudoscience and denialism is that the public rapidly become inured to the consequences, even complacent. When I saw this latest report about another measles outbreak, I had to think carefully before deciding to blog about it. I have blogged about outbreaks before, and there is nothing new with yet another measles outbreak. Will my readers be bored? It is hard to sustain outrage – things like unnecessary measles outbreaks become old news with a waning grasp on our collective attention.

So it is useful, from time to time, to remind ourselves and the public that there are consequences to nonsensical and irrational beliefs, and to placing ideology above science and evidence. We live in an increasingly complex civilization, with vexing problems that require more and more clever and elaborate solutions. It’s not easing supporting over 6 billion people (and growing) on this world, while feeding them all and avoiding the endemic problems of a large population – minimizing infectious diseases, limiting our footprint on the natural world, providing enough energy and other resources, and not killing each other over access to limited resources.

Our best tool in achieving our goals and solving the difficult problems of civilization is science – taking an objective, evidence-based approach to our problems so that we can work out the most effective solutions. Pseudoscience, denialism, and ideology are the enemies of science and reason, and therefore frustrate our attempts to find optimal solutions.

Think about the billions that are being wasted on useless or even harmful medical interventions because the science of medicine is being compromised, by clever marketing, corporate greed, by rank pseudoscience, by the infiltration of sectarian belief systems into what should be a science-based endeavor. I see this every day – and yes, my outrage is blunted. I almost chuckle to myself when I see someone become aware of the extent and nature of the problem for the first time – their fresh outrage strikes me as naive. But it is preferable to the “shruggies” who are not even aware of the problem.

Our most precious resource, arguably, is the human intellect. And that is being dulled by organized and well-funded movements to water down the teaching of science and critical thinking, because it conflicts with personal belief systems like creationism. It is impossible to tease out all the cultural effects that conspire together to hamper the intellect – anti-scientific ideology, anti-intellectual culture, politics, low standards in the educational system, and simple apathy. They all work together and reinforce each other.

Despite the strides the skeptical movement has made in the last decade, I am still frequently asked why I waste my time with the whole skepticism thing. There are many reasons, but perhaps chief among them is the understanding that pseudoscience and quackery have consequences – increasingly dire consequences, for the individual, for any society, and for human civilization. Measles outbreaks are only the tip of the iceberg. The skeptical movement endeavors to be a force in the other direction – to make the world a more rational place, to increase the level of critical thinking , and to keep science in its rightful place as the best method for understanding the world and finding practical solutions to our many problems.

There is also a certain love and respect for truth and intellectual honesty for its own sake. But knowing that beliefs have consequences is a huge motivating force.

Like Sagan, I would rather know the truth than believe in a comforting delusion. And I also recognize that as a civilization, we can no longer afford the comforting delusions. They have consequences.

No one study can ever be definitive, but now we have a large body of evidence from multiple studies showing a lack of association between thimerosal and autism. This won’t stop the dedicated anti-vaccinationists and mercury militia from continuing their anti-vaccine propaganda, but hopefully it will further reassure those who actually care about the science.

Background

This has been a long and complex story, so let me review some of the background. Diagnosis rates of ASD have been climbing for the last 20 years, prompting some to search for an environmental cause. The existing anti-vaccine community, not surprisingly, blamed vaccines. This was given a tremendous boost by the now-discredited study by Andrew Wakefield concerning MMR (which never contained thimerosal) and autism. When the evidence was going against MMR as a cause, attention turned to thimerosal in some vaccines. This notion was popularized by journalist David Kirby in his book, Evidence of Harm.

However, this important premise of a correlation – rising ASD rates – is not as simple as the anti-vaccine crowd assumes. In fact there have been many studies of autism prevalence and the consensus at this time is that most of the increase in ASD is due to a broadened diagnosis, diagnostic substitution, and increased surveillance. There may be a real small increase, but most if not all of the increase is an artifact of diagnosis, not a real increase. (Side note – I have written about this topic many times before, and the links I will provide for background are to my previous reviews and summaries, not the original research. But of course, the links to the original research can be found in my prior articles.)

As further support of this a recent NHS study found a consistent prevalence of autism of about 1% in all age groups. If autism rates were truly increasing we would expect a lower prevalence in older age groups, but that is not what they found.

Another line of evidence is the younger and younger identification of signs of autism. Formal diagnosis is often made around 2-3 years old, after many vaccines are given. But numerous recent studies have documented signs of autism as young as 6 months of age. This makes it difficult to blame vaccines given after 6 months.

Holdouts for vaccines as an important contributor to autism rates have pointed to prenatal vaccines given to the mother, but a study finds no correlation there either.

