Whooping cough, vaccines, cocooning and the IAS

By Grant Jacobs 08/10/2011 150


Earlier this week the Otago Daily Times, locally known as the ODT, had on page nine an article titled Whooping cough vaccination ‘cocooning’ call.

In New Zealand, at this time, we have a number of vaccine-preventable illness in the community. One is meningococcal meningitis (strain C). Rubella is another. Whooping cough, or pertussis, is yet another.

The title and overall thesis of the article in the ODT are straight-forward enough. Family members visiting their new grandchild might get vaccinated to prevent accidentally passing the disease on to the little one.

It’s a similar to a key concept behind rubella vaccination. Rubella infections in a pregnant mother have serious implications for their unborn child.[1] Vaccinate the community and you prevent rubella infection being passed to mothers.

Pertussis occurs at all ages, but it’s effects are most severe in the very young. The older population is effectively a reservoir of disease that can infect infants. (From HeiningerUpdate on pertussis in children.) It is a very contagious disease, one that readily passes between people, ’infecting 70 to 100% of susceptible household contacts and 50 to 80% of susceptible school contacts.’ (See: IMAC pertussis page.)

In the middle of the ODT story the journalist, Eileen Goodwin, elected to offer ‘balance’ in the form of a quote from the Immunisation Awareness Society (IAS).

Invercargill-based Michelle Rudgley, of the Immunisation Awareness Society, was concerned by the push for more vaccinations. “One day they are really going to have to accept that the pertussis [whooping cough] vaccine is useless and no matter how many boosters you have it is not going to stop the occurrence of whooping cough and the best bet is for parents to educate themselves on how to look after their children should they develop it. “The best way to do that is high doses of vitamin C. It is a toxin-mediated illness, so vitamin C is the way to go and lots of it,” Ms Rudgley said.

I’m not very keen on uncritical reporting, so let’s look at Rudgley’s claims for ourselves.

I’d usually recommend first looking at the general style and line of advice of a source to get a feel for the soundness of their claims (e.g. visiting the IAS website), but instead let’s look at the claims on their own merit.

I’m not a specialist in pertussis or a clinician. What I’d like to do is to use local material in a similar manner as a non-specialist might, say a journalist, myself (!), or visitor to Rudgley’s site – a sort-of worked example of briefly scoping Rudgley’s claims out.

My exercise shows that readily-found sources, including one Rudgley recommends, contradict what she offered the journalist.

Rudgley writes that ’the pertussis vaccine is useless’.

First we’d want to know what she means by ‘useful’. For the sake of this article, let us assume she means ‘reduction in the number of cases of pertussis in young children’. Other measures might be the number of deaths in infants, or cost to the country, and so on.

On the IAS FAQ page the writer (I presume it is Michelle Rudgley) writes ’I also fully recommend you read the MoH’s ’Immunisation Handbook 2011″.’ (I’ve placed the link within the quote.)

This document is really intended for clinicians (i.e. doctors), but it has a lot of helpful material. It’s much easier to read than the original research literature, providing a useful half-way step between the research literature and ‘layman’ summaries. Each chapter is available as a separate PDF file, including the one for pertussis.

Of the effectiveness of the pertussis vaccine the MoH Immunisation Handbook 2011 says (page 143, paragraph 4),

That immunisation made a considerable contribution to the reduction in pertussis mortality was demonstrated in a review of the infant pertussis death rate in the US from 1900 to 1974. Had the decline in mortality from pertussis continued at the same rate as it did from 1900 to 1939, there would have been 8000 deaths from pertussis in the US between 1970 and 1974 rather than the 52 deaths that occurred.14

and later (page 135, paragraph 2),

The introduction of mass immunisation was associated with a 5- to 100-fold reduction in pertussis incidence in Canada, England and Wales and the US between 1930 and 1980.25—27

The source Rudgley advocates indicates that the pertussis vaccine is of use, contrary to what she offered to the journalist.

The Immunisation Advisory Centre, IMAC, offers information on vaccines and vaccine-preventable illness for both parents and health professionals.

The IMAC page on pertussis offers this for efficacy and effectiveness:

  • More than 80% through to 6 years of age, without boosting for some 3 or more component vaccines. Refer to manufacturer for efficacy data specific to preparation used.
  • Immunity wanes 5-10 years after primary or booster immunisation.
  • Studies on additional booster doses given during adolescence and adulthood suggest a protective efficacy of 32-99%.

Travelling away from New Zealand sources, this summary, titled Vaccines Refusers Are at Increased Risk for Contracting Pertussis, of Glanz et al’s study published in Pediatrics conclude their viewpoint writing ’Even so, the authors make the point that, given the relatively low rate of pertussis in the general population, almost all pertussis cases probably result from vaccine refusal.’ (A viewpoint this in an interpretation but importantly for the discussion here it is an informed interpretation.)

Rudgley writes ’the best bet is for parents to educate themselves on how to look after their children should they develop it.’

My reading of this is that she advocates not preventing children from getting ill–the aim of the vaccines–but dealing with it once they are ill.

This would presume that the illness so rarely causes serious harm as to not be a concern and that dealing with an ill child is of relatively little consequence.

In particular, carried with this statement, is a presumption that the illness causes less harm than the vaccine. If evidence showed that the illness caused more harm, then informed choice would be to use the vaccine.

Let’s briefly touch on each in turn.

Does pertussis so rarely cause harm as to not be a concern?

Since she is advocating that people not take the vaccine, we have to look at the rate of harm in absence of vaccination. We have already seen the MOH Immunisation Handbook 2011–that she recommends people read–state the rate of illness was higher before the vaccine was introduced.

New Zealand, like most countries, has researchers studying the vaccines used within their country. Grant et al’s research study (see references, below) on pertussis vaccination in New Zealand opens with,

Pertussis remains a severe disease in infants. As about two thirds of infants with pertussis are admitted to hospital,

Parents don’t send their children to hospital lightly. This by itself indicates that there is concern.

Two-thirds of infected children being admitted to hospital strikes me as very high. (Grant et al., do note that this is quite a bit higher than in the UK. I suppose Rudgley might suggest that better treatment of children might counter this; let’s leave that for when we look at her claim that high-dose vitamin C will treat pertussis.)

Grant et al’s study show that early immunisation is associated with a lower hospital admission rate.

What harm is caused?

The IMAC page on pertussis for parents summarises the effects of the disease as including:

  • 0.1-0.3% risk of permanent brain damage for patients with paroxysmal cough
  • Case fatality of 3.5% in hospitalised infants under 6 months.

Likewise, the IMAC for health professionals summarises mortality:

  • The estimated pertussis case fatality rate in New Zealand for the period 1970 to 1992 was 0.4 percent.
  • This is comparable to reported case fatality rates from the UK and the US over a similar period.
  • There were no deaths from pertussis in New Zealand between 1988 and 1995, one death in 1996, and since 1999 there has been one death each year up to 2004.

More important is if the rate of harm is higher when vaccines are used compared to when they are not used – we’ll come to that soon.

Is dealing with an ill child of relatively little consequence?

This would be the impact on the family, their time, loss of income and so forth. I would have thought that it be straight-forward that dealing with any ill child has consequences. Pertussis infections run for several weeks (six weeks or so is an oft-cited figure), not a few days, and are followed by a convalescent stage that may last several months. I can only speak for myself, but it is hard to see that it would not be disruptive to a family.

The  consequences for infants are more severe than older children or adults, and include death.

Because it is contagious, the long period of illness of older children or adults gives opportunity for them to pass the disease on to infants who are more vulnerable to it.

Does the the illness causes less harm than the vaccine?

One of the key arguments for vaccination is that, taken as a whole, the population is better off with the vaccine programme than without.

This does not say that individual cases of disease will not still occur, or that rare effects due to the vaccines will not occur. Everything we do in life has some risk. That’s as true for vaccines as anything else. It says that the overall health of the population is better with the vaccine programme than without it. It is the balance of the risks that is of the essence: which approach are we better taking?

Grant et al’s study show that delayed immunisation for pertussis is associated with a higher risk of the child being admitted to hospital. They find that ’fully immunised infants and children are 4-6 times less likely to be admitted to Starship children’s hospital with pertussis than [their] under unimmunised or under immunised peers.’ (Source Grant et al and IMAC.)*

This is one part of the ’equation’ – the rate of serious pertussis infection. (I write serious, as they’ve been administered to hospital.) Those who were vaccinated for pertussis were better off.

The other part of the equation would be the rate of ill effects from the pertussis vaccine.

Right at the bottom of the IMAC health professionals page it summaries the balance of risk, first the risks from the disease:

  • 90% risk of contracting pertussis for non-immune infants.
  • 20% of all adults and adolescents may be infected at one time.
  • 0.1-0.3% risk of permanent neurological damage for patients with paroxysmal cough.
  • Case fatality of 0.05% in hospitalised infants.

then the risks from the vaccine (the web page says that these rare reactions resolve spontaneously):

  • Mild local or systemic reactions (0.8-62%)
  • Severe local reaction (0.8-8.0%)
  • Convulsions (0.00007%)
  • Persistent screaming (<0.005%)
  • HHE (<0.003%)[2]
  • Anaphylaxis (<0.00001%)

A key point is that the serious reactions to the vaccine–risks might be placed alongside the serious consequences of the illness–are much rarer than the serious consequences of the illness. Furthermore, the vaccine reactions apparently resolve spontaneously whereas the serious consequences of the illness are permanent.

MIlder reactions could perhaps be usefully compared with the weeks of looking after a sick child.

Booster vaccinations

Rudgley mentions booster vaccinations. This might be read as her saying that these later vaccinations are not effective for the children they are given to. In practice a key reason for the booster vaccinations are so that older siblings are less likely to pass on the illness to their younger siblings who are more vulnerable to the disease.

High-dose vitamin C as a treatment

Finally Rudgley offers that high-dose vitamin C will put paid to the illness.

Vitamin C is offered to ’cure’ a vast array of illnesses. When you see a claim of a single treatment being able to treat a wide array of illnesses, it’s best to be very wary of the claim. Illnesses differ; it is expected that their treatments will differ too.

If Rudgley’s advice were sound, we’d expect to see research reporting that vitamin C can treat pertussis infections. To do this I’m going to have to look at the research literature as whole, rather than (mainly) limit myself to local sources as I have earlier.

Searching PubMed, I find just 25 articles containing the keywords ‘pertussis vitamin C’. This is very small number of articles given that pertussis is a major illness. (Searching using ‘pertussis’ alone gives 26,966 articles.)

Several of these articles do not relate to treatment of pertussis. Judging from the article titles, none of those relating to vitamin C as a treatment for pertussis were written after the 1950s.

When a line of thinking in research ‘dies’ from the research literature it most often it is because it has been rejected.

Of the ten articles, only three are in English – these few are from the 1930s. The first two English-language papers are by the same authors and thus not independent studies. These two papers claim a reduction in the illness through high-dose vitamin C treatment. The third, attempting to repeat this claim, finds no effect beyond statistical chance variation.

If there were support for Rudgley’s claim that vitamin C can treat pertussis, you would expect to see a body of references to it in the literature. A complete absence of reference to it in over fifty years would strongly indicate that there is no (substantiative) evidence to support her claim that high-dose vitamin C is a known to treat pertussis.

I don’t claim to be an expert in all of this, I’m not.

