Slamming UK antiscience

By Phil Plait | March 14, 2009 10:28 am

I’ve written about one of my heroes, Ben Goldacre, before: he writes the Bad Science column for the UK newspaper The Guardian, and is a tireless fighter against medical nonsense like vitamins curing AIDS, homeopathy, and chiropractic.

He’s in some hot water right now. As I mentioned in February, a "journalist" named Jeni Barnett, who went on the radio and basically spewed dangerous antivax nonsense for an hour. Ben posted the entire audio clip, and predictably the radio station asked him to take it down. In America, given copyright restrictions, that would be understandable, but in the UK the laws are different, and the legality of this is questionable.

What I don’t understand is the radio station’s steadfast defense for themselves in their right to air fearmongering conspiracy theories which spend a lot of air time telling parents it’s better to put their kids at serious risk of fatal diseases than to get a simple vaccination, and to air someone saying demonstrably incorrect things while doing it. Where does personal or company pride end when it puts little children at risk?

Ben created an excellent short video news segment which is now on YouTube. I strongly urge everyone to watch it and spread the word.

People like Jeni Barnett have a right to speech, but speech, even free, comes with a price when it advocates parents putting their kids at risk. This story needs to be heard.

Comments (101)

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  1. Here is my reiteration about a couple of good books to get you armed to handle dubious media claims. I posted this earlier on the 47% of Americans need to be sent into heliocentric orbit, the first is Ben’s book, Bad Science (the UK version). A version will be coming out in the US soon.

    There are two excellent books that I will soon be reviewing. They both have the same goal, giving people the tools and savvy to understand when one might be encountering suspicious scientific claims and how can you tell quality research from junk science, etc.

    Note: I am going to talk about two books OTHER than the marvelous one written by Phil. I still love his, I’ve read it a few times (dissecting his style) and if he puts it on audio, read by himself, I will most certainly listen to it and maybe even blast it down the hall and out my car window…oh, you rap and hard rock blasting cars don’t intimidate me! Just listen to how the world will end! :-)

    The first is Bad Science by Ben Goldacre. His work focuses more on health issues as he has an MD. He helps us understand how a good study is set up and how many times health claims are made erroneously either innocently or on purpose (to take our money)…and it is humorous. The other is called Lies, Damned Lies and Science by Sherry Seethaler. Her book is phenomenal! It is the most well thought out book on understanding how science is done and presented to the public without overwhelming us with unnecessary information. I would love to see her book turned into a video instructional series, that’s how important this work is.

    Ben’s work is very easy to read and entertaining. I read most of it in a room full of middle schoolers playing their band instruments.

  2. CS

    This is the UK Parliament’s Early Day Motion by Norman Lamb, the MP featured in the video.

    MMR VACCINE AND THE MEDIA
    10.02.2009
    Lamb, Norman

    That this House expresses its support for the use of the combined MMR vaccine; notes with concern the re-emergence of measles and the loss of life and long-term health problems which will afflict children as a result of the decline in the vaccination rate which followed Dr Andrew Wakefield’s now discredited research paper suggesting a link between MMR vaccine and autism; expresses its disappointment that ill-informed comments by presenters such as Jeni Barnett on her LBC radio show will continue to cause unfounded anxieties for many parents and are likely to result in some parents choosing not to vaccinate their children; recognises the right of Jeni Barnett as a parent to make her own judgement about vaccinations for her own children but implores her and others in the media to act more responsibly when making comments in the public domain; and further expresses its hope that in the future reporting the issue of MMR will be less sensationalist and more evidence-based.

  3. In the UK an original work is automatically copyright of the creator, so reproducing the entire text without permission would be a clear breach of copyright here, I think. Also the BBC doesn’t necessarily own the copyright, only the broadcast rights as agreed by the author. I’ve always understood that copyright law is a lot stricter here than in the US.

    That said, I totally oppose misinformation against science.

  4. James Pannozzi

    Goldacre is most certainly NOT one of my heroes, his campaign of, in my opinion, innuendo and unceasing misrepresentation of Homeopathy and other alternative medicine modalities has now come full circle. Deservedly so.

    For those that did not know, Goldacre was the recipient, several years ago, of an award of thousands of pounds for excellence in “scientific” journalism for anartic(s) le he wrote in defending MMR vaccines against critics. That award was, upon a little research, sponsored, I believe, by (surprise!!!!) SmithGlaxoKline one of whose subsidiaries manufactures (surprise!!!!) MMR vaccines.

    Thank goodness for “unbiased” “scientific” journalism.

    The fact remains that despite all the pretensions of scientific credibility and “evidence”, what Goldacre has been publishing is merely his OPINION. I’ll repeat that in capitals, again so it is entirely clear and stands out from all the “scientific” appeal to authority, and “evidence” rhetoric endemic to his writing – it was his OPINION and nothing more.

    So now there is some opposing OPINION from somebody questioning the MMR vaccines. AGAIN it is just somebody’s OPINION, nothing more. Goldacre may not like it but that’s just too bad.

    If the legality of Goldacre’s posting of the clip is confirmed, then the Guardian should be obligated, as a public service in discussing a public issue like this, to provide equal column space to the anti-Vax opinionated person as well.

    The bottom line is I think people are FED UP with one sided views of things and would like to hear both sides of the issue – something that is fairly rare, quite possibly extinct, in Goldacre’s columns, in my opnion, particularly in the light of his writings themselves and that award he accepted as in indicator of his very biased OPINIONS indeed.

  5. James

    Sadly, attempting to discredit public health excercises is not classed as the same thing as shouting ‘FIRE’ in a crowded theatre.

    I loved this line though:
    “because in the media everything is 50:50, and the truth lies exactly half way between the two most extreme views”

  6. That Science Writers award was worth around £2000 – and yes, it is astonishing the stick that Ben Goldacre takes for that. Even from people who neglect to mention that their own co-authors were nominated for that self-same award which they publicise as proof of the alleged venality of others.

    Ben Goldacre hosted that clip of Jeni Barnett and LBC 97.3 Global Radio on his own Bad Science blog, nothing to do with the Guardian. The above news segment is from ITV London.

  7. IVAN3MAN

    It has to be said that one of the reasons why people don’t take scientists seriously, here in the UK, is because of the contradictory advice that people hear on TV or read in newspapers. For example: on BBC News, in January 9th 2008, it was reported that “A little alcohol ‘can be healthy’“; however, the following year, in February 24th 2009, a contradictory report on BBC News stated that “Drink a day ‘raises cancer risk’” for women.

    Whiskey-Tango-Foxtrot?!

  8. IBY

    @James
    No my man, the fact that vaccines don’t cause autism or that homeopathy sucks as medicine is the current fact, as shown by various research. Oh, and who was the guy who falsified research about vaccine being bad? That is right, Andrew Wakefield. So no, it is not an opinion, it is an established fact that the MMR is safe. It is also dumb to say it is completely safe. Nothing in life is 100% safe. Being alive means you take the chance, and fortunately, the MMR is very safe.

  9. IBY

    Oh, and by the way, if it ain’t just medicine, it is just that. It is not medicine. I don’t know why “alternative” has to be added. If it works, it works, and it is just medicine. What d’ya know.

  10. Jeff

    @James: “The bottom line is I think people are FED UP with one sided views of things and would like to hear both sides of the issue”

    What are you going on about? There’s only one side to this story: Vaccinations are safe, and the ignorance and fear-mongering is detrimental to society. That’s not my OPINION, that’s a fact. Sometimes a story only has one side to it: the truthful side.

    @Sciencegoddess: I’m gonna check those out… thanks!

  11. IVAN3MAN

    Furthermore, bloody Prince Charles is not helping the cause of science by promoting his own brand of Duchy Herbals’ Detox Tincture, which Edzard Ernst, the UK’s first professor of complementary medicine, described as “outright quackery”.

  12. zaardvark

    @James Pannozzi … which award exactly did Ben Goldacre receive, which was sponsored by SmithGlaxoKline? You’ve stated this on a number of websites, without giving any evidence.

  13. Dave W

    Goldacre’s appearance on Charlie Brooker’s Screenwipe:

    http://www.youtube.com/watch?v=8lZ4QEOrzzI (His bit starts at 06:58)

  14. IVAN3MAN

    After my last comment, I think that I have just ruined my chance of Knighthood!

  15. James: Goldacre’s award was actually sponsored by an agribusiness company called Syngenta, which has nothing to do with pharmaceuticals. And there’s a big difference between opinion and the scientific facts that Goldacre cites. It’s not his opinion about the facts, it’s the research that speaks for itself. The other side of “fact” is unproven conjecture.