Where the “mercury militia” gains their only support is from the fact that mercury is indeed a known toxin, and a neurotoxin. However, there are still problems with the notion that mercury toxicity from thimerosal causes any neurological damage or specifically contributes to autism rates. The first is that thimerosal contains ethylmercury, which is not nearly as toxic as methylmercury, the form that is found in fish and other environmental sources. Second, the doses given is vaccines is well  below safety limits. Anti-vaccinationists argue that the cumulative dose is high enough to cause damage, but there is no evidence for this. What there is evidence for is the fact that infants excrete mercury very efficiently, and therefore likely clear their mercury load after one vaccine and before the next, so it does not accumulate. And finally – mercury toxicity does not resemble autism (despite the false claims of the anti-vaccine crowd).

Another line of evidence that presents problems for the vaccine hypothesis of autism is the massive and growing evidence that autism is dominantly a genetic (not environmental) disorder. Of course, genes interact with the environment, and there may be environmental factors, but the dominant factor is genetic.

In addition to the multiple independent lines of evidence all arguing against a link between vaccines in general and thimerosal in particular to ASD, there is the ecological and epidemiological evidence which looks specifically at if there is any correlation between thimerosal exposure and risk of autism. Here the answer is a clear – no. There have been multiple such studies in multiple countries (summarized here) showing no correlation.

In addition, A recent Italian study showed no link between the amount of thimerosal exposure and autism risk. Another study showed no correlation between blood levels of mercury and risk of autism.

But the most compelling evidence against a link came from the removal of thimerosal from the routine childhood vaccine schedule in the US. By the end of 2002 all thimerosal, except for insignificant trace amounts, was removed from all vaccines given routinely to children. Only some flu vaccines still contained a small amount of thimerosal, but this is an optional vaccine with thimerosal-free options. The result was a dramatic plummet of thimerosal exposure in the US childhood population. If thimerosal were a significant contributor to autism incidence then we should have also seen a plummet in autism rates. David Kirby predicted this, and the anti-vaccine movement agreed. They gloated about the day they would be proven undeniably correct.

But now it has been 8 years – and autism rates continue to rise at the same rate, without so much as a blip. They tried to move the goalposts for a while, and make some desperate arguments to rescue their failed predictions, but there is no hope. There is no rational conclusion remaining except that thimerosal in vaccines is not a measurable contributor to autism rates.

The CDC Studies

Three years ago I wrote about a CDC study that looked at thimerosal exposure and 42 different neurological outcomes (but not autism). What they found was that there were a few scores that were worse among those exposed to more thimerosal, but there were also a few scores that were better. There was a random distribution of slight positive and negative effects that essentially average out to no net effect. It’s all just noise.

The bottom line is that this study showed no correlation between thimerosal exposure and adverse neurological outcomes.

At the time we were promised a follow up study of similar design that looked specifically at autism – and now, after a three year wait, we finally have those results. This is a case-control observational study that looked at managed care organization (MCO) members for their history of vaccination, including pre-natal vaccination, as well as exposure to thimerosal through immunoglobulins. They correlated thimerosal exposure from these sources to later diagnosis with autism, autism spectrum disorder, and regressive autism. They found:

RESULTS: There were no findings of increased risk for any of the 3 ASD outcomes. The adjusted odds ratios (95% confidence intervals) for ASD associated with a 2-SD increase in ethylmercury exposure were 1.12 (0.83–1.51) for prenatal exposure, 0.88 (0.62–1.26) for exposure from birth to 1 month, 0.60 (0.36–0.99) for exposure from birth to 7 months, and 0.60 (0.32– 0.97) for exposure from birth to 20 months.
CONCLUSIONS: In our study of MCO members, prenatal and early-life exposure to ethylmercury from thimerosal-containing vaccines and immunoglobulin preparations was not related to increased risk of ASDs.

The strengths of this study are the large numbers, the thorough assessment of ethylmercury exposure, and the confirmation of diagnosis. However, this is not a perfect study – it suffers from the limitations of observations studies, as the authors point out in their discussion. The primary weakness was the fact that of 771 potential case-children and 2760 controls they ended up with 246 cases-children and 752 controls. Around 12% were not eligible for various reasons, and the rest were not able to participate for various reasons (because they could not be located, for example), but most of the drop out was simply because potential subjects did not wish to participate.

This high percentage not participating in the study opens the door wide for bias in the final results. The authors were fairly thorough in exploring possible sources of bias from this fact. They found that study participants did not differ significantly from those not participating in various key aspects – such as having an older sibling with autism. Also most case-children were diagnosed with autism after their infant vaccines, so this unlikely to have affected vaccination rate.

But of course it is always possible for there to be unknown confounding factors biasing the results.  A protective effect from thimerosal is biologically implausible, so these results are due to either random chance or some bias in reporting or participation that is not apparent.