What I am struck by are two main things. Firstly, readily-available sources, most of them local, used in a fairly straight-forward manner contradict Rudgley’s claims, including a source that Rudgley herself advocates. Secondly, that a journalist uncritically repeated these claims.

One more titbit is worth mentioning. While the immunity offered by the vaccine is known to be limited, so is the immunity from natural infection. (Personal communication from IMAC.)

Earlier in the article I wrote that I’d usually recommend looking over the (IAS) site as a whole to get a feel for it or to test if a source offers sound comment (as a journalist might do before quoting them).

I would like to tackle this, but having written as much as I have already, I feel I should pass that baton onto those offering comments!

Footnotes

I would like to thank the prompt and excellent assistance of Helen Petousis-Harris of IMAC in writing this article.

I offered Eileen Goodwin–the journalist who wrote the article–an opportunity to explain ’why you considered it appropriate to quote Rudgley from IAS this article’, but I have not had a reply. [She has since replied, but offered no comment.]

* For clarity regards the citation ’(Source Grant et al and IMAC.)’: the source of the quote is correspondence with IMAC, the source of what the quotation summarises is Grant et al. – hence the ‘double’ citation.

1. I’m a ‘rubella kid’ myself, being born hard-of-hearing/deaf and partially blind as a consequence.

2. HHE = Hypotonic-hyporesponsive episode.

(Updated to add to footnotes: starred [*] footnote and that Goodwin has replied. Further updated to correct an typing error (‘replied’ for ‘relied’).)

Sources

I’ve deliberately used a small number of local sources, in an effort to limit myself to what might be reasonably found by a careful non-specialist (like myself!)

IMAC has information on vaccines in general, the vaccine-preventable illnesses, including about pertussis for parents and health professionals.

The MoH Immunisation Handbook 2011. Note that chapters are available as separate downloads.

Grant et al., Brit. Med. J. 326:852-2 (2003)

Heininger, Expert Rev Anti Infect Ther. 8(2):163-73 (2010), Abstract.

Basco, MedScape Pediatrics.

PubMed.

Other articles in Code for life:

Immunisation, then and now

Sources for medical information for non-medics and non-scientists

Reviewing Deadly Choices

Abbie Smith on vaccines, your immune system and viruses

Fact or fallacy, a survey of immunisation statements in the print media

Google personalised searches and the ‘echo chamber’ effect?

Reviews & IV vitamin C as treatment for severe pneumonia


150 Responses to “Whooping cough, vaccines, cocooning and the IAS”

  • A fascinating read, as always, Grant… perhaps the MOH isn’t the most reliable source of info…

    The MOH handbook states… “Mortality due to pertussis, diphtheria and measles started to decline in developed countries prior to the introduction of mass immunisation,
    indicating that the initial decline in mortality was due to a reduction in the case fatality rate. In 1951 Gordon and Aycock argued that the principal reason for the decline in the case fatality rate was ‘an absolute and proportional reduction in physically substandard children’.11 This improvement in the general standard of health of children was due to a number of factors, including better nutrition, decreasing size of families and
    a decrease in birth rates during the Great Depression.”

    It then says what you’ve quoted regarding reductions and expected deaths in the USA in the early 1970’s.

    Were you aware that whole cell pertussis vaccines used in the 1970’s were found to be very poor and were replaced in the 1990’s with effective vaccines?

    Part way through the trial, the two-component acellular vaccine
    was shown (in Gustafsson 1996) to have an unacceptably low efficacy, so the blind was broken for infants who had received this vaccine [so they could receive better vaccine protection.]
    See the cochrane reviews at http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD001478/frame.html

    Of all the vaccines used in mass vaccinations, whooping cough vaccines (especially whole cell and one or two component) have been the least effective and most problematic.

  • Basically what Simon said. You’ve seen the effectiveness (cited above). It may be lower than some vaccines, but it’s not “useless” as Michelle Rudgley claimed, and using the vaccine is clearly better than no vaccine.

    [Edited for clarity; the earlier wording reads open to misinterpretation in hindsight.]

  • The panic over whole cell pertussis vaccine (which was more effective, but had more side effects than the modern version) in the 70s led to a massive drop in uptake and a resurgence of whooping cough. A friend of mine got it as an infant because her mother was influenced by the panic (and now regrets it), and has ongoing lung trouble when she gets sick as a result. She was lucky – others died. The panic was later found to be unjustified, although minor side effects were an issue. As trust has been restored and vaccination rates risen, mortality has fallen again.

    Minus the panic, replacing an older vaccine with an improved version is exactly the sort of thing you’d expect responsive and honest health authorities to do.

  • I’ve just gone back through the MOH data for whooping cough deaths over the past 120 years… using 5 year averages there was a steady decline in whooping cough deaths interrupted briefly following WWII… the death rate declined from a peak of 123 deaths per million in 1907 to less than one per year in 1964.

    The fact is that deaths had essentially declined to negligible levels before the introduction of mass vaccination programmes.

    A monovalent pertussis vaccine was introduced by the Department of Health in 1945, and from 1953 it was also available combined with the diphtheria and tetanus vaccine. Routine childhood immunisation began in 1960 using the plain (ie, no adjuvant, not adsorbed) diphtheria tetanus and whole-cell
    pertussis (DTwP) triple vaccine. Three doses were given at ages three, four and five months.

    The number of deaths per million from 1945 (inclusive) were,
    (1945) 53, 1, 19, 3, 11, 8, 4, 3, 2, 2, 1, 1, 0, 4, 3, 1, 1, 1, 0, (1964) 0, 0, 1, 0, 0, 0, 0,

    So the vaccine can’t be the cause of the dramatic declines in deaths as claimed.

  • Ron,

    “So the vaccine can’t be the cause of the dramatic declines in deaths as claimed” doesn’t fit what was actually claimed. As you noted earlier, they noted that there was a decline before mass vaccination, but also pointed out that there was a substantial effect from introducing the vaccines too.

    You can see the effectiveness of vaccines by comparing the number of cases with vaccination status, comparing hospitalisation in (fully) vaccinated and not (e.g. Grant et al as mentioned in the article), etc.

  • Trouble,

    Thanks for sharing that.

    There was indeed a fuss raised over the earlier ‘cellular’ pertussis vaccine. It’s covered in Offit’s book that I reviewed at little while ago; he also examined if it was justified or not. (I believe there’s resurgence of whooping cough in the USA at present apparently.)

    I have to admit when I saw your nickname I thought “uh-oh”! :-)

    (Only if it matters to you – your first link is broken.)

  • Grant, from the MOH (NZ, not USA) data, can you point out what the “substantial effect” of the vaccine was?

  • The underlying question is the effectiveness of the vaccine, in particular the one in present use. The article included that.

    There are too many confounding factors for a naïve list of deaths to be very meaningful (or even meaningful at all) in it’s own. Deaths relate to infected and treatment; prevention relates to infection. What of (changes in) diagnosis? (Including culturing the bacteria to confirm the diagnosis.) What of notification? What of former social practices, e.g. keeping a newborn at home? Population density? Etc., etc. The work simply may not have been done in New Zealand in a way that can cover these; it may not even be realistically possible now. Seeing as the work has been done elsewhere, you use what has been done and what is available.

    Even if there are no studies on the causes of the trends in the long-term statistics in New Zealand, this wouldn’t “take away” or “undo” the present-day studies of effectiveness, etc.

  • But Grant… studies you referred to did exactly that… “Of the effectiveness of the pertussis vaccine the MoH Immunisation Handbook 2011 says (page 143, paragraph 4),

    That immunisation made a considerable contribution to the reduction in pertussis mortality was demonstrated in a review of the infant pertussis death rate in the US from 1900 to 1974. Had the decline in mortality from pertussis continued at the same rate as it did from 1900 to 1939, there would have been 8000 deaths from pertussis in the US between 1970 and 1974 rather than the 52 deaths that occurred.14”

    Reference 14 is Mortimer EA Jr, Jones PK. 1979. An evaluation of pertussis vaccine. Reviews of Infectious
    Diseases 1(6): 927–34… a 33 year old ‘review’ undertaken in the days when the WC vaccine didn’t work so well…

    These diseases were feared because they killed people… it was death that was the cause of fear… in the case of whooping cough, the whoop in babies was feared because it often led to death… but death rates had plummeted before the vaccines were widely used… In that sense, the introduction of the vaccine did not prevent most of the deaths,… something else, or a combination of something elses did.

  • In that sense, the introduction of the vaccine did not prevent most of the deaths,… something else, or a combination of something elses did, etc., has already been explained. (You’re going around in a circle; I suggest you take a break.)

  • To anyone who follows Erwin Alber’s Facebook page (for those not familiar with Erwin Alber, he is an avid anti-vaccinist who has occasionally written comments here):

    I understand that Erwin is unable to tolerate comments politely pointing out things that are contrary to his personal view and feels a need to delete the all comments of people who do have made, then ban them. (He wrote as much himself.) I can assure you my comments were polite, careful and, importantly, germane – despite his attempts to slur me, my blog and colleagues.

    In fact, the comment that he decided to ban me on was one that I wrote replying to one of his “accepted” commenters saying I thought they had made an interesting point. This lent a certainly irony to his actions. I get banned for acknowledging something one of his “followers” wrote. Hmm.

    All-in-all, an interesting experience even though I think his behaviour lame!

  • Have a look at the latest report out of California.
    http://www.cdph.ca.gov/programs/immunize/Documents/PertussisReport20119.pdf

    Note figure 3 for rates since 1947.

    Have a look at Sth Australian data … see Figures 1 & 2. Mortality and notification rates for pertussis in South Australia, 1893 to 1996

    http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi2205-pdf-cnt.htm/$FILE/cdi2205c.pdf

    Clearly, in an historical context, whooping cough vaccine has not been the cause of dramatic declines in disease mortality or morbidity at least in NZ, Australia and many other places.

  • This doesn’t make your point, either. (You’re essentially just repeating yourself.)

    My article doesn’t actually talk about historic data in the way you make it out to; neither did Rudgley (whose claims are what my article is about).

    If the present-day vaccine (and that is what matters) has no effect as you infer, why are those who are not fully vaccinated hospitalised 4-6 times more than those who are fully vaccinated? (See Grant et al.)

    Likewise, why does a studying examining the effect anti-vaccine movements find that:

    Pertussis incidence was 10 to 100 times lower in countries where high vaccine coverage was maintained than in countries where immunisation programs were compromised by anti-vaccine movements.

    Gangarosa EJ, et al. Impact of anti-vaccine movements on pertussis control: the untold story. Lancet 1998;351:356-61.

    Here’s the full abstract (Note Australia is included in this study):

    To assess the impact of anti-vaccine movements that targeted pertussis whole-cell vaccines, we compared pertussis incidence in countries where high coverage with diphtheria-tetanus-pertussis vaccines (DTP) was maintained (Hungary, the former East Germany, Poland, and the USA) with countries where immunisation was disrupted by anti-vaccine movements (Sweden, Japan, UK, The Russian Federation, Ireland, Italy, the former West Germany, and Australia). Pertussis incidence was 10 to 100 times lower in countries where high vaccine coverage was maintained than in countries where immunisation programs were compromised by anti-vaccine movements. Comparisons of neighbouring countries with high and low vaccine coverage further underscore the efficacy of these vaccines. Given the safety and cost-effectiveness of whole-cell pertussis vaccines, our study shows that, far from being obsolete, these vaccines continue to have an important role in global immunisation.