  16. I love the announcer’s semi-snarky comment on the outro….where he goes out of his way to emphasize that the preceding has been one person’s personal opinion. I bet there was a BBC lawyer hovering in the control room.

  17. Brian

    True, but on the other hand, he was also quite careful to point out that Goldacre’s message was directed at all of the media, including his own channel. I thought that was a very respectful touch that only helped to emphasize the importance of the video.

    Phil, thanks for sharing that. Mr Goldacre hit the nail on the head. Bravo.

  18. Didac

    All evidence points that MMR vaccination entrails far less risk that “abstinence” from MMR vaccination. However, there are serious ethical issues in the use of drugs (including vaccines) against the will of pacients. So we must weigh here personal freedom (tainted by disinformation) and public health (the fact of herd immunity). Moreover we have the question of children: who can decide for them? Parents? Health authorities?

  19. I’ve dugg and stumbled it, this article and the YouTube video from Bad Sciences Ben Goldacre. I usually don’t read much about medicine, I hate doctors, no personal offense meant :-D , but this is just too bad. We scientists need to use our voices more often I think, to counter the wave of antiscience.

  20. Wow. I’ve never listened to Ben before. What an amazing representative of science and such a wonderful commentary. I will be sure to not miss a chance to listen to him again. Thanks so much for writing such a great blog, and for bringing other such great scientists to our attention.

  21. Subocaji

    Is it just me or does this English Doctor have THE DOCTOR potential.

  22. James Pannozzi

    @ zaardvark:

    “James Pannozzi … which award exactly did Ben Goldacre receive, which was sponsored by SmithGlaxoKline? You’ve stated this on a number of websites, without giving any evidence.”

    Zaardvark, here is some evidence for you, this website shows a picture of Goldacre accepting the award and also has additional comments about his “journalism” and career.
    http://www.whale.to/b/goldacre_h.html

    This blog critically examines and dissects another of Goldacre’s “journalistic” contributions, this time his opinion on Homeopathy.
    http://laughingmysocksoff.wordpress.com/2007/12/11/smelly-socks/

  23. Daniel J. Andrews

    Amazing how easy it is to spot a conspiracy poster by their habit of capitalizing some words. Do moon hoaxers, ufo-ists, antivaxxers, creationists, 9/11ers all go to the same writing camp?

  24. José

    Amazing how easy it is to spot a conspiracy poster by their habit of capitalizing some words.

    They don’t type it that way. The WORLD GOVERNMET controlled Internet automatically inserts capital letters when a poster comes too close to the TRUTH. That way they sound NUTS.

  25. Sir Eccles

    I have to say that Poirot’s brother is looking rather old in that clip.

  26. innuendo and unceasing misrepresentation of Homeopathy and other alternative medicine modalities

    How does he do that? I am unaware of him saying that homeopathy or other alternative medicine is helpful, and safe. It’s my understanding that he condemns such things as unsubstantiated, unhealthy, useless quackery – which is pretty accurate.

  27. If the legality of Goldacre’s posting of the clip is confirmed, then the Guardian should be obligated, as a public service in discussing a public issue like this, to provide equal column space to the anti-Vax opinionated person as well.

    I disagree. Nobody should be forced to give a public forum to people who are demonstrably, unequivocally, absolutely-in-every-way, wrong.

  28. Nigel Depledge

    Sciencegoddess said:

    The first is Bad Science by Ben Goldacre. His work focuses more on health issues as he has an MD. He helps us understand how a good study is set up and how many times health claims are made erroneously either innocently or on purpose (to take our money)…and it is humorous

    Hear, hear.

    I would go even further. Your education – in fact, your life – is incomplete until you have read Bad Science.

    Ben’s style is easy-going, but his message is crystal-clear, and some of the shenanigans he uncovers in this book are shocking (like, for instance, the fact that, although he was the newspaper’s science correspondant at the time, his editor did not allow him to write the lead MMR article when the MMR scare first broke). Furthermore, he does something with which many people struggle – he explains things in a way that makes them easy to understand, without dumbing down or diluting the truth.

  29. Nigel Depledge

    James Panozzi said:

    For those that did not know, Goldacre was the recipient, several years ago, of an award of thousands of pounds for excellence in “scientific” journalism for anartic(s) le he wrote in defending MMR vaccines against critics. That award was, upon a little research, sponsored, I believe, by (surprise!!!!) SmithGlaxoKline one of whose subsidiaries manufactures (surprise!!!!) MMR vaccines

    If you are correct (cite your source, please), there may be a conflict of interest.

    However, this does not change the fact that your argument is a logical fallacy, called Poisoning the Well. You attempt to discredit Goldacre, but you fail to address the actual arguments he made. Therefore, I can only conclude that you actually cannot address his arguments.

  30. Nigel Depledge

    James Panozzi also said:

    The fact remains that despite all the pretensions of scientific credibility and “evidence”, what Goldacre has been publishing is merely his OPINION. I’ll repeat that in capitals, again so it is entirely clear and stands out from all the “scientific” appeal to authority, and “evidence” rhetoric endemic to his writing – it was his OPINION and nothing more.

    So now there is some opposing OPINION from somebody questioning the MMR vaccines. AGAIN it is just somebody’s OPINION, nothing more. Goldacre may not like it but that’s just too bad.

    If the legality of Goldacre’s posting of the clip is confirmed, then the Guardian should be obligated, as a public service in discussing a public issue like this, to provide equal column space to the anti-Vax opinionated person as well.

    The bottom line is I think people are FED UP with one sided views of things and would like to hear both sides of the issue – something that is fairly rare, quite possibly extinct, in Goldacre’s columns, in my opnion, particularly in the light of his writings themselves and that award he accepted as in indicator of his very biased OPINIONS indeed.

    OK, there are several things wrong here.

    First, Goldacre’s book frequently refers to actual studies – it has a whole list of references at the end. He bases his opinion on facts.

    Second, since Goldacre has taken the trouble to become informed on this issue, i.e. he has read the original research on which the medical establishment’s claims are based, his opinion is that of an expert. In science, an uninformed, ignorance-based opinion (such as yours) is worth virtually nothing.

    The fact is that there is no link between MMR and autism. If you disagree, then first you should go and read up on the relevant medical literature, and also make sure you understand it, before you start spouting off in the comments of a science blog.

    Or were you just trolling?

  31. Direct link as the one given above doesn’t seem to be identifiable to some readers.

    Ben Goldacre won the Sygenta ABSW Science Writers’ Award 2005. The prize was for an article published in the Guardian, Don’t Dumb Me Down. Read the article and its contents for yourself. You will see that that particular article is mostly about the mistreatment of statistics in mainstream reporting.

    It was a prize of £2000.

  32. HCN

    Panozzi invoked Scopie’s Law: In any discussion involving science or medicine, citing Whale.to as a credible source loses you the argument immediately …and gets you laughed out of the room.

  33. Prolix

    the fact that … homeopathy sucks as medicine is the current fact, as shown by various research.

    Citation?

    condemns [homeopathy] as unsubstantiated, unhealthy, useless quackery – which is pretty accurate.

    Citation??

  34. Spooky

    Subocaji, I was about to say the same thing!

    I think it’s the hair and the vest … and the out-and-out enthusiasm! :)

  35. Ginger Yellow

    I love the fact he got his wonderful aphorism about the Mail into that segment. I do wish, however, he’d included Barnett’s horrendous comment that “Most children aren’t that 1 in 15″ who die from measles.

  36. Baz

    Before I mention this, can I just say … wow, whale.to is nuts! Hadn’t seen that before.

    Ben did win an award sponsored by GSK; in the 2003 ABSW awards 2003. Sygenta were the sponsor in 2005, when he also won.

    http://www.absw.org.uk/Awards/abswwinners2003.htm

    For this article:
    http://www.guardian.co.uk/education/2003/dec/11/science.highereducation

    Yes, Ben Goldacre has won multiple awards. And well deserved they are too. The suggestion that this one (of many) smll awards that he has won means that he is in the pocket of this one (of many) title sponsors, 6 years later, is frankly ludicrous.

    -Baz

    Competing interests: third prize solo trumpet, 1981. £10 from the local coumcil, got my soul cheap.

  37. Kew View

    I was intrigued by the assertion that “…Goldacre was the recipient…of an award of thousands of pounds for excellence in “scientific” journalism for anartic(s) le he wrote in defending MMR vaccines against critics. That award was, upon a little research, sponsored, I believe, by (surprise!!!!) SmithGlaxoKline one of whose subsidiaries manufactures (surprise!!!!) MMR vaccines.”

    Since no references were provided, I did a little research myself.