Even still, if there were a significant causal effect from thimerosal it should be apparent in this type of study, and it wasn’t.

Conclusion

No one study, especially an observational study, is ever very compelling. I don’t think this one new study changes the scientific picture of vaccines or thimerosal and autism. But it is one more study that fails to show any correlation between thimerosal exposure and risk of developing autism or ASD. This comes on top of multiple independent lines of evidence all pointing away from the notion that vaccines or thimerosal are a significant cause of autism.

The scientific community is likely to see this as further confirmation of a lack of association between vaccines and autism – just one more piece of the big picture. The anti-vaccine community is likely to dismiss it as either hopelessly flawed or as part of the conspiracy. In other words – this study is unlikely to change anyone’s mind on this issue.

They Just Don’t Learn: CDC Votes To Poison Children Again With Two Doses of Vaccines

Parents of children over 6 months and under 9 years beware. The Centers for Disease Control (CDC) is once again choosing to adopt policies which poison your children with what is now two doses of seasonal flu vaccine this fall.

So she emailed the guy the following:

Editors of PreventDisease.com,

It is this kind of fear mongering and sensationalism that lead me to unsubscribe. You should be ashamed to publish this. The use of “votes to poison” and “poison your children” is paranoid and unethical. As an educated, thoughtful person, mother and teacher, I feel your newsletter is insulting.

He replied:

From: dave.mihalovic@yahoo.com
Subject: RE: your article
cc: susan.mchilley@preventdisease.com

Are we talking about the truth or semantics here? Could you please explain to me what the “big difference” is between deliberately vaccinating children and poisoning children? Anybody who votes to inject any child with known neurotoxins, immunotoxins and sterile chemicals is, in my opinion a criminal and poisoning that child. I’m not using lies to get people to read the article…it is an unequivocal fact that vaccines are poison. If you are debating that with me, please provide your evidence that suggests the opposite.

Dave

I deal every day with people like Dave who simply deny science or medicine. Many of them are very much of the “Nothing can convince me” mindset: Dave has, quite obviously, been given all the information about vaccines time and time again; he simply denies it all and believes that his own notions are better founded. He’s probably not malicious and probably does not want children to die from preventable disease. He’s most likely just scientifically illiterate (like most people) and places more emphasis on anecdotal information that supports his ideology than on information that clashes with it.

My sense is that it’s probably futile for my friend to “provide the evidence” that he pretends to be interested in seeing. How, then, do we reach such people, people who are out actively advocating against public health? I put the question to you.

Another ideological alliance is brewing – that between the anti-vaccine movement and extreme environmentalists. This post is not a commentary on environmentalism, and please do not take it as such – the purposes and  claims of the two movements are quite distinct. But they share a common thread: distrust of scientific experts and government regulators who reassure the public that environmental exposures are safe.

Robert F. Kennedy Jr. has been the most prominent environmentalist to take up the anti-vaccine cause, in several articles and speeches. While he appears to be only a part-time anti-vaccinationist, his celebrity and street cred among evnironmentalists led a great deal of weight to his paranoid musings about scientific fraud and government coverups. It seems he wants to recapitulate the moral clarity that his uncles displayed in the 1960s, defending the little guy against abuses by the powerful and privileged. He is ready to see a conspiracy, and he wants to be the crusader for environmental justice – and if kids are the alleged victims, all the better. His article in the Huffington Post – “Attack on Mothers,” says it all.

Now there appears to be another environmentalist, who is also a journalist, getting into the anti-vaccine game – one Steven Higgs who writes for The Bloomington Alternative. He came to our attention recently when he wrote a fawning piece about Generation Rescue’s J.B. Handley. David Gorski and I attempted to reason with him over e-mail, but the result indicated to us that Higgs is not an objective journalist but an anti-vaccine activist – and he came to this position largely through his environmental activism – a budding RFK Jr. (David covers this topic also over at Science-Based Medicine today.)

In a recent article Higgs wrote:

I’ve spent most of the past 28 years journalistically investigating conflicts between environmental victims and experts in the relevant fields. And, I can say without qualification, the victims have been right and the experts wrong in every significant story I’ve covered. I can’t think of a single exception.

Such a definitive statement should raise a red flag – no qualifiers or exceptions? That sounds like confirmation bias. Many of the famous environmental cases usually end ambiguously, in that there is no definitive scientific evidence of harm from the environmental exposure, but the families and activists believe they have been harmed. So I guess if someone always sides with the alleged victims, regardless of the scientific evidence, that could confirm the belief that the victims are always right and the experts always wrong.