  • OK, you quoted Rudgley from the ODT article you link to… what about quoting the Ministry of Health expert… presumably someone who is pro-vaccine…

    “Ministry of Health immunisation manager David Wansbrough said there was insufficient evidence to justify public funding, but the ministry recommended those in direct contact with newborns be vaccinated.

    “The cocoon strategy for whooping cough – vaccinating parents and caregivers for newborns – is being used overseas but there isn’t enough evidence yet about whether it works to justify public funding.” ”

    mmm… so the Ministry of Health immunisation manager isn’t aware of evidence to warrant what you are endorsing… cocooning…

    By the way, I never said the vaccine didn’t work… I said that it wasn’t the reason for the dramatic fall in whooping cough cases/deaths over the past century. The fall preceded the introduction of mass vaccination for whooping cough.

    As an aside, the vast majority of whooping cough cases in many countries are in 15+ year olds. In Australia that percentage is about 75 percent.

  • Ron,

    I wrote looking at Rudgley’s quotes to the journalist. While you’re welcome to it, this other stuff really is your thing, not mine.

    While I certainly summarised what it meant, I didn’t advocate cocooning – not yet. I couldn’t really say either way without a good look into it, and neither could you; ditto for the data you’ve pointed to earlier. I haven’t time to do the reading that’d need. Cocooning does seem a reasonable thing to investigate, however – the concept is pretty straight-forward after all – and there certainly is no harm in erring on the side of caution. Note, however, I believe the real question in the ODT piece wasn’t actually if cocooning was effective, but if it ought to be publicly-funded.

    I never said the vaccine didn’t work…

    Should I take it that you agree, then, that the present-day vaccine is to be used (rather than not), effective to the extent that it is, and certainly not “useless” as Rudgley claimed?

  • On the face of it at least it seems Rudgley will only offer her views on forums that those with different views can’t reply to: to the public via a journalist; a Facbook page I and others with what they term “pro-vaccine views” are “not allowed” to interact with; and now her blog, which she disallows comments!

    Just kidding: but with an underlying serious point, I guess.

    Joking aside, if I find time and feel still feel so-inclined I’ll attempt some sort of reply later. In the meantime, it’d be good if she could correct her misspelling of my name (at least she’s consistent, I guess). Suffice to say for now that a quick reading shows a number of remarks that are remiss.

    It’ll be interesting to see if she comments on Darcy’s articles on her charity, IAS and the subsequent articles in his series.

  • The IAS is not MY charity

    I’m happy to stand corrected. (Keep your hair on though please!)

    As I say I am not interested in a dialogue with any of you and the reason becomes more and more obvious with every comment you and your cronies make.

    I can’t understand your objection here and in your article.

    In order to gain an ‘informed choice’, which if I am correct is essence of the by-line of IAS, you have to engage with others – including those that have different viewpoints. You can’t learn otherwise.

    As for comments here, the only person commenting to any real extent is Ron Law.

    All my replies him, and my attempts to engage on this topic elsewhere have been quite polite. Your objection on this count seems quite strange to me.

    You’ll notice I did not start my article by characterising you but tried to be polite and let the claims stand and address them, rather than the messenger, as it were.

    I’ll try get back about your more substantiative statement later.

    (BTW the email issue is just a personal choice—I don’t have to open myself to email correspondence after all—and I did try let you know that politely, if briefly. My choice is partly owing to being hassled by others with similar views to your own.)

  • Grant said, “As for comments here, the only person commenting to any real extent is Ron Law.

    All my replies him, and my attempts to engage on this topic elsewhere have been quite polite. Your objection on this count seems quite strange to me.”

    LOL… Michelle, your objection is what democracy and informed choice is all about… not wrong, not right, just different…!

  • on this count seems quite strange to me

    Well it is strange to object to someone who has consistently been polite – unless she is objecting merely to that my views differ, which isn’t an equitable basis for complaining.

    Michelle, your objection is what democracy and informed choice is all about… not wrong, not right, just different…!

    I wouldn’t quite agree – she has blocked all comments on the IAS website and according to her will not engage in open discussion. It seems to me that it follows that she does not advocate informed choice. (She is of course free to express her views – I’m hardly stopping that. But she discourages ‘democracy’ amongst her followers by shutting down discussion.)

    I have to say that over the past few days I have been struck by how Erwin, Michelle, and now you, seem to prefer to fall back to characterisations rather than substance – something I have tried to refrain from myself.

    I can sort-of expect that from Erwin. It’s very much his style. (Some of his characterisations are pretty exotic; I recall you distancing yourself from them yourself.)

    I didn’t know Michelle’s style before this, and had hoped she might prove open to discussion if approached politely, but it seems I’ve been proven wrong, if her statements about no dialogue and the closed commenting are a fair judge.

    For all your faults you do usually at least try to deal with “stuff” rather than this sort of nonsense.

    (Seeing the ‘LOL’ stuff creeping in, fair warning: don’t let your standards slide, please.)

    [Edit for typo – sorry.]

  • Grant, my LOL related to your comment about “All my replies him, and my attempts to engage on this topic elsewhere have been quite polite.”

    Whenever I ask you for evidence to back up positions you censor me… that’s what the LOL was about… now you are threatening to shut me down again… LOL… you are about to do the very thing you are criticizing Michelle for doing…

  • Grant, my LOL related to your comment about “All my replies him, and my attempts to engage on this topic elsewhere have been quite polite.” Whenever I ask you for evidence to back up positions you censor me… that’s what the LOL was about…

    Your reply was to my saying that my writing has been polite, as
    you pointed out — there is nothing about “asking for evidence”, etc., in it.

    I have never censored you – that’s self-evident anyway from my allowing you to post here. You’ve had this pointed out to you many times. Repeating it one more time won’t make a false accusation right.

    now you are threatening to shut me down again… LOL…

    I gave you a gentle head’s up not to lower the tone, so that I would not have to put you on temporary furlough. If you go there, you’ll have yourself to blame for it.

    you are about to do the very thing you are criticizing Michelle for doing…

    I wrote that she blocks all discussion; self evidently I don’t.

    I give you chance, which is a hell of a lot more than she does. You couldn’t even comment on her blog yourself.

    What I do ask is that those writing here respect others and be polite, there’s a huge difference to that and disabling any discussion.

  • Grant… So why are you censoring this one????

    Your comment is awaiting moderation.

    Grant asked, “Should I take it that you agree, then, that the present-day vaccine is to be used (rather than not), effective to the extent that it is, and certainly not “useless” as Rudgley claimed?”

    Firstly, whooping cough vaccine is quite different to other vaccines in that its effects wane quickly, hence the regular increase in the number of boosters and the redesign.

    Increases in the number of cases at regular ~3-5 year intervals has nothing to do with vaccination rates… it has much to do with waning immunity. Whooping cough hospitalisations have been rising since the 1970’s… why? It’s not because of reduced vaccination rates…

    Whooping cough vaccination is unreliable and has comparatively high level of primary and secondary failures. It has been calculated that NZ’s effective vaccination rate for pertussis is between 33 and 50 percent.

  • Grant… So why are you censoring this one????

    Most people don’t accuse, they ask. Accidents do happen & I’m extremely busy.

    You didn’t answer what was asked, really. Your penultimate paragraph is left dangling without you saying what you think it is.

    No-one has disagreed that the pertussis vaccine is less effective than some, just that it’s better than none and not “useless” as Michelle described it — this was pointed out in reply to your first comment here.

  • You have still censored it… why????

    [There’s no need for it to be posted twice. Obvious isn’t it? Still to the subject or move along.]

  • Ah… now we cut to the chase… “it’s better than none and not “useless” as Michelle described it..”

    Is ‘better than none’ good enough?How good is good enough??? That’s an important question.

  • You’ve just dodged the question again. It wasn’t what is “good enough”, it’s simply is it “better than none and not “useless” as Michelle described it”.

    As far as ‘good enough’ goes, it’s not a case of “good enough” in the sense of absolute measures (unless you’re into the finanical aspects, which have no been any part of this), but which is better than the other: no vaccine or use the vaccine – so back to what I actually asked…

    I really don’t have a lot more time for you. You’ve had more than your fair share after all, I’ve still got work to do, and I’d like to put time aside to write some sort of reply to Michelle.

  • Let’s make it simpler.

    Are the present-day pertussis vaccines better than no vaccine?: yes/no

    ‘Yes’, of course, infers that the vaccine is better than “useless” –
    what Rudgley claimed.

    So: yes or no?

  • Grant, risk management is never as simple as yes/no… what are the costs? What are the lost opportunities? What are the benefits?

    You’ve chosen the wrong vaccine to argue this on a yes/no basis… Whooping Cough vaccine is one of the least beneficial vaccines around and one of the most problematic. Vaccines like measles are one dose vaccines… sure, they give a second one at 4 years, but that isn’t a booster, it is to try and catch those who didn’t respond to the first dose at 18 months before they go to school.

    WC vaccine is now up to 6-7 doses… why so many? Well, mainly because it’s not very effective, any protection wanes withing 3-5 years (some say up to 10, but if that was the case they wouldn’t be giving so many doses before they get to school…) Vaccinated Mothers produce less effective antibodies to pass onto the foetus and through her milk, etc, etc.

    The WC vaccine does not, as far as I’m aware, prevent transmission of bacteria. Herd effect only kicks in if 92-95 percent of the populace are immunised… NZ’s effective vaccination rate is much less than 50 percent and only about 6070 percent in 2 year olds. Most cases in most Western countries are in teenagers and adults… not young children.

    Cost-Effective strategies for the excess burden of disease is, in my opinion, what’s needed, not blind faith in more of the same old same old. If more doses of the new acellular vaccine than the old relatively ineffective cellular vaccine, how can it be claimed to be better?

    There are plenty of researchers who argue that things like quality housing and lower density housing would be a better spend than the millions we spend on vaccines per se. In the case of WC vaccine 6-7 doses makes it a very expensive vaccine to administer… for what over-all benefit. Even people like Professor Grant acknowledge that despite more WC vaccines and a shift to [more expensive] acellular vaccines more and more kids are being admitted to hospital…
    This from the CDC…
    http://www.cdc.gov/ncidod/eid/vol6no5/pdf/srugo.pdf

    “The effects of whole-cell pertussis vaccine wane after 5 to 10 years, and infection in a vaccinated person causes nonspecific symptoms (3-7). Vaccinated adolescents and adults may serve as reservoirs for silent infection and become potential transmitters to unprotected infants (3-11). The whole-cell vaccine for pertussis is protective only against clinical disease, not against infection (15-17). Therefore, even young, recently vaccinated children may serve as reservoirs and potential transmitters of infection.”