    1. Goldacre received an award from HealthWatch. They give them “ to someone who has made significant steps either in medical research or in improving the public’s understanding of health issues by clarifying complicated and often misunderstood medical matters for the general public.” http://www.healthwatch-uk.org/ It is a registered charity and says it’s independent of drugs companies.

    2. He also received the first annual prize for ‘Statistical excellence in journalism’ from the Royal Statistical Society “for the best journalistic coverage of a statistical issue.” http://www.rss.org.uk/main.asp?page=2721 This doesn’t seem to be a subsidiary of GlaxoSmithKline.

    3. There was also an award from the Medical Journalists’ Association in 2006 as the best freelance.
    http://www.mja-uk.org/admin/upload/pdf/MJA News Oct-Nov2006.pdf
    Norwich Union Healthcare are co-sponsors of the award—they’re a private medical insurance company.

    4. But aha! Goldacre twice received awards from the British Science Writers Association. (Or should that be the British “Science” Writers Association?) One of the sponsors of these awards was indeed GlaxSmithKline. The others are the Medical Research Council (distributes Government research funds), the Royal Society (Britains’s national science academy), the Wellcome Trust (medical research charity). http://www.absw.org.uk/Awards/abswwinners2003.htm

    The awards are worth £2000. OK, 2000 is, strictly speaking, “thousands of pounds” and yet …..

    BTW I hope LOTS OF CAPITALS don’t catch on as a substitute for thoughtful, well-researched argument. Because they make my eyes ache.

  38. Joe

    Funny time to post an article like this just after Baxter pharma put live bird flu virus in its flu shots. The concept of vaccination may be sound, but the producers and purveyors of it just simply cannot be trusted to be competent at best. It is interesting that they were testing a bird flu vaccine also which no doubt would have been highly called-for given a mutated bird flu pandemic.

  39. Prolix: Citation?

    Here’s the official opinion from NCCAM (National Center for Complimentary and Alternative Medicine, a US government organization set up to study these things):

    “In sum, systematic reviews have not found homeopathy to be a definitively proven treatment for any medical condition. [...] Each author or group of authors criticized the quality of evidence in the studies [in their systematic reviews]. Examples of problems they noted include weaknesses in design and/or reporting, choice of measuring techniques, small numbers of participants, and difficulties in replicating results. A common theme in the reviews of homeopathy trials is that because of these problems and others, it is difficult or impossible to draw firm conclusions about whether homeopathy is effective for any single clinical condition.”

    http://nccam.nih.gov/health/homeopathy/#q8

    Their full answer is worth reading. While they don’t explicitly say homeopathy is bunk (the organization was started by a pro-CAM member of the US government), their wording makes you wonder; if homeopathy is effective, how come no-one’s been able to conclusively show that?

  40. Knurl

    @Prolix

    A more meaningful citation would be a valid peer reviewed study indicating that homeopathy works. I have not been successful in finding any, and you are very welcome indeed to provide such. The readers and commenters on this blog have been waiting for such an event to occur.

    Perhaps I’m mistaken, but I think that we all agree that great strides have been made in medicine and that science is on the right track. Everyone would be extremely pleased if any of the various CAM methods were shown to be effective, but so far none have.

  41. JayS

    Ok first off, homeopathy and chripractic medicine DO work, anyone who says they dont is dumb, like the author of this post. Also, have any of you heard of the Flu vaccines they found in Canada recently? One of our Biomed analysis facilities found AVIAN flu wihtin a number of flu vaccines ready to go to the market. This avian flu came from an American biomed facility. Also, I personally know person who dies from aids from infected blood. Guess what people, telling others o0f the dangers of vaccines, blood transfusion and the medical community is not fear mongering, its being straight up wuth people and the very REAL dangers there is out there right now

  42. Torbjörn Larsson, OM

    I’m not sure Goldacre is in hot water as much as forcing LBC to do same coverup.

    Luckily the coverup is so far a major fail.

    whale.to is nuts!

    Yeah. I learned that “every medical procedure that isn’t homeopathy”, whether useful or not, is called allopathy by these quacks, in the very first sentence. (And stopped reading there.)

    Funny time to post an article like this just after Baxter pharma put live bird flu virus in its flu shots.

    I’m sure Goldacre thought of conspiracy nuts when he decided to respond timely to Barnett’s dangerous shenanigans.

    Besides, there are plenty of attenuated vaccines that have been using live virus for best effect, for example the very progenitor Jenner’s smallpox vaccine using cow pox virus.

    “Vaccines containing live, attenuated virus microorganisms – these are live micro-organisms that have been cultivated under conditions that disable their virulent properties or which use closely-related but less dangerous organisms to produce a broad immune response. They typically provoke more durable immunological responses and are the preferred type for healthy adults. Examples include yellow fever, measles, rubella, and mumps. The live tuberculosis vaccine is not the contagious strain, but a related strain called “BCG”; it is used in the United States very infrequently.” [Wikipedia.]

    Trust conspiracy nuts to complain when pharmacy companies produces products that are considered among best-of-breed.

  43. Autumn

    Frankly, I view every instance of the media allowing “equal time” to anti-vaxers exactly the same as if a major television station featured a commenter who advised parents to allow their children to drink bleach. They should be prosecuted in the same manner as those whose speech causes a “clear and present danger”, such as the “fire” in a crowded theatre example.

  44. Eric TF Bat

    Phil, be careful about throwing chiropractic in there with the woo-woo rubbish. Granted there are chiropractors who are gibbering frootloops with the same grasp of basic science as a dyslexic turnip, but the majority of the ones I’ve seen are effective physical therapists with a strong grasp on reality. It’s a shame that the organisations that oversee the profession will give equal support to the clued-up, switched-on healers and to the homeopathic, new-age loony subluxation freaks who give the whole thing a bad name. But that’s the organisations’ fault, not the process of chiropractic; it’s something that needs to be addressed by acknowledging where the flaw lies, not by tarring the lot with the same brush. Might as well blame all Christians for Fred Phelps, for example — which might be PZ’s preference, but you seem slightly more relaxed.

  45. Mark Hansen

    @Knurl,
    The peer reviewed study of homeopathy will probably appear at the same time as [i]Sus Volans[/i] is discovered.

  46. Autumn

    Eric TF Bat,
    You seem to be saying that chiropractic shouldn’t be disparaged because you know a bunch of chiropracters who don’t follow chiropractic. Subluxations are one of the basic foundations of the practice. If you know chiropractors who follow the same treatments as physical therapists, then you know a bunch of people who should be physical therapists, instead of lending their abilities to the ludicrous idiocies that a belief in chiropractic medicine requires.
    I know a bunch of geocentrics who don’t really think that the Sun goes around the Earth, so should we all stop criticizing geocentrism?

    Chiropractic is just stupid. Read anything about it. The fact that its inherant stupidity has caused its practitioners to retreat into the umbrella of other disciplines is one big clue to its uselessness.

    Yes, a massage feels good, and may make me forget about years of bodily neglect.
    It does not fix any imaginary “subluxions” in my spine.

  47. MadScientist

    The problem is not so much free speech but that imbeciles like Jeni Barnett are parading their ignorant hallucinations as facts and people who say she’s a moron and spouting nonsense get into trouble. Anyone is free to state their opinion, but they should say it’s their opinion. The radio and news shows should tell their audience that Barnett is not qualified to pick up dog poo much less talk about vaccines.

  48. Ted Fogarty, MD

    There really has never been any great science on the long term safety of an entire vaccine schedule in the US and UK. Even a simple protocol A versus protocol B study carried out prospectively for five years would be helpful in really assessing the long term risks of playing with the most complex biological system in the body. The lack of transparency in the UK and US medical establishments and governance towards vaccine reactions should be concerning to all of a scientific nature. Really anyone in this debate should read the Simpsonwood conference transcripts. It clearly shows that there is a signal between increased rates of vaccines and increased rates of neurobehavioral problems, but the entire discussion and all data presented were kept secret and furthermore in violation of US law.

    For the true scientist no hypothesis should be excluded from investigation. In this area the work has not being done with enough exacting rigorous exploration to completely right off a weak to medium association. If you look at the genetics of poor heavy metal excretion in humans via corrupted sulfation and methylation pathways you can see how metals dosed into the human population via medicine could get a bad name.

    Further just look at some of the basic science on some issues with vaccines. Vaccines are used all the time in the basic scientific study of experimental autoimmune encephalomyelitis. So a vaccine is mixed up with a little nerve tissue and injected into a rate and boom autoimmune brain disease sets in. With the literally millions of jabs given every day it seems possible that a few could lay down an nice bit of adjuvant close enough to nerve tissue to encite a little encphalitis reaction-those parents who say their child had a rapid neurological decline after a vaccine may have a point here. The most intriquing thing to me is why none of these kids get an MRI of their brain after parents report these thing s to their pediatiricans, institutionalized denial and conflicts of interest in the mix?