Another source of confirmation bias is that when claims of environmental toxicity first come to light, the standard scientific approach is to be cautious but investigate. Good scientists are initially skeptical, and require a threshold of evidence before they accept a claim. So initially scientists may say, “Wait a minute, slow down, this evidence is not compelling, we need better evidence.” If eventually the evidence suggests that there was environmental toxicity, then Higgs and others can claim that the experts were wrong – but this is a gross misreading of the nature of scientific skepticism.

This article from 1980 about the Love Canal is a good example – the scientists are simply calling for better evidence, but that can be interpreted as concluded that there was no problem. Love Canal also demonstrates that these issues are complex. There were toxins being dumped into the environment by industry who tried to deny responsibility, local residents were exposed, but the actual health consequences remain a bit controversial, and were likely not as bad as the worst of the media hype suggested. But eventually the science sorted itself out and the government cleaned up the spill and relocated all the residents.

The lesson is – that environmental stories like this one are complex, and anyone who takes a one-sided position “without qualification” is either not looking into it deeply enough or has an axe to grind.

The story of thimerosal in vaccines is far more complex. When I first looked deeply into this issue I actually was not sure which way I would go – I wanted to get the bottom line correct, and did not want to commit myself without fully wrapping my head around this complex story. At points in my research I felt there might really be something going on. It wasn’t until after I fully digested all the science and all the arguments that I was convinced there is no correlation between vaccines and autism or autism spectrum disorder (ASD).

Steven Higgs claims to have done the same thing, as an environmental journalist, but he came away with the opposite conclusion. I am interested in why – how can two people look at the same information and come to opposite conclusions? Of course, I think I am correct (although I am always willing to reconsider my position in light of new information or arguments) and I detect in Higgs the tell-tale signs of bias, as I noted above. Higgs was prepared from an environmental scandal, and he found one.

I have also seen many intelligent and well-meaning people get sucked into a complex pseudoscience – essentially they are overwhelmed by misinformation in an area where they lack expertise, and therefore cannot put that information into context. When one is confronted by a large volume of information all pointing in one direction, it seems compelling. I have even known skeptics who, after watching Loose Change, thought there had to be some hanky panky going on with 9/11. I have debated creationists who are loaded with information – all subtly distorted against evolution. Sophisticated and complex pseudosciences are a nuisance in this way, and the anti-vaccine movement has now developed into just such a pseudoscience.

What is more interesting is how Higgs has responded to scientists with whom he disagrees – and this reflects the danger of “going down the rabbit hole” of a complex pseudoscience, especially those with a conspiracy angle. Higgs wrote:

And with respect to vaccines and autism, I say again, without reservation, parents like J.B. Handley and grandparents like Dan Burton are right about vaccines and autism. The experts are wrong, and their behaviors — their vitriolic attacks upon those who disagree, their underhanded political tactics — suggest they know they were wrong.

We know we are wrong? The undeniable implication (although Higgs denied this to me and David in an e-mail) is that we are lying. We are therefore complicit in a cover up. Also – look at the extreme bias. Higgs thinks that scientists are guilty of “vitriol.” Mostly, scientists will sharply but accurately criticize Handley and his ilk, and some science bloggers will get “insolent” and that can be considered vitriolic. But it is nothing – nothing – compared to personal smear campaign that Handley and others have launched against those scientists trying to educate the public about vaccines. Remember the infamous “baby-eating” Photoshop job that was published on Handley’s propaganda blog, Age of Autism (and then taken down after it disgusted even the vitriolic echochamber of that blog community). Higgs’ characterization of the situation is so out of touch with reality that it is inexcusable for a journalist.

Also note the populist anti-intellectualism of stating that the experts are always wrong. This reminds me of creationist McLeroy’s famous comment, “Somebody has to stand up to those experts.” In his e-mail to us, Higgs coupled this with the argument ad populi logical fallacy, that he must be right because the anti-vaccine movement has successfully scared much of the public about vaccines.

He also stated that what scientists do is not hard – “That,” as Yoda said, “is why you fail.” Forgive me, but science is hard. That is, doing rigorous science, or even just properly interpreted a complex set of scientific data, is complex, tedious, and exacting. There are numerous pitfalls, and even experienced scientists can get it wrong. We need a community of scientists pouring over methods and data, and correcting each other, to grind out a consensus. I’m sorry, but being a passionate journalist (or parent) does not qualify you (as Handley himself has demonstrated on numerous occasions). It is worse to not even have any pause about the fact that the scientific community disagrees with you. That is hubris.

But I am willing to believe that Higgs and others are sincere crusaders, who are just grossly mistaken in their approach and conclusions. Higgs and Handley are not willing to give us the same courtesy – they think we are lying, dishonest, and on the take. They demonstrate that personal attacks is what you do when you don’t have science or even logic on your side.