    In other words there is no herd effect with this vaccine… so it would be immoral and unscientific to blame the endemic/epidemic cycles of disease on those who choose not to vaccinate…

    As I posted earlier, deaths due to whooping cough in NZ had declined to near zero before the introduction of mass vaccination… whilst the WC vaccine might be effective from a theoretical point of view, it has not made much difference to the epidemiology of disease over the past 50 years… it can not confer a herd effect as it does not disrupt transmission of the bacteria… therefore, how can one say that it is particularly useful? If it not particularly useful, then how much of a stretch is it for a lay person to be quoted as saying that it is useless? Personally, I would say that the successive pertussis vaccines have made negligible impact on disease, and especially mortality, and therefore, from a public health perspective, that particular vaccine is next to useless… in my opinion, the money spent of pertussis vaccines would pay better public health dividends it it was spent elsewhere. So, if you want a yes/no answer, then you be the judge… but bare in mind that science rarely provides yes/no answers at an individual level when it comes to medicine… there are medicines that work and medicines that don’t work. If a vaccine is 70 percent effective and fails to prevent bacterial transmission then for 30 percent of the population it is useless… especially if they catch the disease. I suspect if you had a child who was vaccinated for WC and still got it, then you would rightly claim that in your case the vaccine was useless. So was Michelle saying it was useless at an individual level or at societal level… either way, the whooping cough vaccine is not a shining light in the vaccine world…

  • Your blog states; “Grant et al’s study show that delayed immunisation for pertussis is associated with a higher risk of the child being admitted to hospital. They find that “fully immunised infants and children are 4-6 times less likely to be admitted to Starship children’s hospital with pertussis than [their] under unimmunised or under immunised peers.” (Source Grant et al and IMAC.)

    This is one part of the “equation” – the rate of serious pertussis infection. (I write serious, as they’ve been administered to hospital.) Those who were vaccinated for pertussis were better off.”

    Grant, can you provide the url to the evidence that Grant et al made that statement? The reference you provide does not even mention unvaccinated/unimmunised… it is about delayed vaccination and is an unmatched case-control study… not the most reliable…
    http://www.bmj.com/content/326/7394/852.full

    Can you explain to readers what “under unimmunised” means?

  • Sorry Simon – I think I may have had a hand in their closing down comments on threads…

    I see they have taken their head in the sand approach again by posting a rebuttal of sorts to this blog with reference to the usual reliable sources such as beyondconformity (beyondinsanity?). Again, closed to discussion.

    I guess if you close discussion it makes continuing your fixed mindset easier…

  • Ron –

    You’re still evading the question!

    (You’re repeating things that have already been covered too.)

    BTW, as I wrote before I haven’t much more time for you, have other things to do and would rather give time to replying to Michelle – that’s whose words the article is about after all, not you.

  • Ron,

    Grant, can you provide the url to the evidence that Grant et al made that statement? The reference you provide does not even mention unvaccinated/unimmunised…

    You obviously already have the reference. I gave a formal citation.

    I’ve summarised for readers – if you want to do more, that’s your own homework, eh? I’m not here as a servant to do your bidding 😉

    Note (i.e. read closer): “(Source Grant et al and IMAC.)”

    Can you explain to readers what “under unimmunised” means?

    Don’t even bother play word games or be snarky. Everyone understands the intended meaning.

  • To those that follow Ron Law or Michelle Rudgley, IAS, etc. –

    I think Ron Law’s increasingly strenuous efforts to avoid answering two simple questions are very telling.

    Readers might wish to consider: do they really want someone who repeatedly evades answering key questions as someone to “inform” them?

    Here’s something to think about, then.

    There were two parts to my question.

    1. Is the vaccine better than none? – y/n

    2. Is the vaccine not “useless” (i.e. having no effect) as Michelle Rudgley claimed? – y/n

    Ron has already said the vaccine has a positive effect, that it is not “useless” as Michelle Rudgley claimed to the journalist.

    He gave the efficacy of the vaccine several times (let’s leave aside that he’s trying to play the efficacy down).

    He knows that the vaccine is better than “useless”.

  • Grant, the terms ‘useless’ and ‘having no effect’ are not synonyms.

    “Everyone understands the […] meaning [of what I wrote].”

    Grant, risk management is never as simple as yes/no…

    By the way… I don’t have a blog… I don’t promote a cause… as far as I’m aware, I don’t have a following… I do do risk analysis work for a variety of clients who actually pay me for my work. I turn down work if there are predetermined outcomes required.

    Most work I do results in options out side of the square… people fight wars over black and white y/n solutions… life mostly isn’t like that…

    Regardsing whooping cough vaccines, you have chosen the wrong one to ask for a yes/no answer… whooping cough vaccines are not the most effective long term… I certainly would not defend vaccines per se using whooping cough as an example. It is irrational to accept that all vaccines are good or even useful… each vaccine has to be considered on its merits…

    “The year 1929 was a light oue for both whoopiug-cough and measles. Epidemics of these two diseases tend to recur every few years, but the death-rate over the last fifty years has reduced greatly.”

    As a risk analyst, I scavenge a wide range of material and trace evidence back to primary sources as much as possible. The above quote is from a copy of the 1930 Appendices to the New Zealand Parliamentary Journals… It has a lovely graph showing a steady decline in whooping cough mortality from 1972 to 1929… Whooping cough mortality had, by and large died a natural death before the introduction of the whooping cough vaccine… So if death is the measure of the effectiveness of successive whooping cough vaccines in New Zealand, then, yes, it has been next to useless in reducing/preventing whooping cough… But then the vaccine does not just contain whooping cough antigens… it also contains diphtheria and tetanus antigens…

    By the way, your blog contained a quote ““fully immunised infants and children are 4-6 times less likely to be admitted to Starship children’s hospital with pertussis than [their] under unimmunised or under immunised peers.””

    It appears from your response above that this was a made up quote… tsk, tsk…

  • Ron,

    You’re still evading the question.

    This isn’t about what you think or other possible meanings in other contexts, or what you do for a living or not.

    Trying to side-track, or discredit me,* won’t address it.

    It’s about what was in the ODT article. She was quoted as having said: “the pertussis [whooping cough] vaccine is useless”

    The questions I asked were a straight-forward yes/no questions.

    Why are you evading them? Because you don’t want to get off-side with Michelle Rudgley and company?

    About the other stuff:

    I’ve pointed out several times now that pointing at the historical cannot “take away” or “undo” the present-day studies of effectiveness, etc. By all means have your interest in it, but there’s no value in endlessly pointing at them here. (Set up you own blog if you want to blab about it, maybe – they’re free at wordpress.com, etc.)

    * Your attempts to misrepresent me are irrelevant and I’d have to say, pretty cheap. My reading of it is you’re boxing from the corner and stooping low… And trying distracting to evade the question. No dice, sorry.

    I think readers can now fairly conclude that you are just trying to evade the questions.

    By the way, your blog contained […] tsk, tsk…

    No snarks, please. The source was given, as I pointed out to you earlier. I shouldn’t have to repeat this.

  • Grant, I don’t know Michelle… not sure I’ve even met her…

    Your references don’t stack up…. they don’t say what you quoted… a quote is a quote. Otherwise putting it in “quotes” is a fabrication.

  • It’s not all about deaths, Ron, although one death is one too many. The vaccine does more than prevent death as you well know. You keep going on about this as if it’s the only measure that should be used – reminds me of your MeNZB “statistics”.

  • Ron,

    Last word this, I have explained this more than once now. It *is* a quote – it was written to me. I *did* give the source: you just don’t get it. That’s your problem, not mine. IMAC. It‘s right there in the article. I put in bold for you earlier when I explained to you. I couldn’t make that clearer if I tried. There is no need to keep misrepresenting me.

    It does, however, show up the extent to which you are trying evade the question in every which way. Your attempts to try discredit are desperate stuff and of too low a standard for here.

    No more on this and raise your standards, please.

  • Ron,

    Perhaps if you can’t deal with the subject you should move on? You’re stooping far too low.

    Either answer the questions, or admit you won’t face them.

    In particular,

    Is the vaccine not “useless” (i.e. having no effect) as Michelle Rudgley claimed? – y/n

    You gave figures for efficacy. (Leaving aside that you tried to play the efficacy down, they still substantially above zero.)

    You know that the vaccine is better than “useless”.

  • Simon, Grant referred to deaths 8 times… deaths are the most accurate measure of disease… there are about 400 deaths in children under 12 months each year… less than one of those are due to whooping cough… in that context, the effort is never going to have any significant effect… you could say that with regards to reducing teh death toll of infants, the pertussis vaccine is useless.

    Grant… I looked up your references… could not find the quote… I got the original Grant et al paper and it makes no such reference… I searched IMAC’s website and couldn’t find it… fabrication is a serious form of scientific misconduct.

  • Grant referred to deaths 8 times…

    You’ve sort-of-accidentally left out that I also talk about illnesses and permanent damage too.

    Simon is right, more than deaths matter and not it’s not the only measure, esp. with respect to infectious illnesses – I pointed that out myself several days ago. (Death rates can be confounded by other factors.)

    Grant… I looked up your references…

    Are you completely daft? I guess you must be. (Alternatively, are you that childish?) I told you no more on this. Continuing shows you have neither sense, politeness, or any respect for others.

    You could have simply asked politely without making accusations, but it seems that’s beyond you.

    So let me tell you one more thing that is serious: repeatedly accusing someone of something serious that they simply haven’t done.

    You have already had this explained to you. If you can’t get it, that’s your failing, not mine.

    But to repeat myself (sigh): “It *is* a quote – it was written to me.” How hard is “it was written to me” to understand? Obviously it’s correspondence, isn’t it? Duh.

    Now I’ll tell you something else.

    Apologise. Sincerely. It’ll have to be very good.

    I ask for people to polite and treat others reasonably, it’s not much to ask. But you can’t seem to. Every time your arguments struggle you start slinging mud around…

    You’ve given up answering the questions and are now just trying to attack the messenger. That’s pretty poor.

  • Ron,

    Seeing as you have not apologised, but have continued to try smear me – this time making straightforward false claims* and play word games you are now on furlough – the length of time determined by your actions. (Check with the About page if you’ve forgotten how it words.)

    * e.g. “now you acknowledge that you made the quote up ????” – I did no such thing; I told you it was correspondence.

    Smearing others and accusing them of things they haven’t done reflects very badly on you and is not something I should have to put up with.

  • > deaths are the most accurate measure of disease

    What rubbish. Someone would only say this when it suited their twisted understanding of statistics.

    > …in that context…you could say that…the pertussis vaccine is useless.

    Except that isn’t the real world context, Ron. In the real world the vaccine is far from useless. We live in the real world, Ron, as do the babies that need a chance of a normal life.

    > Ron furloughed

    Pity.

  • Simon,

    I agree with all three of your points. You do a good job of putting them concisely, too.

    I’m torn either way on putting Ron out—it’s one of those things that no-one quite wins. I’m happy for people to present alternative views but as I insist that people be polite and treat others with respect, I feel I have to draw the line somewhere. I feel I gave him a fair chance to withdraw the accusation and apologise, but IMHO Ron seems set on trying smear rather than deal with the issues hand.

  • Ron said “deaths are the most accurate measure of disease”. Oh really? So in your eyes, Ron, a disease with very high morbidity but relatively low mortality, would be a non-issue? What an extraordinarily callous viewpoint!

  • Ashton,

    re your suggestion of “uninformed ” – I’d agree with ‘ill-considered’, but I’m pretty sure he has been told this general point a long time ago; if so you’d have to err towards him choosing to keep his point of view, as opposed to being uninformed of it’s weaknesses.

    I’d have thought the most accurate measures use confirmation of the causative organism (Bordetella pertussis) regardless of looking at deaths or infections. I’m told it’s not all that easy to culture; the move towards PCR, etc., which will have helped improve this.