  49. Eric TF Bat

    @Autumn: the first step from superstition to science is finding a hypothesis that matches the facts. While the purported explanation of how subluxations work doesn’t do that, it works as a metaphor, so clearly there’s something that’s being accurately modelled. Granted it would be nice if chiropractors would realise that the words they use are tainted and pick new ones (“twinges” would be good, or “nasty bits”, instead of subluxations) but you don’t get it both ways: woo-woo is unfalsifiable faith-based gibberish in science’s clothing; chiropractic is a functioning, self-consistent method of solving a constrained set of problems that only suffers from its practitioners taking their uneducated guesses too seriously. The reality remains that, regardless of the philosophical meanderings, it works, much more often than not.

  50. Nigel Depledge

    Didac said:

    All evidence points that MMR vaccination entrails far less risk that “abstinence” from MMR vaccination. However, there are serious ethical issues in the use of drugs (including vaccines) against the will of pacients. So we must weigh here personal freedom (tainted by disinformation) and public health (the fact of herd immunity). Moreover we have the question of children: who can decide for them? Parents? Health authorities?

    Vaccination, though, is a special case.

    Should we have the freedom to endanger the rest of our community by not getting vaccinated? Because that is what we are doing if we allow the vaccination rate to fall below the “herd immunity” threshold.

  51. Nigel Depledge

    James Pannozzi said:

    This blog critically examines and dissects another of Goldacre’s “journalistic” contributions, this time his opinion on Homeopathy.
    http://laughingmysocksoff.wordpress.com/2007/12/11/smelly-socks/

    This is rubbish.

    You quote an anonymous blog that is full of conspiracy-theorising and speculation, and you call that “critical examination”?

    A true critical examination of Goldacre’s claims would focus on two things:
    (a) what exactly Goldacre is claiming, and (b) how this compares to demonstrated facts. If you do this, you will find that he is right.

    So put away your conspiracy theorising, put away your speculation about GSK having subverted Goldacre’s objectivity (BTW, his opinion was exactly the same before he receivced that award as it was afterwards, so your concept of a conspiracy is at best built on sand, and at worst pure mud-slinging), and focus on the facts.

  52. Nigel Depledge

    Prolix said:

    the fact that … homeopathy sucks as medicine is the current fact, as shown by various research.

    Citation?

    condemns [homeopathy] as unsubstantiated, unhealthy, useless quackery – which is pretty accurate.

    Citation??

    Just go to PubMed and enter “homeopathy” as a search term. There’ll be plenty of papers showing that it performs no better than a placebo.

    Curiously, Goldacre’s book does mention that homeopathy works, precisely because it elicits the placebo effect.

  53. Nigel Depledge

    Eric TF Bat said:

    Phil, be careful about throwing chiropractic in there with the woo-woo rubbish. Granted there are chiropractors who are gibbering frootloops with the same grasp of basic science as a dyslexic turnip, but the majority of the ones I’ve seen are effective physical therapists with a strong grasp on reality. It’s a shame that the organisations that oversee the profession will give equal support to the clued-up, switched-on healers and to the homeopathic, new-age loony subluxation freaks who give the whole thing a bad name. But that’s the organisations’ fault, not the process of chiropractic; it’s something that needs to be addressed by acknowledging where the flaw lies, not by tarring the lot with the same brush. Might as well blame all Christians for Fred Phelps, for example — which might be PZ’s preference, but you seem slightly more relaxed.

    What a lovely turn of phrase you have.

  54. Nigel Depledge

    Mad Scientist said:

    The problem is not so much free speech but that imbeciles like Jeni Barnett are parading their ignorant hallucinations as facts and people who say she’s a moron and spouting nonsense get into trouble. Anyone is free to state their opinion, but they should say it’s their opinion. The radio and news shows should tell their audience that Barnett is not qualified to pick up dog poo much less talk about vaccines.

    I must disagree with you, sir. Barnett is, in fact, qualified to pick up dog poo.

  55. Nigel Depledge

    @ Ted Fogarty, MD – Do you really have an MD? Because I would expect an MD to know the difference between “right” and “write”, and you do not.

    What you seem to be claiming is that some vaccines carry a risk to a small proportion of the population.

    I do not think anyone disputes this – nothing is 100% safe.

    What you fail to do is to put that risk into the context of the risks associated with failure to vaccinate enough people to achieve herd immunity. The community as a whole is at a far larger risk from measles, mumps and rubella than from the vaccines that prevent these diseases.

  56. Muzz

    Man, if Goldacre is a shill-for-hire for Big Pharma he mustn’t be very good. He’s far too cheap.

  57. James Pannozzi

    @Nigel Depledge:

    Excuse me, I found the comments of Dr. Ted Fogarty of interest and he said quite a bit more than merely that vaccines carry some risk.

    Ted Fogarty also said the following which I believe is of interest to all of us:

    “There really has never been any great science on the long term safety of an entire vaccine schedule in the US and UK. Even a simple protocol A versus protocol B study carried out prospectively for five years would be helpful in really assessing the long term risks of playing with the most complex biological system in the body. The lack of transparency in the UK and US medical establishments and governance towards vaccine reactions should be concerning to all of a scientific nature.”

    Many of the commentators here have been extolling the opinions of Dr. Goldaacre. Fine. Well here is another opinion and when I say we need to look at both sides of an issue, this is an excellent example.

    Ted Fogarty MD goes on to say that:

    ” Really anyone in this debate should read the Simpsonwood conference transcripts. It clearly shows that there is a signal between increased rates of vaccines and increased rates of neurobehavioral problems, but the entire discussion and all data presented were kept secret and furthermore in violation of US law.”

    Ted Fogarty continues with another comment which, in my opinion, is of interest to all of us, particularly parents, and quite relevant to this discussion:

    “With the literally millions of jabs given every day it seems possible that a few could lay down an nice bit of adjuvant close enough to nerve tissue to encite a little encphalitis reaction-those parents who say their child had a rapid neurological decline after a vaccine may have a point here.

    The most intriquing thing to me is why none of these kids get an MRI of their brain after parents report these thing s to their pediatiricans, institutionalized denial and conflicts of interest in the mix?”

  58. Mike

    Interesting question to the scientists here:

    What other living system on the planet needs “medicine” or “vaccines” to be healthy besides humans?

    anyone?

    anyone?

    maybe the “medicine/allopathic” model is right, but every other living cell on the planet just didn’t get the memo.

  59. Ted Fogarty, MD

    ANOTHER:
    Nigel,

    I really do have an MD and we really are human beings that make mistakes. In fact if you ever spent a day rounding in a hospital you would see how often we MDs make grammatical, spelling and syntax errors ;-) . Oh, I also believe I typed rate when I meant rat.

    So yes, I am saying that vaccines carry a risk to a small proportion of people. With any universal mandate in medicine we continue to fail to seek out and define the at risk individuals. When we do, lawyers have a heyday-so we institutionally deny any such situation when we can to protect large public health initiatives.

    Further on a simple clinical basis, vaccination is a very sloppy scientific situation. Physicians should not be as interested in herd immunity as they should be in individual immunity. Therefore we ought to be checking individual titer levels in people for EVIDENCE of immunity. I have 3 kids that all went through the Hep B series as per the CDC schedule and all three have ZERO for titers. The concept of herd immunity is built on this sloppy science, costs and inconvenience make titer checking everyone a difficult situation right now, but reallly if we were being scientific all kids should have titer documented evidence of immunity for school entrance etc. 95% kids are immune for life after 1 dose of MMR so who is benefiting from giving two doses-the vaccine company get a free ride foe 95% of the second dose and then the kids who failed seroconversion on the first try get another chance. Finger stick titer check technology has been available for 5 years for HIV testing, it cost $15 per test and is point of care, a simple porting of this technology into pediatrics would cost pharmaceutical companies billions and prevent unneeded over vaccination in those who are clearly immunocompetent after the initial vaccinations. Personally, I lost my vaccine records and my proof for medical school was my titer labs.

    The Hep B vaccine schedule is the evidence of a lack of reality in CDC policy making. All pregnant women should be getting checked for Hep B infection. If they are not infected then their one day old child should not be getting a vaccine that hasn’t ever been studied for safety on this very special day of life. The blood brain barrier permeability index is quite high on day one of life and the Hep B vaccine maybe triggering problems much further down the line after revaccination that no one is looking into in medicine. Even if the day one of life Hep B vaccine is creating problems on a 1 in 10,000 rate it still a problem when its done so cavalierly in a completely unneeded scenario..