When it comes to the details of the analysis of the scientific evidence, Higgs buys the anti-vaccine propaganda down the line. Clearly he has consumed Handley’s campaign of misinformation. With regard to a large CDC study showing no correlation between thimerosal and neurodevelopmental disorders, Higgs writes:

The study, titled “Early Thimerosal Exposure and Neuropsychological Outcomes at 7 to 10 Years,” found that exposure to mercury between birth and 28 days was related to significantly poorer “speech articulation.” It also found a “significant negative association with verbal IQ” among girls.

I have dealt with this this claim here – essentially the study looked at many outcomes, and a couple (when looked at individually) were correlated greater than chance, some positive, and some negative. But when considered as a whole, this is what we expect from chance alone. In other words, the results of this study are exactly what we would predict if there were no correlation between thimerosal and any neurodevelopmental disorder. Put into scientific parlance – this study fails to reject the null hypothesis. Understanding statistic on this level is one of those things experts do that Higgs thinks is so easy.

Higgs also engages in massive cherry picking. He still thinks that thimerosal is responsible for an epidemic of autism – even though the evidence suggests there is no epidemic of autism. But more to the point – the final nail was put into the coffin of the thimerosal hypothesis when almost all of the thimerosal was removed from the vaccine schedule by 2002. The anti-vaccine crowd (most notably David Kirby – another journalist gone astray) predicted that autism rates would plummet. They didn’t – they continued to rise. I and others predicted they would continue to rise, but ultimately would have to level off once diagnostic rates reached saturation. There are some early signs that diagnoses are starting to level off, but it’s too early to say yet. But they did not plummet.

Higgs is now trying to use some recent and minor decrease in a narrow data set in the Ohio Valley to conclude that the much predicted decline in autism rates is finally here (better late than never). He does not mention that the California data, which is the data that the anti-vaccine crowd originally used to argue for a correlation – shows no decline. David takes down this argument further on SBM – for example, the rates are leveling off for all age groups, not just the youngest cohort, which is what you would predict if this were really an effect of removing thimerosal.

This episode also reminds me of David Kirby, who in 2005 was trumping a very short-term downward deflection in the California numbers and happily extrapolating to the predicted “plummet.” But short term trends cannot blithely be extrapolated – as the California data showed. It was just a fluctuation – but the trend continued upward at the same slope.

Conclusion

Steven Higgs appears to be another player in the anti-vaccine scene. His path to this particular pseudoscience appears to be (like RFK Jr.) through environment activism. But the intellectual failings are the same that skeptics encounter over and over again in denial and pseudoscience. Higgs is cherry picking data, dismissing experts, misunderstanding statistic, and engaging in massive confirmation bias. He then shields himself from the very people who can point out his errors by denigrating them and writing them off as tainted (the Handley method).

Meanwhile he embraces the likes of J. B. Handley and turns a blind eye to his shenanigans.

I like to examine people like Higgs the way doctors study disease – there is pathology there, and by understanding it perhaps we can get better at fighting it. I tried the “seek common ground and understanding” approach over e-mail with Higgs, but he was not interested. Maybe my observations gave him a moment of pause. I doubt it, but I try never to give up on optimism.

Here is a pdf of the complaint.

The subject of the suit is the excellent article by Amy Wallace criticizing the anti-vaccine movement. Wallace was attacked for this piece by anti-vaccinationists – essentially because she got the story correct. Wallace pointed out that the science strongly favors vaccine effectiveness and safety, and that the anti-vaccine movement is dangerously wrong – hurting the public health with their misinformation. The anti-vaccinationists were apparently very upset over be called out by a mainstream journalist. They got a lot of bad press this year, the Chicago Tribune also did a series of articles detailing the dangerous pseudoscience of the anti-vaccine movement. Wallace’s article earned her a place in the infamous baby-eating photo (along side Offit and yours truly) that only served to further embarrass the anti-vaccine movement via the blog, Age of Autism.

The law suit, in this context, seems like just the next step in the campaign against Offit and Wallace.

The NVIC, despite its innocuous name, is an ideological anti-vaccination group, and they were targeted among others in the Wallace piece. Fisher found a sentence in the article that she felt she could build a libel case around.

Fisher, who has long been the media’s go-to interview for what some in the autism arena call “parents rights,” makes him particularly nuts, as in “You just want to scream.” The reason? “She lies,” he says flatly.

“She lies” will now be the subject of as much analysis as the term “bogus” was in Singh’s article about the BCA, so I might as well start. Critics often walk a fine line – we want to accurately portray the actions and claims of the targets of our criticism, without holding any punches, but we have to be clear in our terminology and careful not to inadvertently give the wrong impression. The term “lie” is problematic. It is not necessarily inaccurate, but it can carry implications not intended by the writer, because it may imply something about what another person knows or believes.