    (I apologise in advance if that’s not very clear to those not familiar with the science.)

    From memory—haven’t time to look it up at the moment—this issue of diagnosis turns up in one of the ‘sources’ Michelle Rudgley refers to in her response to my article.

  • Grant says, “I’d have thought the most accurate measures use confirmation of the causative organism (Bordetella pertussis) regardless of looking at deaths or infections. I’m told it’s not all that easy to culture; the move towards PCR, etc., which will have helped improve this.”

    Who told you Grant? IMAC? PCR is renown for giving false positive results for whooping cough…

    Grant et al’s paper defines whooping cough simply as, as cough that lasted for more than two weeks… not tests at all…

    Real science… not!

  • Ron,

    Who told you Grant?

    That’s ad hominem – stick to substantiative things please.

    Grant et al’s paper defines whooping cough simply as, as cough that lasted for more than two weeks… not tests at all…

    You say here that they didn’t use PCR.

    Wrong: they explicitly said that they did, and also that they cultured samples. This from Grant et al:

    “We obtained nasopharyngeal samples for culture
    from 95 (98%) of the 97 infants with pertussis and for
    polymerase chain reaction from 83 (86%). We
    identified B pertussis by culture in 32 (34%), by
    polymerase chain reaction in 73 (75%), and by either
    method in 76 (80%) infants.”

    They also examined their controls this way.

    Getting back to unfinished business:

    I think you need to show that you’ve moved on from the fuss you created before I accept any further comments from you.

    If you’re ‘good’ enough to make accusations, then you ought to be good enough to apologise, right?

    If you feel you are unable to do this (sincerely and without extra ‘baggage’), then I suggest you should move on.

  • The paper says, “Pertussis was defined as cough lasting at
    least two weeks, with coughing paroxysms, inspiratory
    “whoop,” or vomiting after coughing.”

    ie, tests were not used to establish a diagnosis…

    They “identified 179 infants with a diagnosis of pertussis at discharge and enrolled 97 (54%).” Controls were unmatched.

    They then tested 95 of the 97 “pertussis’ children as you point out… but didn’t test any of the controls…

    Diagnosis was entirely clinical with a 2 week cut off…

    No apology required.

  • ie, tests were not used to establish […]

    You wrote “not tests all”, but they used PCR and culture tests.

    but didn’t test any of the controls…

    As I explained in the previous comment they tested the controls. It’s in the paper – this from Grant et al:

    “The control group consisted of 98 infants admitted to hospital with a coughing illness who were culture negative for Bordetella pertussis and had no B pertussis DNA detected in
    their nasopharyngeal sample after amplification by polymerase chain reaction.”

    (Your “controls were unmatched” reference isn’t relevant here.)

    No apology required.

    I need a clear indication from you that your fuss over accusing me of fabrication, etc., is resolved otherwise I can’t see that you should continue to use my forum – hence asking for an apology.

    If you can’t (or won’t) apologise, as seems the case, then I really suggest you move on.

  • Grant, you have a bad habit of putting things in “quotes” as quotes when they aren’t quotes… I never sid, “not tests all”

    I conceed that the controls were tested and were negative… I missed that for some reason… it does not negte the fact that testing was not used to diagnose whooping cough… only “[a] cough lasting at least two weeks, with coughing paroxysms, inspiratory “whoop,” or vomiting after coughing.”

    The controls were not matched… that is relevant as it is a requirement of good science research practice for such studies… if it was irrelevant they wouldn’t have mentioned it in the heading…

    We have travelled a bit from the statement in quotes attributed to Grant et al and IMAC… if it was a personal communication it should have been referenced as such…

    In order for me to offer an apology, can you confirm the quote was obtained via email from someone at IMAC?

  • I never s[a]id, “not tests all”

    Avoid the dressed-up inane tit-for-tat stuff.

    I’m sure you realise this was an innocent typo (it should be “not tests at all”). Typos don’t deserve accusations of fabrication, like those you gave me earlier – it’s a poor example for a comparison.

    Your comment is riddled with typos: should I nitpick each in turn?

    it does not neg[a]te […]

    Your original point was with reference to PCR, claiming no tests were used, but PCR and culture diagnostic tests were done as the paper explains.

    The controls were not matched… that is relevant as it is a requirement of good science research practice for such studies… if it was irrelevant they wouldn’t have mentioned it in the heading…

    I’m amazed at the effort you are putting in to try dismiss this paper. (You’re also misreading what I wrote.) It’s making me wonder if this paper is some lynch-pin that the local anti-vaccine community cannot let be ‘right’ or their world will collapse! (I notice Michelle refers to an article by Hilary Butler that tries [badly] to dismiss it too.)

    I wrote your reference to “unmatched” wasn’t “relevant here” – i.e. in the context you wrote it – in the context of diagnosis. Matching is used as one way to control for potential confounders, e.g. sex, age, etc., not diagnosis.

    Claiming that because it is an unmatched study, it ought to be dismissed out-of-hand is nonsense. Aside from that it’d be unlikely to make it into BMJ if that were true, in practice unmatched studies can be appropriate, even preferred.

    We have travelled a bit from

    You have you mean: you keep moving on as if you’ve done no wrong!

    if it was a personal communication it should have been referenced as such…

    I note that you have shifted past considering the quote to be fabrication, to worrying about the style of citation used.

    My impression from this is that you accept the quote was not fabrication. Why then are you having trouble apologising?

    I can’t really help much if you prefer some other style of citation. That’d hardly worth much fuss really. (The ellipsis, with it’s implication of insinuation isn’t warranted either.) Accusing me of fabrication on the other hand is accusing me of dishonesty an entirely different matter.

    In order for me to offer an apology, can you confirm the quote was obtained via email from someone at IMAC?

    See footnote added earlier. (Marked with asterix.)

    Surely all you need in order to apologise is accept it wasn’t fabrication. I’m under the impression you already accept that.

    I’m concerned about your claim the quote was fabrication as I wrote earlier (“over accusing me of fabrication”).

    That’s it’s email, phone, etc., or whatever other means isn’t really relevant to that, and the style of citation is really neither here nor there as it isn’t worth fuss (that the source of the quote was correspondence was explained to you earlier and in any event it was clarified in the article earlier).

  • Grant, thanks for pointing out that you have recently added a footnote… it was not there when I read the article… I now accept the “quote” was not a fabrication on your part.

    Your article states, “I’ve deliberately used a small number of local sources, in an effort to limit myself to what might be reasonably found by a careful non-specialist (like myself!)”

    This shows that IMAC is not a reliable source of information at all… the quote is inaccurate and highlights that even people with a PhD like yourself can’t rely on them…

    I will be following this up formally.

    And by the way, I have never ever been anti-vaccine… you can make that claim as often as you like… but you would be wrong in fact. I certainly am a skeptic… but all good science advocates should be.

    For the record, given your addition of the clarification at the asterix in the footnotes that the false statement was sourced from IMAC directly I formally withdraw my inference that it was fabricated by yourself and unreservedly apologise.

  • This shows that IMAC is not a reliable source of information at all… the quote is inaccurate and highlights that even people with a PhD like yourself can’t rely on them…

    Careful: you’re back insinuating things of others. This ad hominem only works if you first assume that the other person is doing wrong then foist your assumption on them.

    (You’re also implying that I can’t read the paper accurately – despite that I have repeatedly pointed out basic errors in your objections. Reads like a cheap poke to me.)

    I see an “accuse first” pattern here. Your statement above looks headed for exactly the same pattern that had you accusing me of fabrication, then being forced to apologise.

    I will be following this up formally.

    Why bother? You’d first need to examine if you understand correctly and that you’ve repeatedly made mistakes over this paper should ring some loud warning bells, surely. If you can’t get them right, why should you hassle them?

    And by the way, I have never ever been anti-vaccine… you can make that claim as often as you like… but you would be wrong in fact.

    Careful, read what I actually wrote.

    but you would be wrong in fact.

    But having said that said, I will be taking this claim with a (very large) pinch of salt.

    For the record, given your addition of the clarification at the asterix in the footnotes that the false statement was sourced from IMAC directly I formally withdraw my inference that it was fabricated by yourself and unreservedly apologise.

    You’d want to take out the ‘false’.

    Until you can show positively that it is in fact in error you’d be making an empty claim and you won’t know either way for some time until you have a full understanding.

    I’d quibble that it’s taken far too much effort on my and other’s part to get this apology, especially given you were told earlier it was correspondence, etc. I also don’t quite agree that it rests on the footnote, but “whatever”.

    Others can comment if they wish, not that I imagine many, or any, will!

  • Simon, Grant et al never mentioned unvaccinated… if IMAC quote them as saying that then they are disseminating false information…

    Besides, what makes you say, ‘again’…?

  • “And by the way, I have never ever been anti-vaccine… you can make that claim as often as you like… but you would be wrong in fact. I certainly am a skeptic… but all good science advocates should be.”
    Really, Ron, that is very disingenuous indeed.
    It’s rather ironic when anti-vaccine people claim to be sceptics or good science advocates. Their own forays into research tend to be laughable, such as the study of the health of vaccinated and unvaccinated children (referred to on the IAS website) which is so wildly biased that it is used for teaching purposes at Auckland University as an example of shoddy research.

  • Carol, I don’t follow IAS’s website so I’ll have to defer to those of you who do. I do, however, note Peter Griffin’s post on the shoddy MENZB policy and research. Even the Principal Investigator is complaining…

  • Ron,

    You might consider ordinary explanations before insinuating exotic and dramatic suggestions like “disseminating false information…” I would prefer you treated others with respect – there’s no good sense in accusing before you know the answer in my opinion.

    Regards “if IMAC quote” – if you look at my quotation you’d see I’m not quoting them quoting Grant et al – you seem to be confusing yourself again. The quote has one set of quotation marks, not two nested sets.

    It was a summary of Grant et al that I quoted, not them quoting Grant et al.

    Should I now start by insinuating that you are ‘disseminating false information…’? 😉 [Don’t be offended at my attempt a humour.] Or just look for a more ordinary explanation first? Occam’s Razor helps here. Just food for thought. It does suggest to me that you shouldn’t point the finger too hard, though.

    The 4-6x lower odds ratio of hospitalisations in fully immunised infants compared to those with delayed vaccination (i.e. under immunised), etc., is in the paper, towards the end.

  • Ron,

    I do, however, note Peter Griffin’s post on the shoddy MENZB policy and research. Even the Principal Investigator is complaining…

    Perhaps you could supply a link so that Carol can verify this. It’s good to supply the original sources so that readers can judge for themselves, etc.

  • Fair enough, Grant. In that spirit, here is the IAS study:
    http://www.ias.org.nz/wp-content/uploads/IAS1992study.pdf

    Interestingly, in the comments thread, Sue Clairidge says “The IAS study was not rigorous science – it never claimed to be.” But in the study itself, Ms Claridge claims that “the study .. provides solid scientific evidence in support of considerable anecdotal evidence that unvaccinated children are healthier than their vaccinated peers.”