    When we talk about evidence based medicine this issues completely defies the process. I find it odd that no one on this blog seems to look at such things, our public health initiatives really need to be scrutinized for stupidity every now and then, and this clearly is the obvious wasteful and dangerous point that is more likely to be the ultimate risk elevator for a vaccine-autism link than any other thing in the vaccine schedules.

    When we look at the risks of radiation to an individual across the lifespan, day one of life has exponentially higher risk of cancer induction by a radiation event versus declining risk in the remainder of the lifespan. This is essentially an exponential decay in risk, I would surmise that there may be a similar curve for many exposure risks….but we have defined these things in radiation safety because of Hiroshima and Nakasaki where as the ethics of purposefully overvaccinating kids to see how their autoimmune disease rates and autism rates increase would be quite difficult to naviagate. Somehow the CDC navigated the ethics of dropping a vaccine on day one of life without ANY IRB approved study of the idea.

  60. The UK Government, as a response to worries about alternative treatment, set up the Complementary and Natural Healthcare Council, whose job is to regulate practitioners. However, it has turned into a rubber-stamp body run by the practitioners themselves, and has rightly become known as OfQuack.

    Chief among its problems is the complete lack of requirement to show efficacy, or even safety, before receiving a government certification. UK citizens can sign a petition at http://petitions.number10.gov.uk/CNHCsafety to demand that the rules be changed, so that this most basic measure be required.

    You can also follow “ofquack” on twitter for an irreverent take on the whole thing.

  61. Grump

    @Mike on March 15th, 2009 at 7:28 am

    Don’t ever let me catch you using aspirin (or paracetamol or ibuprofin) or any antibiotic. If you ever need surgery for anything, remember to insist on no painkillers or antibiotics. Or maybe surgery isn’t for you in the first place: Animals never use it!

    In fact, get the hell off my internet! And only come back when you can show me an animal using it.

    No: I take all that back. What I meant to say is: “Get back under your bridge!” because no actual human being can possibly be that stupid and still be able to remember to breathe let alone use a keyboard.

    Or, alternatively, use smileys, you dolt!

  62. James Pannozzi

    I have located a link to the Simpsonwood Conference proceedings and am reading them now.

    http://www.autismhelpforyou.com/HG%20IN%20VACCINES%20-%20Simpsonwood%20-%20Internet%20File.pdf

    My goodness! Quite a revelation indeed.

    I suspect we won’t be reading about this in any of Goldacre’s posts….ever.

    My thanks to Dr. Ted Fogarty for posting about Simpsonwood.

  63. Nigel Depledge

    Ted Fogarty MD said:

    The lack of transparency in the UK and US medical establishments and governance towards vaccine reactions should be concerning to all of a scientific nature. Really anyone in this debate should read the Simpsonwood conference transcripts.

    This is a part of the portion of this comment that has subsequently been highlighted by James Pannozzi.

    I find it shows a remarkable logical inconsistency. Either there is insufficient transparency, or those conference proceedings are available for all to read. Which is correct? because the two concepts are mutually exclusive.

    I think a more significant issue here is one that Goldacre has highlighted – that the mass media (newspapers, TV and so on) report scares with big headlines, but they don’t report the actual science. The average member of the public hears only one side of the issue, and is unlikely ever to hear about the actual scientific studies that have been performed to determine the truth or otherwise of the claim.

  64. Nigel Depledge

    James pannozzi said:

    @Nigel Depledge:

    Excuse me, I found the comments of Dr. Ted Fogarty of interest and he said quite a bit more than merely that vaccines carry some risk.

    Ted Fogarty also said the following which I believe is of interest to all of us:

    “There really has never been any great science on the long term safety of an entire vaccine schedule in the US and UK. Even a simple protocol A versus protocol B study carried out prospectively for five years would be helpful in really assessing the long term risks of playing with the most complex biological system in the body. The lack of transparency in the UK and US medical establishments and governance towards vaccine reactions should be concerning to all of a scientific nature.”

    Many of the commentators here have been extolling the opinions of Dr. Goldaacre. Fine. Well here is another opinion and when I say we need to look at both sides of an issue, this is an excellent example.

    Ted Fogarty MD goes on to say that:

    ” Really anyone in this debate should read the Simpsonwood conference transcripts. It clearly shows that there is a signal between increased rates of vaccines and increased rates of neurobehavioral problems, but the entire discussion and all data presented were kept secret and furthermore in violation of US law.”

    Ted Fogarty continues with another comment which, in my opinion, is of interest to all of us, particularly parents, and quite relevant to this discussion:

    “With the literally millions of jabs given every day it seems possible that a few could lay down an nice bit of adjuvant close enough to nerve tissue to encite a little encphalitis reaction-those parents who say their child had a rapid neurological decline after a vaccine may have a point here.

    The most intriquing thing to me is why none of these kids get an MRI of their brain after parents report these thing s to their pediatiricans, institutionalized denial and conflicts of interest in the mix?”

    So, James, did you have anything to add, or were you simply trying to point out that Ted Fogarty (incidentally, if you want to call him “Dr. Ted Fogarty”, then you’ll have to start calling me “Dr. Nigel Depledge”, as I have PhD in biochemistry) agrees with you.

    It seems to me that all that Ted Fogarty was saying was that vaccines carry some risk. If you would care to re-read my response to him, you will notice that you have failed to address the same point that he failed to address – how much smaller is that risk than the risk of people suffering permanent harm from having not been vaccinated?

    If you really want, I can propose arguments against his proposed mechanism whereby vaccine adjuvants may stimulate anti-idiotype reactions.

  65. Sir Eccles

    Mike asks:

    “What other living system on the planet needs “medicine” or “vaccines” to be healthy besides humans?”

    I recall seeing a documentary once following a group of primates in the jungle (I’m afraid my memory is too fuzzy to remember if they were chimps or gorillas or whatevers). Anyway, they were shown selecting leaves from a very particular tree and these leaves had a fuzzy underside. They took the leaf, carefully rolled it so it had the fuzzy side out and swallowed it whole. The apparent effect being to scrape parasites from their insides. Or what about the recent reports of monkeys in Thailand demonstrating flossing.

    Either way, without modern medicine average life expectancy would probably be of the order of 40 years or so.

  66. “What other living system on the planet needs “medicine” or “vaccines” to be healthy besides humans?”

    What other living “system” on the planet engages in trade? Or invents airplanes? Or treats lymphoma? Or travels into space?

    Human beings and all our inventions and medicines are every bit a part of the natural world as any other organism.

  67. Ted Fogarty, MD

    Simpsonwood transcripts required a 2005 FOIA filing for release. US MDs should have been sent a copy of these or alerted as to their access online at the CDC website (I believe they have even been pulled off the CDC website). Further no one in that meeting was an MD or PhD scientist that didn’t have some sort of vested professional interest in the conclusion of the discussion. A few surgeons, pathologists and radiologists might have added a more dispassionate assessment of the data.

  68. James Pannozzi

    Dr. Nigel Depledge, do you REALLY have a PhD because if so then I would expect you to have read the items I quoted from Dr. Fogarty’s comments and to understand why they were given emphasis.

    You stated:
    “It seems to me that all that Ted Fogarty was saying was that vaccines carry some risk. ”

    It seems to me that he said a whole lot more and no, I have no desire to re-read any of your opinions.
    I’d suggest that you re-read some of his.

    Try reviewing his comments on the issues of long term safety of an entire vaccine schedule in the US and UK. His comments also stated a relation between increased rates of vaccinations and increased rates of neuobehavioral problems clearly shown in a discussion in something called the Simpsonwood conference, which discussion apparently was initially suppressed or attempted to be kept secret.

    Dr. Fogarty then made other comments which did indeed involve items involving, as you say, risk.

    In summary, there are political, medical policy and vaccine testing issues clearly indicated in his comments that go way beyond risk to individuals from vaccines.

    These issues which you have somehow missed, or else intentionally ignore, connect with my earlier comments regarding the necessity of Goldacre and the Guardian disclosing when he gets industry backed awards and then writes columns involving issues favorable to that industry.

    No additional clarifications are needed nor will they be given.

  69. Nigel Depledge

    Ted Fogarty MD said:

    I really do have an MD and we really are human beings that make mistakes. In fact if you ever spent a day rounding in a hospital you would see how often we MDs make grammatical, spelling and syntax errors ;-) . Oh, I also believe I typed rate when I meant rat.

    Yeah, I was gonna let you off that one.

    Regarding right / write: I apologise for extrapolating a simple error into something more sinister.

    So yes, I am saying that vaccines carry a risk to a small proportion of people.

    But how large is this risk in comparison to the risk posed by the many viruses against which vaccination largely protects us?