Often we speculate, when someone makes a claim that is demonstrably false, are they deliberately lying or are they grossly mistaken. But this is a false dichotomy. There is a vast gray zone in between. Making a claim without due diligence is a form of deception. Often people will make claims as if they are verified and documented truths, without acknowledging that the claim is controversial, or without really verifying the facts. People may care more about the utility of a claim and its relationship to their ideology than whether or not it is objectively true. Are making such claims lying? It is more than being wrong, but not quite a knowing lie.

However, when one is engaged in a public debate and advocacy about an important health issue, one has a responsibility to get basic information correct and to relay it in as unbiased a manner as possible. Being recklessly wrong in such a case may be the moral equivalent of lying.

On the NVIC website there are numerous examples of misinformation. For example, about squalene (a vaccine adjuvant) they write:

However, the use of squalene type vaccine adjuvants, which were allegedly added to experimental anthrax vaccines and made Gulf War soldiers sick, is controversial.

OK – they write “allegedly” so I guess they are covered. But this is still deceptive, and meant to scare people off vaccines. It turns out that there was no squalene in the anthrax vaccines given to Gulf War soldiers. And soldiers who developed unexplained symptoms in the Gulf War were not more likely to have antibodies to squalene. The anthrax vaccine-squalene-Gulf War syndrome connection has been completely demolished at every point. It is no longer “controversial” among scientists.

So is the NVIC statement above a “lie” or is it just sloppy misinformation – and is there a functional difference between the two?

The use of libel suits to intimidate critics and have a chilling effect on open discussion is an old strategy. As I said, the BCA attempted to do that by suing Simon Singh, taking advantage of the horrible English Libel laws. Uri Geller sued James Randi in the past for saying he cannot really bend spoons. Matthias Rath sued Ben Goldacre for criticizing his health claims. Skeptics have, to a degree, engaged in public criticism of pseudoscience with the constant threat of being sued. Even when such suits are legally unsuccessful, they can be financially ruinous and therefore an effective bullying tool.

The ability to sue for libel is an important right to redress legitimate wrongs. But this right can easily be abused to silence open discussion. For this reason many states have SLAPP laws (strategic lawsuit against public participation). Recently the Canadian Supreme Court ruled that the need for open public discussion of important issues is a legitimate defense against a libel suit.

This is also the point behind the Keep Libel Laws out of Science movement, which is partly a backlash against the BCA suit against Singh.

Now the anti-vaccine movement in getting in the game, using the threat of libel to place a chill on legitimate criticism of their dangerous misinformation. It is time for the scientific and skeptical communities to rally behind Paul Offit as we did Simon Singh. I suspect this lawsuit will backfire against Fisher as much as the Singh suit did against the BCA. Let’s take a close look at the claims Fisher makes and whether they constitute “lying”. I suspect she will not hold up well under close scrutiny, just as the BCA claims did not.

Skeptical analysis is all about shining the light of science into those dark places of dubious claims and ideology that fear the light. Libel suits are often used as a tool to shield against the light of open examination, but we should fight back by using them as opportunities to shine even more light. Fisher better put on her sunglasses.

The Richard Dawkins Award will be given every year to honor an outstanding atheist whose contributions raise public awareness of the nontheist life stance; who through writings, media, the arts, film, and/or the stage advocates increased scientific knowledge; who through work or by example teaches acceptance of the nontheist philosophy; and whose public posture mirrors the uncompromising nontheist life stance of Dr. Richard Dawkins.

The part that caused controversy was the bit about “advocates increased scientific knowledge.” A number of skeptics (Orac, I think, was most verbose)  had a problem with this because Bill Maher is an advocate for medical pseudoscience. He does not believe in vaccines, he denigrates “western medicine” as a scam, and he has a problem with germ theory.

On RichardDawkins.net Josh Timonen gave was appears to be the official defense of the decision:

Whilst Richard was not involved in the decision, he is nevertheless happy to go along with it. Just as he worked with Bishop Harries to protest against creationist schools in the UK, and just as he regularly recommends Kenneth Miller’s books on evolution to religious people, he understands that it is not a prerequisite to agree with a person on all issues in order to unite in support of a common objective. Richard and Christopher Hitchens don’t see eye to eye on all political matters, but that doesn’t stop them from working together against the dangers of religion. Honoring the creation of ‘Religulous’ does not imply endorsement of all of Bill Maher’s other views, and does not preclude Richard’s arguing against them on future occasions. It is simply showing proper appreciation of his brilliant film.

This misses the point, in my opinion. If the award were solely for Religulous, and that were clear, I don’t think anyone would have a problem with it. But the award specifically cites “science” as a necessary criterion for the award. Giving the Richard Dawkins Award to Maher was the equivalent of giving a prominent advocate of creationism and intelligent design a science award because of their opposition to the 911 truther movement. I suspect that such a decision would not sit well with Richard Dawkins and some others who were perceived to be soft on AAI’s decision. The analogies to Miller and Hitchens are not apt – Maher is so far outside the scientific mainstream on medicine that it is incongruous to give him any science award.