  • The shoddy IAS survey goes hand in hand with this rubbish one from a German Homeopath:

    http://journal.livingfood.us/2011/10/09/new-study-vaccinated-children-have-2-to-5-times-more-diseases-and-disorders-than-unvaccinated-children/

    Both are touted again and again as “proof” that vaccines are harming children.
    Orac gave it a piece of respectful insolence:

    http://scienceblogs.com/insolence/2011/08/an_anti-vaccine-administered_survey_back.php

    The ideological opposition to vaccines from these people blinds them to reality.

  • Carol,

    I’m going to put my hands over my eyes and pretend I never saw that link! I don’t want to be distracted into another post examining something someone from IAS has written – not yet :-) But I should cover myself here… won’t say ‘never’, etc…

  • Simon,

    Now there’s one more I have to not look at. Good thing Orac already has it well-covered! I remember looking at this quickly not long ago – I’m pretty sure it’s one of the ‘references’ that Michelle Rudgley offered in her response to my article above [on the IAS website].

  • Grant said, “It’s good to supply the original sources so that readers can judge for themselves, etc.”

    Totally agree, Grant… so how about posting the wrong IMAC “quote” that you have kept from purvey…

  • Ron,

    I’ve asked you before not to post inane tit-for-tat stuff or insinuations. No more of this type of thing, please.

    My question was polite and wasn’t trying to hit on you. I looked for the article you refer to, but there are several articles with Peter’s name on mentioning MENZB and wouldn’t know which it is.

    The quote is posted in the article & something that is quoted isn’t hidden, right? :-)

    My impression is that you veer to insinuations and all the rest of it when you’re stuck, been shown to be wrong, get frustrated etc. If you can’t accept things gracefully, I suggest you move on.

  • Grant, I’m please you weren’t trying to hit on me… :-))

    Look this up… Professor Lennon: MeNZB delay “ethically and morally defunct” Now bare in mind that Professor Lennon complained bitterly that she had to sign off research without being able to verify it… and the MOH responded in part by removing funding for her study after she said the disease had died a natural death and there weren’t enough cases to verify effectiveness… the MOH switched their funding to Victoria uni…

  • Look this up…

    Besides that you haven’t linked to the source, it’s well off topic really. If you want to push your own interests, you’d be best to visit wordpress.com, etc., and start your own blog, etc.

  • In case anyone is wondering (or even still reading this!), I have mostly written an article examining what Michelle Rudgley offered in response to my article above. I’m doubtful I’ll post it, though.

    The problem for me is trying to do something positive with it. I don’t like things that are all negative.

    She presents several assertions, offering a linked source as her support for her assertion. She doesn’t explain what in the linked source is supposed to support her assertions, which makes it a bit hard going. (IMHO, she’s not really informing her readers doing it this way, she’s not bringing out the material and showing her claims.)

    On examination of her sources—yes, I’ve read them all!—none of her linked sources back her assertions. (I’m generalising across all her claims collectively here; explaining this accurately would involve looking at each one separately – each one has different issues.)

    Trouble is, writing just that much is negative. (It does at least try show to her readers how Rudgley has erred, I suppose.)

    To try make something positive out of it, I could present some material clarifying each point for her readers, but realistically it’d be a lot of work and I’m skeptical her readers would make the effort to try inform themselves via my efforts.

    So… there you have it. There is a reply of sort, but it’s stuck in limbo for want of more time and effort needed to make something more positive out of it!

  • Given that the latest posts on the IAS site, linked presumably because they are considered exemplars of clear thinking and honest intellectual discourse on the subject, include:

    a link to the “study” of vaccinated vs unvaccinated child health outcomes run out of Germany and already thoroughly discreditted worldwide;

    a link to “research” proposing a link between vaccination and subdural hemorrhages mistakenly diagnosed as shaken baby syndrome (Vera, is that you?) and laughably enough, references the study above as well as information from such credible sources as whale.to;

    and an interview with Andrew Wakefield, martyr and patron saint of the anti-vaccine’s lunatic fringe;

    I don’t hold any hope that a considered and scientific response will be met by anything other than hysteria (in its truest sense) and quasi-religious outrage.

    Don’t let that stop you though.

  • I don’t hold any hope that a considered and scientific response will be met by anything other than hysteria (in its truest sense) and quasi-religious outrage.

    I always try imagine I’m targeting the fence-sitters (this, of course, assumes that there are some!) or those that have enough sense to pause and think before charging off on what they’ve read on the likes of the IAS website.

    Those that are ‘committed’ aren’t likely to be swayed, as you say.

  • “Given where it is publicised the results are almost foregone.”

    Almost?

    Given the “survey” is an extension of an already existing open-access survey that asked for the health status of unvaccinated children and which claims as a result that unvaccinated children are SO healthy they are very nearly indestructible (I exaggerate slightly… but only slightly) I think “Almost…” is giving undue hope for a result that is valid, credible, untainted, repeatable, etc etc…

  • I live in hope.

    It’s possible that the survey could be influenced to give more balanced results. But that just shows how worthless such surveys are. Even if it gave results that showed that vaccinated children were just as indestructible as vaccinated I wouldn’t use it to wipe, er, the floor.

  • Darcy,

    Sigh. Set to suffer some (all?) of the deficiencies of their previous one (the results of which they link to, as if they were meaningful).

    Couldn’t help noticing that none of the radio button options on that survey have defaults, except for “no” for every question about vaccination status.

    Perhaps it’s worth forwarding this to Orac? Or PZ Myers? It’d take a pretty large readership to balance out any selection bias, though, I imagine.

  • Grant, I’m of two minds about that on the one hand they might just whine that we skewed the results in which case we could say :EXACTLY!.

    On the other hand I’m not sure we could gather the troops given the general apathy….worth a try perhaps.

  • The link to the vaccinated children survey doesn’t work, though the other link (to the results of the unvaccinated survey) does.
    Heh.

  • Darcy,

    I’m not sure we could gather the troops given the general apathy

    I don’t think *we* could, but PZ Myers is known for rustling up crowds. I have seen him say that one of the reasons he encourages people to vote on on-line polls and surveys is to up show how vulnerable on-line surveys are to selection bias, poll-spamming, etc.

  • Carol,

    Cut’n’paste the text of the link into another tab. Like you I noticed their link to the new survey was broken; maybe that’s even a good thing! :-) (JK)

  • Ah well, I have attempted to balance the ledger. One wonders, one does, what will actually become of the information on fully-vaccinated children if – as I suspect – it turns out not to confirm the existing biases of the survey’s author… (yes, I know, I have a nasty cynical nature!)

  • I briefly wondered that as well Alison, but given were it is publicised I’m sure there will be no shortage of parents who feel their children are “vaccine damaged” to fill this out.
    Does that make me more cynical than you?

  • Alison,

    You’re better than most of us!

    It won’t help if the compare to their earlier survey as that’s already meaningless, right? Comparing data, no matter how sound, with unsound data is a garbage in—garbage out situation, as the cliché goes.

  • Darcy,

    I imagine he gets far more email that he can actually read – might just be that? (Also he must get ‘asked’ to do one thing or other every day, many times over!)

    Ben Goldacre might be another to try – ?

  • Grant, yeah….that’s kind of what I was afraid of before I even sent the email.
    Worth a try though.
    Goldacre…hmm…I guess. Could just flood every science/skeptical blogger I can think of.
    Or not…not my style.
    Others are free to though :)

  • The journalist who wrote the piece my article, above, responds to has a piece out in yesterday’s ODT (Saturday, 12th November 2011) titled in the ODT ‘Epidemic of measles reflects ‘sad’ progress’:

    http://www.odt.co.nz/news/dunedin/186286/dismay-nz-measles-epidemic

    This piece has no ‘false balance’, as in the piece my article addressed. My first reading of it is that it looks a good effort; she certainly has more space to elaborate in this piece.

  • I thought so too. The author didn’t give any space at all to the antivaxxers which was quite refreshing.

  • She certainly has drawn together quite a few strands.

    Carol – I think it suits her focus that she referred to the underlying issues—briefly—rather than the advocates, e.g.

    “That is further complicated by the fact that, when the Measles Mumps Rubella vaccine came out, some parents chose not to vaccinate their children, because of claims (now discredited) about possible links between the vaccine and autism.”

    Concise, avoids the ‘he said, she said’ and ‘who said what’ elements that can creep in, and avoids getting sidelined with distractions.

  • Grant said, “Carol – I think it suits her focus that she referred to the underlying issues—briefly—rather than the advocates, e.g.

    “That is further complicated by the fact that, when the Measles Mumps Rubella vaccine came out, some parents chose not to vaccinate their children, because of claims (now discredited) about possible links between the vaccine and autism.”

    Concise,…”

    Maybe concise, but not very accurate…

    MMR vaccine was introduced in NZ in 1990 to be given at age 12–15 months in place of the measles vaccine. The dose at age 11 years was introduced in 1992. In 1996 the timing of the first dose of MMR was changed to age 15 months,…

    The infamous Lancet paper was published in 1998… nearly a decade after it was introduced into NZ…

  • Sure, I saw that and thought to mention it but it didn’t seem worth nit-picking something that doesn’t affect her message (or the point I was making either).

  • Doesn’t it affect the credibility of the whole article… I could point out a number of other significant factual errors… added up they mean that the article is a mix of fact, facet, fallacy and fiction… surely if you want to be taken seriously as a sci-blogger you shouldn’t accept/ignore falsities that significant… I think it suits her focus to quote errors, but then I suspect she is only writing what so-called experts gave her. Inaccuracies from experts should be treated with far more disdain than inaccuracy from the unwashed… don’t you think?

  • Ron,

    To me your comments say much more about yourself than anything else. In the past few months, you have nitpicked, dismissed out-of-hand, tried to ‘colour’ others unfairly (in particular you too often try make others out to have done things they haven’t through word games), and so on. Looks like a troll, acts like a troll, etc.

    If you’re looking to criticise others, you might want to first look at the errors in your own comments.

    Doesn’t it affect the credibility of the whole article

    I’d suggest this just shows your bias.

    It’s logically incorrect too: unless the rest of what she has written rests on that point, it says nothing about if the rest of her article is right or wrong.

    they mean that the article is a mix of fact, facet, fallacy and fiction

    Leave empty hand-waving to muck-raking politicians.

    surely if you want to be taken seriously as a sci-blogger you shouldn’t accept/ignore falsities that significant…

    Implying things through word games is for muck-raking politicians too.

    I suspect she is only writing what so-called experts gave her. Inaccuracies from experts […]

    You don’t have the ‘why’ and what you ‘suspect’ doesn’t really matter.

    Your latter portion rests on your assumption, presented there as a ‘given’ when it’s not a given, it’s something you don’t know.

    Inaccuracies from experts should be treated with far more disdain than inaccuracy from the unwashed… don’t you think?

    A claim doesn’t change because someone else presented it. (i.e. logical fallacy.) For example Michelle Rudgley’s remarks would be just as wrong if you had written them instead of her.

  • “It’s logically incorrect too: unless the rest of what she has written rests on that point, it says nothing about if the rest of her article is right or wrong.”

    When I see an article with such glaring errors of fact, I take much less notice of the rest of the article.. and critique it more fully… that is logical and simple commonsense…

    “A claim doesn’t change because someone else presented it. (i.e. logical fallacy.) For example Michelle Rudgley’s remarks would be just as wrong if you had written them instead of her.”

    That’s interesting… firstly, I didn’t write it… and secondly, you quoted the ODT and then stated, “I’m not very keen on uncritical reporting, so let’s look at Rudgley’s claims for ourselves.”