    With any universal mandate in medicine we continue to fail to seek out and define the at risk individuals. When we do, lawyers have a heyday-so we institutionally deny any such situation when we can to protect large public health initiatives.

    Well, I agree with this, but I cannot see a viable alternative without prohibitively large increases in healthcare costs. What do you propose should be done?

    Further on a simple clinical basis, vaccination is a very sloppy scientific situation.

    Erm … IIUC, it has a sound basis in good science. What about vaccination is “sloppy”, exactly?

    After all, have we not very nearly wiped out smallpox by mass vaccination?

    And nearly wiped out polio in most of western Europe and North America?

    Physicians should not be as interested in herd immunity as they should be in individual immunity.

    Why?

    Surely, individual immunity is far less important if you live in a community with immunity levels above the threshold for herd immunity?

    Therefore we ought to be checking individual titer levels in people for EVIDENCE of immunity. I have 3 kids that all went through the Hep B series as per the CDC schedule and all three have ZERO for titers. The concept of herd immunity is built on this sloppy science, costs and inconvenience make titer checking everyone a difficult situation right now, but reallly if we were being scientific all kids should have titer documented evidence of immunity for school entrance etc.

    Well, first off, the herd immunity concept is based on good epidemiology, unless the epidemiologists have been lying to us for all this time…

    Second, it is far easier to deliver a second vaccine to hundreds of schoolchildren, even if only (say) 95% of them will develop immunity, than it is to actually measure the antibody titre in each individual child. What are you suggesting – blood sampling from each child a few weeks after inoculation and multiple arrays of robotic ELISAs to check their immunity against all relevant pathogens?

    95% kids are immune for life after 1 dose of MMR so who is benefiting from giving two doses-the vaccine company get a free ride foe 95% of the second dose and then the kids who failed seroconversion on the first try get another chance. Finger stick titer check technology has been available for 5 years for HIV testing, it cost $15 per test and is point of care,

    OK, so fingerstick testing is available for HIV. What if that particualr technology does not work for some of the more complex viruses, like influenza? And is not $15 per test significantly more than a second dose of MMR (I ask for information as I have no idea how much each dose of MMR costs)?

    You must be in the pockets of the diagnostics companies!!!! It’s a conspiracy!!!!

    Oh, wait. Aren’t those diagnostics companies mostly owned by big pharma anyway…?

    a simple porting of this technology into pediatrics would cost pharmaceutical companies billions

    Billions? Really?

    Is MMR, like, $1500 per dose or something???!!

    and prevent unneeded over vaccination in those who are clearly immunocompetent after the initial vaccinations. Personally, I lost my vaccine records and my proof for medical school was my titer labs.

    But isn’t this over-vaccination simply an application of the precautionary principle?

    The Hep B vaccine schedule is the evidence of a lack of reality in CDC policy making. All pregnant women should be getting checked for Hep B infection.

    Interesting example.

    Now, bear with me, as my virology is a little bit shaky these days and I may misremember a few bits of this picture.

    IIRC, Hep B is one of the viruses that can integrate into the genome and go dormant. And when this happens, don’t the cirulating levels of IgG fall right off, so the only indicator in serum is IgM, which is present at very low levels? How easy is it to detect this? How easy is it to get false negatives?

    If they are not infected then their one day old child should not be getting a vaccine that hasn’t ever been studied for safety on this very special day of life.

    Well, you’re right that no-one has ever done a clinical trial with one-day old infants.

    Again, it all comes down to a risk-benefit analysis.

    The blood brain barrier permeability index is quite high on day one of life and the Hep B vaccine maybe triggering problems much further down the line after revaccination that no one is looking into in medicine. Even if the day one of life Hep B vaccine is creating problems on a 1 in 10,000 rate it still a problem when its done so cavalierly in a completely unneeded scenario.

    OK, accepting for the sake of argument a rate of 1 in 10,000 infants with an adverse reaction to HepB vaccination (which I don’t necessarily, but that’s by the bye), this would mean that your test for HepB in mothers-to-be must return less than 1 false negative in 10,000 tests to be any better (and this assumes, of course, that the consequences of a reaction to the vaccine are equivalent to the consequences of having HepB). Now, I have no idea what the prevalence of HepB is, but it would need to be significantly higher than 1 in 10,000 to even be able to test your diagnostic tool to the required statistical significance.

    When we talk about evidence based medicine this issues completely defies the process. I find it odd that no one on this blog seems to look at such things, our public health initiatives really need to be scrutinized for stupidity every now and then, and this clearly is the obvious wasteful and dangerous point that is more likely to be the ultimate risk elevator for a vaccine-autism link than any other thing in the vaccine schedules.

    While I agree with your general point that we should scrutinise public health policy for idiotic initiatives, I also accept that science has examined MMR for a link to autism, and found none.

    Now, this means one of two things:

    (1) either there is absolutely no link between MMR and autism, or

    (2) any link is so minor in comparison to other causes of autism that none of the studies yet conducted has the statistical power to detect it. Again, it comes back to a risk-benefit analysis. Is it worth pursuing the potential link, given the enormous cost that a study involving millions of children would entail, and compared against the known, and orders-of-magnitude-larger risk posed my measles, mumps and rubella? Surely this money would be better spent elucidating the real causes of autism?

    When we look at the risks of radiation to an individual across the lifespan, day one of life has exponentially higher risk of cancer induction by a radiation event versus declining risk in the remainder of the lifespan.

    I’m not sure I see the relevance of this.

    This is essentially an exponential decay in risk, I would surmise that there may be a similar curve for many exposure risks….

    On what basis?

    This has the ring of “bloke-down-the-pub” reasoning about it.

    but we have defined these things in radiation safety because of Hiroshima and Nakasaki where as the ethics of purposefully overvaccinating kids to see how their autoimmune disease rates and autism rates increase would be quite difficult to naviagate. Somehow the CDC navigated the ethics of dropping a vaccine on day one of life without ANY IRB approved study of the idea.

    Well, perhaps the CDC reasoned that it was better than having HepB, y’know?

    BTW, in this last paragraph, you are assuming a link between vaccination and autism, but no such link has ever been detected (Andrew Wakefield just made his “results” up, or had you missed that bit of news?).

    So, ultimately, you seem to be saying that we should scrutinise public health initiatives and ensure that they are founded on good science. I agree with this. OTOH, you seem to be clinging to a link between MMR and autism, which makes you come across as a bit of a crank. Also, you seem to have a bee in your bonnet about day-one vaccination against HepB, but you have failed to produce any evidence that it is harmful. All you have is reasoning by analogy, which is very dangerous ground to tread.

    Going back to your earlier point about long-term studies not having been done…

    The parents of the sutistic kids were reporting differences in their children within a few dyas or weeks of MMR vaccination. If a long-term study is needed to detect a putative link, then why were these parents even listened to in the first place? If a short(-ish) term study is enough to resolve that there is no link within, say, a year (or whatever), then whence comes the requirement for a long-term study?

  70. Nigel Depledge

    James Pannozzi said:

    Dr. Nigel Depledge, do you REALLY have a PhD because if so then I would expect you to have read the items I quoted from Dr. Fogarty’s comments and to understand why they were given emphasis.

    Yes, I do. Studies of two oxygen-requiring metalloenzymes involved in steroid biosynthesis, University of Southampton, 1997.

    Your emphasis added nothing that was not in Ted Fogarty’s original comment.

    Since you have not addressed my question, I’ll ask it again: Did you have a point?

    You stated:
    “It seems to me that all that Ted Fogarty was saying was that vaccines carry some risk. ”

    It seems to me that he said a whole lot more

    Well, he used a lot of words, but ultimately his take-home message that came across was that vaccines carry some risk.

    His proposed mechanism sounds pretty dodgy to me as a biochemist, but that’s just picking at the detail.

    and no, I have no desire to re-read any of your opinions.
    I’d suggest that you re-read some of his.

    Eh?

    What kind of an argument is that? If you want to play with the grown-ups, I suggest you actually bother to read what people type and address it.

    Try reviewing his comments on the issues of long term safety of an entire vaccine schedule in the US and UK. His comments also stated a relation between increased rates of vaccinations and increased rates of neuobehavioral problems clearly shown in a discussion in something called the Simpsonwood conference, which discussion apparently was initially suppressed or attempted to be kept secret.

    Yes, it appears that some vaccines can stimulate “neurobehavioural problems” in a small number of cases. This has nothing to do with autism.

    What you and he both have failed to address is this:
    Is that risk a smaller one than the risks posed by not immunising kids against a whole range of viral infections?

    Dr. Fogarty then made other comments which did indeed involve items involving, as you say, risk.

    In summary, there are political, medical policy and vaccine testing issues clearly indicated in his comments that go way beyond risk to individuals from vaccines.