I did not attend the AAI conference, but reports from those who did say that Dawkins, in introducing Maher, took care to criticize his views on medicine. PZ Myers writes:

The good news for all the critics of this choice is that Dawkins pulled no punches. In his introduction, he praised Religulous and thanked Maher for his contributions to freethought, but he also very clearly and unambiguously stated that some of his beliefs about medicine were simply crazy. He did a good job of walking a difficult tightrope; he made it clear that the award was granted for some specific worthy matters, his humorous approach to religion, while carefully dissociating the AAI from any endorsement of crackpot medicine. It won’t be enough, I know, but the effort was made, and talking to Dawkins afterwards there was no question but that Maher’s quackery was highly objectionable. I also got the impression that he felt the critics of the award were making good and reasonable points, and that he felt the awkwardness of the decision.

This can be seen as recognition by Dawkins that there were problems with the award. I can only assume that this was specifically in response to criticism about giving Maher the award, since when Dawkins was first asked about the decision he simply said that he was not aware of Maher’s views on medicine.

In the final analysis, the problem that many of us have with Maher getting the award is that the totality of his views clearly indicates that Maher is not a rationalist. Because his religious views happen to coincide with those of the AAI does not mean that his views stem from a rational or scientific worldview. In my opinion, AAI simply got snookered. They focused on one aspect of Maher’s opinions, ignored the big picture, and in the end gave a science award to a pseudoscientist.

We will get past this, but it is a sore spot that will continue to ache, because Maher is not going away. Every time he spouts his nonsense about medicine it will cut a little deeper. He is still at it – take a look at this recent interview with Bill Frist.

Frist is a doctor who has apparently kept up with the literature, and he seems to know what he is talking about. Although I have criticized Frist in the past for putting his own ideology ahead of science on the Terry Schiavo case. But in this interview, Frist was the side of reason. Maher repeated his denigration of “western” medicine.

He also gets his facts wrong – he quotes Jonas Salk about the risks of live virus vaccines, without pointing out that the flu vaccine injections he is referring to are dead virus vaccines. Maher further argues that the flu vaccine does not work, when the data say otherwise. Here is an excellent review by Mark Crislip. The bottom line is that the flu vaccine works, but it is not perfect, and the primary problem (which Maher did get right sort of – it seems he can know the facts when it suits him) is that the flu strains are constantly evolving.

Maher also downplays the risks of the H1N1 pandemic. Here he is simply wrong – while H1N1 is not any more risky overall than the regular seasonal flu (which kills 36,000 people a year in the US alone), it kills more young healthy adults and pregnant women. Maher was telling pregnant women not to get vaccinated – Maher’s advice kills.

And that leads us back to the specific reason why many of us had a problem with the AAI award – it adds to the reputation of a medical crank who is using his celebrity to harm the public health (not intentionally, but that is irrelevant).  There is direct harm in Maher’s medical views, and to me that trumps any other view he might have.

The Thoughtful House agreed to the interviews because they figured they would get fair treatment from the likes of Matt. I’m interested to see what kind of a program NBC has put together on this very sensitive subject.

Depending on how this major media outlet writes the script, it could either be a major affirmation of what many within the science community already know, or it could increase the divide between anti-vax’ers and science.

Please, Matt… don’t go Jenny McCarthy on us. Don’t do the usual journalistic job of being “fair-and-balanced”. This is not a “he said, she said” issue. This is science. Do tell the world what the science supports.

About 10 years ago, Wakefield published a study dealing with children who were autistic, developing symptoms shortly after getting their shots, and linked this with irritated intestinal tracts. This study came under a lot of fire, and eventually most of the authors retracted the conclusion that autism was associated with "environmental factors", that is, vaccinations. By then, though, it was too late, and the modern antivaccination movement was born.

The Sunday Times investigated Wakefield’s original research, and alleges that the symptoms Wakefield reports in his research do not match hospital records of the 12 children studied at the time. In only one case were there symptoms that arose after the injection; in many of the other cases symptoms started before the children had been vaccinated (in fact, there have been allegations for some time that neurological issues occurred in the children before they had actually been vaccinated, casting doubt on Wakefield’s work). Also, hospital pathologists reported that the bowels of many of the children were normal, but Wakefield reported them as having inflammatory disease in his journal paper.

If these allegations are true, then it means that Wakefield out-and-out lied in his original work. He has denied this, according to the Sunday Times, but won’t make further comments.