    Now you are criticising me for criticising uncritical reporting…

    Grant, why is it ok for you, a sci-blogger, to criticise uncritical reporting, but not me?

  • Ron,

    When I see an article with […’

    Sure, fine – but what you’ve written doesn’t take away my point. (Using the opportunity to exaggerate about the article is silly.)

    That’s interesting… firstly, I didn’t write it…

    I never said you wrote it. You seem to not be getting the point – or, perhaps, are trying to walk around it. Either way, never mind.

    Now you are criticising me for criticising uncritical reporting… Grant, why is it ok for you, a sci-blogger, to criticise uncritical reporting, but not me?

    To the first: I didn’t and I believe you know that. I agreed with your original point, I just saw it in a wider context.

    To the second: I pointed out errors in your later comment as to how you criticised, not that you did. I believe you also understand that, too – i.e. enough twisting words & trolling, please.

    If you think the article is open to criticism, why should your comments not be?

    No more tit-for-tat word games, trying personalise things, being argumentative, etc. Lift your standards, please.

  • “If you think the article is open to criticism, why should your comments not be?

    No more tit-for-tat word games, trying personalise things, being argumentative, etc. Lift your standards, please.”

    The question is whether you are up to allowing your comments to be critiqued…

    Tit for tat is a two way street…

  • Grant, indeed it is anecdote, and the baby’s death is a tragedy.

    Have a read of the parents open letter…

    http://danamccaffery.com/openletter.html

    Seems they are blaming the health system more than anything… not sure where the 90 percent of teenagers/adults losing their immunity came from, but if true, surely that is the main source of infection… not unvaccinated… if the parents letter is correct, it is evidence that the vaccine is not flash…

  • Seems they are blaming the health system more than anything…

    I find your presentation of what the article says telling.

    For you everything always seems to be about blaming the health system (and pinging vaccines). You have a long history of attacking health system professionals over many years now, sometimes quite crudely.

    I find it telling that you have lifted out one aspect and highlighted it to make it out to be the writers’ main point. I have little doubt it is the main point to you, but the article equally points at the community.

    After writing that they felt the “NSW Health should have proactively alerted the community of outbreaks and precautions to take before it became an epidemic”, they emphasised that “Everyone in our community must work together to increase vaccination rates to protect our most vulnerable.”

    This theme, that it is both a health system and community issue, is apparent elsewhere in their article. Similarly their final suggestions are aimed at both.

    Unless you are suggesting that the health system ought to have forced everyone to vaccinate the community is a ‘main part’ of this picture too.

  • Yeah, Grant… apart from being a tragic situation, the letter is full of emotion, fact and facet… I suspect also fallacy…

    The director of public health for the northern NSW and Mid North Coast local health districts, Paul Corben, said a 50% rise in reported cases between Tweed Heads and Port Macquarie this year has concerned health workers.

    “We do sometimes see periodic surges on the number of cases as the protection you get from either having the vaccination or the disease wears off over time,” he said.

    Mr Corben said the health department recommended immunising babies at six weeks of age, then again at four months and six months, with a booster shot at four years of age.

    “We also offer free booster shots to Year 7 and Year 10 students at high school,” he said.

    “And if people are planning a family, or have a new baby in the house, we recommend they have their vaccination renewed at that time.”

    Free vaccine is also available for new parents, grandparents and anyone who regularly cares for a baby less than 12 months of age.

    So far this year 772 cases of whooping cough have been diagnosed from Port Macquarie to Tweed Heads on the NSW-Queensland border, with 493 cases between the Tweed and the Clarence.

    “One of the reasons we think we’re seeing more whooping cough reported across the world is because of new, less-invasive diagnostic techniques,” he said.”

    The last sentence sums up a lot… go looking for it and you’ll find it… epidemic my foot!

  • Seeing as you have moved on to a cut’n’paste quote of something else, I will take it you accept the points I made in my previous comment.

    Similarly, seeing as you have moved on to other things, my reading is that you just wish to be argumentative to ‘frame’ your chosen target no matter what. There’s isn’t much point or value in that.

  • Grant, what I’m pointing out is that there case is anecdote and, according to you, you can’t draw conclusions from one case… or have you changed you mind…

    What I’m pointing out is that when you critique their letter, and look at the bigger picture, even the health professionals acknowledge that the reason for the increase in the number of reported cases is because of a surge in interest in testing and improved testing regimes…

    Their case is tragic, but the evidence they have provided even shows that the most likely source of infection was an older person whose protection from vaccine has waned… by the way, how crude to test the family members for DB… imagine the lifetime guilt if mum or dad or one of the kids had been positive… imagine the guilt of thinking they had killed the baby…

    I’m afraid, all this case does is highlight the randomness of life and the frailty of whooping cough vaccination… nothing more, nothing less…. oh, sorry, I forgot… it also highlights double standards… how skeptics latch onto anecdote as fact with great passion when they are trying to discredit people with different opinions who latch onto anecdote with great passion.

  • Ron,

    Given you’re being argumentative & now outright trolling it seems to be that this should be closed. To close this off, briefly:

    “Grant, what I’m pointing out is that there case is anecdote and, according to you, you can’t draw conclusions from one case… or have you changed you mind…”

    Obvious trolling, not worth a reply; the key points have already been elaborated.

    “What I’m pointing out is that when you critique their letter, and look at the bigger picture, even the health professionals acknowledge that the reason for the increase in the number of reported cases is because of a surge in interest in testing and improved testing regimes…”

    Look back at why I posted the letter – this has nothing to do with that. Also, this isn’t from the letter I posted, but one you linked to. Either way, this is your interest your interest, not mine. As I’ve suggested to you many times if you have your own things to push, go to blogger.com or wherever at set up your own blog.

    You’re misrepresenting or are confused about what has been said. In particular, these tests are to confirm the origin of disease in people who are ill – already ill enough to trigger them being tested to confirm a possible cause. Better detection here isn’t a reason to dismiss what’s being found.

    “Their case is tragic, but the evidence they have provided even shows that the most likely source of infection was an older person whose protection from vaccine has waned…”

    So? This is just being argumentative. You don’t know the source, so your throw-away addition is meaningless, it could also be someone who didn’t vaccinate. You don’t know.

    “by the way, how crude to test the family members for DB… imagine the lifetime guilt if mum or dad or one of the kids had been positive… imagine the guilt of thinking they had killed the baby…”

    This seems a bit cheap and trying to be inflammatory; you know the value of locating the source of infection is to track who else they might have infected.

    “I’m afraid, all this case does is highlight the randomness of life and the frailty of whooping cough vaccination… nothing more, nothing less…. ”

    Twisted around to suit your personal agenda.

    “oh, sorry, I forgot… it also highlights double standards… how skeptics latch onto anecdote as fact with great passion when they are trying to discredit people with different opinions who latch onto anecdote with great passion.”

    Trolling and repeating a now very tired line. See my previous reply.

  • I personally would advocate adult boosters in the same manner as the tetanus booster. Just change from a Td vaccine to a Tdap.

    Ron, I can’t quite work out if you think the pertussis vaccine should be discontinued or not. Please enlighten me. You keep attacking it so one gets the impression you don’t support it.

  • Simon says, “Ron, I can’t quite work out if you think the pertussis vaccine should be discontinued or not. Please enlighten me. You keep attacking it so one gets the impression you don’t support it.”

    Simon, what I am pointing out is that skeptics have a habit of dicking anecdote when it is used to support a contrary view, yet use anecdote, as in this post, to argue a skeptic’s cause…

    As for whooping cough, the letter by the parents points out, rightly or wrongly, that 90 percent or there abouts of teenagers and adults have lost their immunity to whooping cough… so therefore their is no basis for blaming the death of their child on people who have chosen not to or simply not bothered to vaccinate their children. The link even suggests that the child might have been infected within the hospital… iatrogenic disease.

    My beef is with people who think that vaccines are the panacea for all infectious disease and that they have been responsible for the vast decline in infectious disease deaths in the past century… the evidence is plain that that is not the case… I would suggest that engineers have had more to do with the decline of such diseases through design and provision of improved water, sewage and roads… and transport…

    A number of studies have suggested that an allele shift to one or more BP genotypes may be playing a play a role in the emergence of pertussis in vaccinated populations…. in which case more vaccine isn’t the answer… provaxers need to start thinking outside the square… to start thinking smarter…

  • Over here in the United States, we’ve been having pertussis outbreaks too. There’s both science and anecdote.

    For the anecdotal side, there’s Everlee’s story, a Minnesota infant too young to be vaccinated . Doctors told Emily the disease is so contagious her daughter likely brought home the bacteria on her clothes.

    I live in California; in 2010 there were a record number of cases of pertussis, including the deaths of 10 infants. 2011 was much better: Vaccination program credited in fight against whooping cough.

    I see that Ron Law is trotting out a version of the tired anti-vaccination trope “vaccines didn’t save us”. Yes, engineering and improved public sanitation did have a positive effect on public health, there’s no question about it. But how about vaccine-preventable, infectious diseases like measles? No amount of sanitation is going to prevent transmission of measles. All you have to do is look at the US measles infection rate between say, 1952 (when the US was highly developed) and the introduction of the measles vaccine (1963) and then decades later:

    Year…..Cases…..Deaths
    1952….683,077..618
    1962….481,530..408
    1972…..32,275…..24
    1982…….1,714…….2
    1992…….2,237……4
    2002………..44…….0

    (full data set available from http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/G/cases&deaths.PDF.)

    I could repeat the exercise for whooping cough, but it is a bit more complicated, as the US has used several different formulations of the whooping cough vaccine. The current formulation is acellular, meaning the vaccine has fewer side-effects but is less effective in conferring immunity.

  • Interesting stats Liz… How do you account for the drop in deaths for polio from 3,145 in 1952 to only 60 in 1962.

    I understand the first polio vaccine (which didn’t actually work! wasn’t licensed until 1962.

    Are you suggesting that the polio vaccine had a retrospective effect?

    Did you know that the US changed the polio definition AFTER the vaccine was introduced?

    By the way, I’m not anti-vaccine; never have been. But I am very much pro-evidence based medicine.

  • Liz, the “Doctors told Emily the disease is so contagious her daughter likely brought home the bacteria on her clothes” article is interesting. Does anyone have any evidence that the good doctors statement is true, and that WC is spread via clothing?

  • I understand the first polio vaccine (which didn’t actually work! wasn’t licensed until 1962.

    I suggest you revise your polio history. It would seem that you’re leaving out the Salk vaccine and only thinking of the Sabin vaccine. The Salk vaccine was approved for use in the USA in 1955 and used in a mass vaccination campaign in the later part of the 1950s as is well documented. It was a major event in the polio story – I can’t see how anyone would miss it. (The Sabin vaccine was approved in 1962.)

  • I stand corrected… in my rush to print I mixed the two vaccines/dates… Of course it was the Salk vaccine that was first cab off the rank and it was the vaccine that was ineffective… Why? In part because the Salk vaccine
    produced only about 10 million viruses per ml of culture fluid in the 1950s. This was 10-fold less than what was needed (10^8/ml) for effective inactivated vaccines without adjuvant… of course the fact that they changed the definition of polio several times helped make the vaccine look effective…

    Have you read The Present Status of Polio Vaccines published in the 1960 Illinois Medical Journal? If not, you should.