    Really? Are you sure about that? It seems to me that he was making a point about how the risk-benefit analyses are conducted. I’m all for transparency of government, but in the case of MMR vaccines this is not needed because there is so much in the medical literature about it.

    These issues which you have somehow missed, or else intentionally ignore, connect with my earlier comments regarding the necessity of Goldacre and the Guardian disclosing when he gets industry backed awards and then writes columns involving issues favorable to that industry.

    As has been clarified by other posters, if those awards put Goldacre in the pockets of Big Pharma, then he’s very cheap. Besides, the awards were sponsored by Big Pharma, but the winners were not decided by the sponsors. Additionally, you still have failed to acknowledge that Goldacre’s opinion is based firmly on the best science available.

    Are you trying to portray your online self as a reality-denier and conspiracy nut?

    No additional clarifications are needed nor will they be given.

    Now this is a typical crank line. Rather than try to engage with the arguments I am making, you instead run off and sulk.

  71. Ted Fogarty, MD

    Nigel Depledge, PhD Said:

    “But how large is this risk in comparison to the risk posed by the many viruses against which vaccination largely protects us?”
    Small on a population basis but potentially huge in epigenetically at risk children who are not being research as an at-risk populace for liability reasons to medicine and pharmaceutical companies. Ironically vaccines are the only product marketed in the US for which there is no corporate liability, seems a slippery slope to irresponsibility. This is about taking care of and protecting the weakest among us, we do it in other areas of medicine where universal mandates don’t exist, but her the policy once set cannot be changed without huge fallout and this drive scientific inquiry out or selects for conflicted individuals to perform the science.

  72. Ted Fogarty, MD

    Nigel Depledge, PhD Said:

    I said: “With any universal mandate in medicine we continue to fail to seek out and define the at risk individuals. When we do, lawyers have a heyday-so we institutionally deny any such situation when we can to protect large public health initiatives.”
    You Said: “Well, I agree with this, but I cannot see a viable alternative without prohibitively large increases in healthcare costs. What do you propose should be done?”

    Change the schedule a bit, drop Hep B until there are legitimate risk factors, start understanding maternal immunointerference as an issue for decreased efficacy in early age innoculations, rotavirus vaccine does not save lives in the western world and should be optional, there are plenty of small ways to save money here but the cultural bias against change and an admission of not doing things as well as possible prevents small moves like this from ever getting through. Generally, I agree with you not much can be done until cheap immuno-surveilence diagnostics are available, but for certain families with high rates of autoimmunity it would be fair for individual MDs to treat children of such as patients rather than cattle and modify their approach to vaccination, thats the responsibility that most physician shirk as soon as some mandate comes down the pike. Most pediatricians don’t even think to do this. History of autoimmunity is listed in vaccine contraindications so the only basis for making that disicsion wisely on clinical grounds in an infant would be family history.

  73. Ted Fogarty, MD

    Nigel Depledge, PhD Said:

    I said: “Further on a simple clinical basis, vaccination is a very sloppy scientific situation.”
    You Said: “Erm … IIUC, it has a sound basis in good science. What about vaccination is “sloppy”, exactly?”

    This is where a PhD may not understand what good medicine is. With any clinical intervention wouldn’t you want as an individual to know that it worked? With most issues, there is a symptom expressed by the patient and say that is a cough in a patient with a pneumonia the intervention has an obvious clinical endpoint as to efficacy. PREVENTIVE IMMUNOTHERAPY which is what vaccination is, has been built on a 50 year old paradigm and never looked at for improvement because we didn’t have the science as easily accessible and available to the patient as we do now (costs and conveninece still an issue). So, maybe its my bias as a physician but if someone is going to offer me a service or product, I want to know that its working in me individaully. The current paradigm is like having a to pay for insurance but being told that the documentation of your coverage will likely show up in case of accident but we won’t give it to you now.

  74. Ted Fogarty, MD

    Nigel Depledge, PhD Said:

    You Said: “After all, have we not very nearly wiped out smallpox by mass vaccination?
    And nearly wiped out polio in most of western Europe and North America?
    Physicians should not be as interested in herd immunity as they should be in individual immunity.
    Why?
    Surely, individual immunity is far less important if you live in a community with immunity levels above the threshold for herd immunity?”

    Clearly mass vaccination has its benefits for society, I have never discounted this I am only saying that the fallout hits individuals and they are maimed without much compensation. Plenty of deaths from vaccination have occured over the years, yes orders less than the wild type epidemics but still we need to be honest here; they do occur and the very mention of the word death and vaccination in the same sentence provokes some very non-scientific zealotry from public health officials.
    The difference between being a public health officer and being a real physician who take responsibility for the care of an individual not a herd is very much reflected in the context of your statements above. Individual immunity is far more important for the scientifically discerning because we humans are not genetically narrow populations like lab rats. Individual immunity is critically important for those that might be in high risk areas with exposure to blood-born pathogen; I would hope every proceduralist in medicine would actually check their Hep B titier instead of naively trusting that they are immune because they “should be” after 3 shots (it was a 3 shot series when I was in college, now its 4, wonder why?). The whole concept of herd immunity is on the basis of the sloppy infectious nidus leftovers in the population that aren’t immune despite having been vaccinated or never got vaccinated. I am not saying its not an important concept in general but its exonerating the sloppiness that we have been trained to believe is the only way to do this for decades. It also means some people are getting vastly overvaccinated and some are even still undervaccinated. This whole blog is about science right?

  75. Ted Fogarty, MD

    Nigel Depledge, PhD Said:

    You Said: “Well, first off, the herd immunity concept is based on good epidemiology, unless the epidemiologists have been lying to us for all this time…”
    They have been worng in the past, look at the conflicts in epidemiology authorship before you read the paper. But specifically, I agree herd immunity is a good concept that allows us to be a bit more sloppy in the realm of clinical science, some day it will be so cheap to check titers this whole debate will be looked at as a quaint anachronism.

  76. Ted Fogarty, MD

    Nigel Depledge, PhD Said:

    You Said: “Second, it is far easier to deliver a second vaccine to hundreds of schoolchildren, even if only (say) 95% of them will develop immunity, than it is to actually measure the antibody titre in each individual child. What are you suggesting – blood sampling from each child a few weeks after inoculation and multiple arrays of robotic ELISAs to check their immunity against all relevant pathogens?
    95% kids are immune for life after 1 dose of MMR so who is benefiting from giving two doses-the vaccine company get a free ride foe 95% of the second dose and then the kids who failed seroconversion on the first try get another chance. Finger stick titer check technology has been available for 5 years for HIV testing, it cost $15 per test and is point of care….
    OK, so fingerstick testing is available for HIV. What if that particualr technology does not work for some of the more complex viruses, like influenza? And is not $15 per test significantly more than a second dose of MMR (I ask for information as I have no idea how much each dose of MMR costs)?
    MMR is $25 per dose I think so yes this is very complicated years away and more of a theoretical point as to how we could make this more of an exacting science in individual immunopreventives. I think the nasla swabs for flu virus are already a point of care device for checking exposure and as the new vaccines for common flu proteins eliminate this year to year antigen shift issue that might be an easy switch to chek the efficacy of the flu shot on individual basis.
    Clearly, the resource shift is fairly lateral and not one that stakeholders want to think of when the mantra is that we can handle 10,000 vaccines (antigens yes, adjuvants-no not in a short time frame).

    You must be in the pockets of the diagnostics companies!!!! It’s a conspiracy!!!!
    Oh, wait. Aren’t those diagnostics companies mostly owned by big pharma anyway…?
    Not neccessarily and even so, I would welsome the idea of being more scientific for the individual, so if Merck makes it great, GSK great, Small-tech awesome….don’t tell me there wouldn’t be some fear mongering from the big pharmaceuticals if a small tech company came out with this idea. I am in the pocket of a diagnostic company, I am a diagnostic radiologist. Understand that every thing I do in relation to a patient has a visual record, not true of most other doctors. The problems radiology has created in medicine by cavalier use of metals-based pharmaceuticals has been repeatedly vetted out by our colleagues….seems the street runs a different way for safety issues here though.

  77. Ted Fogarty, MD

    Nigel Depledge, PhD Said:

    You Said: ” …. Billions? Really?
    Is MMR, like, $1500 per dose or something???!!”

    4 million US kids per year x 36 vaccines in first 3 years at average cost of $25 per shot.
    36 x $25 x 4 million = $3,6 billion
    Double that for the rest of the world and then posit cutting the dose by a quarter and you still have more than a billion dollars on the table.

  78. Ted Fogarty, MD

    Nigel Depledge, PhD Said:

    You Said: “But isn’t this over-vaccination simply an application of the precautionary principle?”