This may cause a firestorm in the antivax community, but there are two things I will guarantee: the first is that in the end antivaxxers will stick to their beliefs that vaccines cause health problems like autism, because this is not and never has been, for them, about the facts and evidence. It’s a belief system, and like most other belief systems, it is impenetrable to evidence. If you have any doubts, I suggest you read the comments to the post I made the other day about measles being on the rise in the UK. One commenter on that post is saying all manners of outrageous things, and ignores the evidence that I (and a pediatrician) have left in the comments to him.

Second, and somewhat related, this hardly matters. Many, many independent tests have shown that vaccines are unrelated to the onset of autism. There is vast evidence that vaccines are very safe, and what small risk they pose is massively outweighed by the good they do. Whether Wakefield faked his results or not, he’s still wrong.

The good news is that if this pans out, then perhaps there will be a net loss of people from the antivax side of the argument. The ones who are true believers won’t waver in their faith, of course, but anyone with doubts may finally see reality for the way it is.

I will be very interested indeed on following this story. If anyone finds more information, please send it along.

Tip o’ the syringe to BABloggee Todd Cissell.

The Centers for Disease Control has put out an alert: in Minnesota in 2008, there were five confirmed cases of Haemophilus influenzae type b (or Hib) among children younger than five years old. Of these five cases, three of the children were unvaccinated, one had started the series of vaccines but did not complete the series due to shortages, and the fifth — who had been fully vaccinated — had an immune deficiency.

Five cases may not sound like a lot… until you learn that one of the unvaccinated children died. This was a baby, just a seven-month-old infant.

I can barely type that sentence out; my heart is aching so. I can only imagine what the parents are feeling. I literally have nightmares about such things.

There are several things to note about this incidence of Hib:

1) It’s the largest number of cases in one year since 1992 in Minnesota, when 10 cases were reported. In the intervening years, between 0 and 4 cases were reported per year (1994 saw four cases, the average is about 2). These are small number statistics, so 5 cases may just be a normal statistical fluctuation. But the stakes are very, very high here.

2) We do not know why three of the five children were unvaccinated. It may be due to the antivax crowd, or it may be due to any number of other factors; the report doesn’t say (however, see (5) below).

3) Out of three unvaccinated children, one died. The historical rate of death from Hib, once infected, is about 1 in 20, so this is something of a fluke. But 1 in 20 is still way, way too high… and of the ones who do survive the infection, 1 in 5 will suffer deafness, blindness, or severe, permanent brain damage.

Russian roulette has better odds than 1 in 5; do you want to play that with your baby? If that sounds harsh, good. We’re dealing with babies’ lives here. The best thing you can do is make sure they don’t get the disease in the first place.

4) Getting a vaccine does not guarantee not getting the disease. We don’t know how many babies were vaccinated, and how many weren’t that didn’t get the disease. But with 1 in 20 odds, I know which way I fall.

5) There is a shortage of Hib vaccines right now, and it’s expected to last for a few more months. However, according to the CDC report, there are adequate supplies to have infants inoculated and complete the primary three-dose infant series.

Data were reviewed for 25,699 children born between November 1, 2007 and March 31, 2008… Among children aged 7 months, 3-dose primary Hib series coverage was 46.5%, which is lower than the age-appropriate coverage for children who had received pneumococcal conjugate or diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccination. In contrast, data from the 2007 National Immunization Survey, conducted prior to the shortage, showed that Hib vaccination coverage among children in Minnesota aged 19 months to 35 months was high and did not differ from the national average, suggesting that coverage has declined as a result of the shortage.

So there has been a decline in coverage due to the shortage, with roughly half the children in the survey being vaccinated.

Putting this all together is difficult, with so many unknowns. But to belabor the obvious, we do know one thing: of the three unvaccinated children who got Hib, one died. The doctors from the CDC add this editorial comment:

Before development of Hib conjugate vaccines, Hib was the most common cause of bacterial meningitis in children aged <5 years. Since implementation of the Hib conjugate vaccine immunization program in the United States in the early 1990s, the incidence of Hib disease has declined from a peak of 41 cases per 100,000 children aged <5 years in 1987 to approximately 0.11 cases per 100,000 in 2007.

In other words, the infection rate among infants dropped by a factor of nearly 400 after the Hib vaccination was developed. This recent increase may reflect a loss of herd immunity, meaning too many kids are not getting vaccinated.

Folks. Please. Vaccinate your children. The science is in, the tests have been done, the results are solid: vaccinations do not cause autism. What vaccines do is save the lives of thousands of children who would otherwise be suffering the effects of preventable diseases… and one of these effects can be death.

Save your kids’ lives. Take them to a doctor and get his or her advice on this. And if they recommend vaccinations, then do it.

My thanks to Dr. Joe Albietz for providing me with some of the numbers in this article.