  • Liz, it is not based on belief at all… the website you have posted examines many of the events related to the arrival of the first polio vaccine in 1955 “through the lens of documents from the Dwight D. Eisenhower Presidential Library.”

    Scientific analysis of the introduction of polio vaccine show that the Salk vaccine was at least an order of magnitude underpowered, and that the change of the definition of polio from one including paralysis upto 3 weeks to one after the vaccine was introduced requiring paralysis of at least six weeks… and then one requiring testing to confirm polio and excluding coxsakie virus and others.

    Have you read The Present Status of Polio Vaccines published in the 1960 Illinois Medical Journal? If not, you should… pages 86-87 reveal the misleading way stats were used to promote the vax and that there had been a significant INCREASE in paralytic polio where the salk vaccine was being used… there is concern expressed at over zealous officials saying the answer was more vaccine, when the facts appeared obvious.

    If you haven’t and would like a copy just ask… When you’ve read it I’m more than happy to continue the discussion.

  • stumbled across this thread. it is interesting that australia has abandoned cocooning for whooping cough as they concluded it didn’t work.

  • Just food for thought (and my habit of stashing away related thoughts in comment threads!): Graham Lappin’s article points to the dramatic rise in whooping cough cases in the UK thus far (end September) this year – to now over 6000 cases, compared to less than 800 in each of the previous four years.

  • A story has broken earlier today that is likely to re-ignite talk about Australia’s decision not to provide free whooping cough boosters for family members. As the full story is subscription-only, I’ve included the full lede below (i.e. unless you subscribe this is as much as you can read anyway):


    MALAKAI Taylor’s tiny body had been ravaged by whooping cough for more than a week, leaving him brain-damaged and on life support, and his parents facing the devastating decision to switch off the machine.

    His parents, Elizabeth Cockroft and Nathan Taylor, believe their seventh son contracted whooping cough from his mother when he was only six weeks old — too early to be vaccinated himself and two months after a free booster program for expectant parents was axed by the Queensland government.

    Source: http://www.theaustralian.com.au/news/health-science/family-rues-call-on-whooping-cough-booster-ban/story-e6frg8y6-1226533226786

  • Sadly I see more & more stories like this, of children are dying of preventable diseases. I only hope it wont take too many deaths before people will wake up and realise the risks they take.

    And that if you are going to tout medical opinions as advice to influence people, then it is unethical (to say the least) to present anything biased or not backed up by “actual” research.

  • Andrea,

    ‘And that if you are going to tout medical opinions as advice to influence people, then it is unethical (to say the least) to present anything biased or not backed up by “actual” research.’

    You’d wish people would better recognise when what they have is poorly-informed opinion, but it’s almost a catch-22. It reminds me of the Dunning-Kruger effect – I never heard of it before learning about the anti-vaccine groups, etc., but when you look at some of the writing (e.g. the articles on the IAS website) I’m reminded of it.

  • Fitting :)

    I didn’t know the name, but I remember when they won the ignobel prize in 2000.

    There is also the Peter Principle, that members of an organisation rise to their level of incompetence:

    http://en.wikipedia.org/wiki/Peter_Principle

    I think the moral of the story is to work within an area that can meet the challenges thrown at it. If you can’t, then you are probably running at the incompetent level (and being unaware of it).

    And this is where pseudoscience falls over, none of the arguments I see stand up to any kind of rigorous scrutiny.

  • So sad. And for that reason it is so important to have herd immunity.

    Obviously this is not the case in NZ, but other countries where you can sue for personal injury etc, are anti-vaccination groups liable for their medical mis-information, holding “chicken-pox parties” etc?

  • I’m not a lawyer, so I couldn’t answer that.

    You’d wish people would think about if they really are in a position to advise others, though. These groups seem to say they’re just offering their ‘opinions’, but then at the same time they seem to want their statements to be more than ‘mere opinion’.

  • “Of the effectiveness of the pertussis vaccine the MoH Immunisation Handbook 2011 says (page 143, paragraph 4),

    That immunisation made a considerable contribution to the reduction in pertussis mortality was demonstrated in a review of the infant pertussis death rate in the US from 1900 to 1974. Had the decline in mortality from pertussis continued at the same rate as it did from 1900 to 1939, there would have been 8000 deaths from pertussis in the US between 1970 and 1974 rather than the 52 deaths that occurred.14

    and later (page 135, paragraph 2),

    The introduction of mass immunisation was associated with a 5- to 100-fold reduction in pertussis incidence in Canada, England and Wales and the US between 1930 and 1980.25—27”

    If one compares the above statement with the actual pertussis mortality graphs from the US and England and Wales, one is faced with the fact that – as Dr G Lanctot MD, Canada points out: “The medical authorities keep lying.”

    http://www.healthsentinel.com/joomla/images/stories/graphs/us-pertussis-1900-1967.jpg

    http://www.healthsentinel.com/joomla/images/stories/graphs/uk-pertussis-1838-1978.jpg

    Or, as Dr Herbert Shelton has observed:

    “Belief in immunization is a form of delusional insanity.”

    Or, as I keep saying:

    “Vaccination is an organised criminal enterprise dressed up as disease prevention by means of junk science.”

  • Or, Erwin, perhaps the medical authorities are not lying at all, but there is a pseudoscientific conspiracy theory that some people are taken in by.

    What reason do you have to try to convince others that healthsentinel.com has better data than the Ministry of Health?

  • Historical improvements in sanitation and nutrition are big components of reduced rates of diseases, vaccination can in no way take all the credit. Imagine what putting some of the $ that vaccines cost into improving these things and educating people on nutrition, breast feeding and living conditions could achieve for prevention of all diseases, not just the few immunised against – rather than artificially provoking an amazingly competent and complex natural immune system. I feel that vaccines have their place (I have chosen specific vaccinations for my children, not the government’s ever changing schedule of the moment) but it seems too close to the ambulance at the bottom of the cliff scenario where people are patched with a substance rather than treating the real causes of disease susceptibility. Also, considering the strong scientific research indicating success in treating colds with vit c and even cancer with high levels of intravenous vitamin C, it would be my first step in supporting my family’s immune system if one of us had the misfortune to contract the disease.

  • Hi Tamara,

    I’d like to think no-one would suggest vaccines are the only reason for reduced disease rates since, say, the 1800s. Public health has played an important role.

    There are, however, a few people online who claim that vaccines have had no effect, which isn’t true.

    “educating people on nutrition, breast feeding and living conditions”

    These things have been done and they’ve made an important difference. (Think of the long view from the 1990s.) It’s true people shouldn’t get complacent and forget these things and you worry some do.

    However, it isn’t a good reason to substitute the existing vaccine programs for these; both are needed and useful.

    “I feel that vaccines have their place (I have chosen specific vaccinations for my children, not the government’s ever changing schedule of the moment)”

    It’s good that you immunise your kids.

    You might like to learn more about why the schedule used has been chosen. The timings are chosen to best help children. They do revise them as new information comes in and as different vaccines become available.

    There is some rather bad misinformation about some childhood illnesses being harmless online. Some of it focuses only deaths, leaving out that hospitalisations or long-term harm they can cause (never mind the hassle of looking after sick kids).

    As one example, I have a hearing loss—completely deaf in one ear and about half-deaf in the other—because I was born just before rubella vaccines were available. It has affected pretty much everything in my life. Bullied as a kid because I had an aid; screwed up socialising because you can’t properly join in and often confused about what is going on and so on. There were two ‘epidemics’ of deafness in New Zealand from rubella. I believe there have been no large ‘waves’ of deaf children since rubella vaccination started. I’ve written about rubella here: http://sciblogs.co.nz/code-for-life/2010/02/10/rubella-not-a-benign-disease-if-experienced-during-early-pregnancy/

    “but it seems too close to the ambulance at the bottom of the cliff scenario”

    Vaccines are at the top of the cliff — they are aimed at preventing kids from getting the disease. Treatments are at the bottom — they try deal with the disease once they have it.

    About vitamin C treatments:-

    I have previously made a (very!) brief survey of the research on high-dose vitamin C to treat pneumonia: http://sciblogs.co.nz/code-for-life/2010/11/05/nothing-in-the-review-literature-on-iv-vitamin-c-for-severe-pneumonia/ It’s not detailed, but it’s a start.

    (I have also written about one local study looking at vitamin D and the common cold: http://sciblogs.co.nz/code-for-life/2012/10/03/vitamin-d-does-not-cures-colds/)

    I am of the impression there is no sound evidence for vitamin C treating cancer.

    One problem with people pushing remedies like high-dose vitamin C for a very wide range of diseases is that cure-alls pretty much invariably prove to be cure-nothings based on wishful thinking or marketing. Claims that one treatment can treat to many diseases that are very different is usually a good sign that the claim to treat them is unlikely. Different diseases are different and will want different treatments.

    It’s also worth remembering that the high-dose vitamin C is a treatment — it is trying to tackle the illness after someone has it, rather than preventing them from getting the illness.

    For example, the HPV vaccine (Gardasil) aims to prevent the person from becoming infected with the main strains of human papilloma virus (HPV) that are known to later be involved in the development of cervical cancer. Vitamin C would be used after they had the cancer and are at risk. Prevention is better than cure, right?

    Feel free to ask any questions – I’ll do my best (even if I have to defer to better people than me!)

  • Hi Tamara,

    it seems to me like saying seatbelts aren’t really necessary because car deaths are much lower than they used to be because of improvement to cars, roads etc.

    But the risks of using seatbelts are extremely low and the benefits are absolutely worthwhile.

    Of course sanitation, nutrition etc are important, but breastfeeding for example, was the only source of nutrition for most of history, yet disease was rife.

    We are incredibly lucky to live now & generally not risk getting these nasty diseases that were so prevalent and lethal. I wouldn’t like to miss out on any opportunity to protect my children so easily.

  • No one is saying vaccines deserve all the credit for controlling infectious diseases – this is a gross misrepresentation of the position of health professionals and scientists. Suggesting that breastfeeding and nutrition is in some way an alternative to vaccination is naive. Infectious diseases are democratic, they do not care if a person is breastfed or provided with a healthy diet. These are simply factors that can result in complications. See my comments on this http://sciblogs.co.nz/diplomaticimmunity/2013/07/02/breast-milk-is-not-a-substitute-for-vaccination/
    The governments ‘ever changing’ schedule is based on science not whim. Given the limited health dollar, the best investment is that which prevents the most sickness and disability. Preventing disease is generally cheaper than trying to cure it and dealing with the aftermath. A dose of vaccine against whooping cough costs a few 10’s of dollars, treating a few infants in Auckland with the disease the last couple of years has cost the country in excess of two million dollars. I also wonder what the toll was on their parents as they lay in intensive care?
    Vitamin C has not been demonstrated to have any therapeutic benefit in any of the vaccine preventable diseases, other than possibly in cases of low plasma levels. For example pneumonia http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005532.pub3/abstract
    Given the most recent Cochrane review based on studies from 1966 – 2012 including 29 trials involving 11,306 people in a meta-analysis of Vit C for preventing and treating the common cold still fails to find a benefit in reducing reduce the incidence I think your claims are on pretty shaky ground.
    However Vitamin A is used in NZ hospitals in measles, an evidence based approach.

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