    Precautionary principle would state that you don’t intervene when efficacy is questionable at such a time and safety has never been proven. I use precautionary principle every day to make sure young children are not needlessly radiated for diagnostic reasons when other non-ionizing imaging modalites are available.

  79. Larrisa

    Surely the correlation in the ammount of vaccines we give our children when they are tiny babies at 8 weeks, 12 weeks and 16 weeks old has to be questioned. Who is benefitting ? the Governemnt, the Dr’s the pharma’s. If any one of us adults were told that we were going to have 19 vaccines in the sapce of 8 weeks, we would question that surely. But with babies we just hand them over, not really knowing what all the letters stand for , no list of ingredients and are told to give calpol ! At 13 months our babies have had 24 vaccines, how can thsi be safe, show me the saftey trial of all these vaccines in this short ammmount of time, there isn’t one, more vaccine sjuts get added. Our children are the ginuea pigs and they are suffering all kinds of ‘different’ disorders than we had as kids, asthma, add, adhd, autism, allergys. you cant feed your child any food until they are 6 months old, why then is egg used in a vaccine product given to a baby? why is alluminuim allowed in a vaccine it is a toxic metal. And the MMr did not contain mercury, the DTP did, they took it out in 2002, but batches were still being used up around the country. So I suggest that Jenny McCarthy and Jeni Barnett keep standing up for the health of our children and we start asking questions about the safety of vaccines. Because the job you are doing is just not helping. I am not anti vaccine, BUT I am for safe vaccines.

  80. James

    Dr Ted Forgarty, MD.

    I am assuming from hints culled from some of your posts that you are what in the UK is called a General Practitioner (GP). If I am wrong about that I apolgise.

    Assuming that I am correct however; why are you as a footsoldier doctor any more qualified to speak on this subject than anyone else? Specificly, on what grounds can you dismiss the work of armies of epidemioligists that have shown the benifits of mass vaccination?

    And what possible justification do you have for supporting the claims of the autisim epidemic movement, when all of their claims are based on reasearch that has now been discredited?

    Lastly, you have addressed several highly separate issues in you posts, but you try to tie them together into one gigantic conspiricy that is ultimatly based on a net profit of only a few billion dollars. Why?

  81. Ted Fogarty, MD

    James…no conspiracy just providing some thoughts that this can be done better and that protectionism is preventing us from ever scientifically knowing what the long term risks of increasing vaccinations are to a populace. Try reading Simpsonwood, understand that medicine has more conflicts than are palatable.

  82. Take a look at independent data that was carried out in the Netherlands. Note the absolute comparisons of vaccinated vs. not vaccinated. It was basically monitored by the parents like you…They have no reason to lie. Please observe the chart I believe on page 2 that shows Autism incidence. Who knows, maybe it’s just a typo?

    Dutch Association for Conscientious Vaccination
    Independant Vaccine Study
    Roosendaal, 1 December 2004
    http://www.vaccination.inoz.com/Vacc%20vs%20unvacc%20results%20survey.pdf
    We need totally unbiased participants such as parents of Autistic children or adults. No one on evaluation panel can be associated with vaccine mfg. or related group.All participants must be screened just as was in Dutch Association for Conscientious Vaccination study.
    Or, just visit their Home page at:
    http://www.vaccination.inoz.com/

  83. Thank you, Dr Ted, for your comments on this thread. I was beginning to despair of a real, legitimate dialogue on this issue, rather than the arrogant ‘I’m right-you’re wrong’ attitude of too many ‘scientific’ types (the priesthood of our day and age).

    Nigel: You really can’t think that it makes good sense to give newborns a vaccine that not only has MS associated with it, but also contains thimerosal – a slug of mercury at birth? That ALL babies have to have, because some needle-sharing youths won’t come in for a HepB shot when it might do them some good? This is arrogant overkill, putting all babies at risk for a ‘we-know-what’s-best’ approach to medicine And how do ‘we know’ what the total incidence of damage is from vaccines if we don’t run long-term studies? Some damage conditions aren’t going to show up immediately. Are you saying it doesn’t matter, because ‘the benefits outweigh the risks’ and so we don’t need to know these things? What kind of science is that?

    What do you say to the investigation of the Classens about the Hib shot clearly being of more risk than benefit, because it is associated with more type 1 diabetes than the danger incidence from the pathogen itself? How are we going to know these things if we don’t keep investigating FOR them? And “‘neurobehavioural problems’ have nothing to do with autism” – really? What do you think autism is? Autism is one of the class of conditions known generally as Minimal Brain Damage/Disorder (MBD) – which not so incidentally have skyrocketed ever since the beginning of the mass vaccination programmes (treating children as members of a herd, not as individuals, with varying predispositions to be damaged by such as vaccines). This is all subclinical encephalitis at work on our children. We’re talking about a huge amount of risk from vaccines – not just a tiny fraction of the total. (And including arthritis/arthralgia, and allergies/asthma/anaphylaxis, and CFS/ME, and type 1 diabetes, and Guillain-Barre Syndrome, and MS & other autoimmune conditions – the list goes on). This needs investigating in depth. Not brushed off, as some sort of bothersome gnat. More light, and less heat, please, from you modern-day priest types.

  84. Sorry for some typos in the above – and some caps, for those who think they’re a sign of woo-woos, or whatever it is you superior types think of people who don’t agree with you. My system doesn’t afford me the chance to put some words in italics.

  85. James Pannozzi

    @Stan and Dr. Ted Fogarty MD

    Gentlemen, my most profound thanks for one of the most interesting discussions I have seen in a long time. I’ve spent some hours reading only a part of the Simpsonwood Meeting transcripts, a link to which I gave earlier in the discussion, and it has proven of great interest.

  86. Charon

    http://www.sciencebasedmedicine.org/

    Read. Enjoy. Learn.

    Good general advice, but also relevant to this discussion.

  87. Grump

    I’m so glad that I haven’t spawned rugrats of my own. Much as I dislike other people’s children, I suspect that I would be outrageously over-protective of my own. And the thought of my little snot-balls being put at risk by arrogant, ignorant, and delusional conspiracy-believers who are barely more evolved than the 911-Truthers, would make me pop a blood-vessel.

    But since I don’t have a personal interest in this, I can disinterestedly say:

    Have a nice life, gentlemen!

    And even though I hate you (in a non-personal way), I nevertheless pray to a non-existent God that your own spawn somehow avoid lethal or scarring infections of preventable childhood diseases. Crude jokes about “Darwin awards” aside, it would be so wrong were your children to suffer just because their Dads think it’s more important to role-play the “lone crusader against the eevil Big Pharma” than it is to protect their own flesh-and-blood from horrible diseases.

    Maybe I should quit this dead-end (pardon the pun) IT job and start marketing baby-coffins. I’m sure it will be a booming industry, soon.

  88. José

    @Lucien Beauley
    We need totally unbiased participants such as parents of Autistic children or adults.

    Why do you think parents of Autistic children who’ve been fed lots of disinformation would be unbiased?

  89. José

    @Lucien Beauley

    Please observe the chart I believe on page 2 that shows Autism incidence. Who knows, maybe it’s just a typo?

    The surveyed parents in the PDF you’ve linked to were not even randomly selected, as it include parents already belonging to the NVKP (The anti-vaccination organization that conducted the survey.) You can’t get more biased than that. The data is useless.

  90. Nigel Depledge

    @ Ted Fogarty MD

    Whoa, there’s lots of stuff to go through there.

    Forgive me if I miss bits or take ages to respond (online time a bit limited in the week).

  91. Nigel Depledge

    Ted Fogarty MD said:

    Change the schedule a bit, drop Hep B until there are legitimate risk factors, start understanding maternal immunointerference as an issue for decreased efficacy in early age innoculations, rotavirus vaccine does not save lives in the western world and should be optional, there are plenty of small ways to save money here but the cultural bias against change and an admission of not doing things as well as possible prevents small moves like this from ever getting through. Generally, I agree with you not much can be done until cheap immuno-surveilence diagnostics are available, but for certain families with high rates of autoimmunity it would be fair for individual MDs to treat children of such as patients rather than cattle and modify their approach to vaccination, thats the responsibility that most physician shirk as soon as some mandate comes down the pike. Most pediatricians don’t even think to do this. History of autoimmunity is listed in vaccine contraindications so the only basis for making that disicsion wisely on clinical grounds in an infant would be family history.

    OK, that makes sense. BTW, I’m not sure about the exact schedules, but I think the day-one HepB inoculation may be a US-specific thing. I am not aware of any inoculations that are applied on day one in Europe.

  92. Nigel Depledge

    Ted Fogarty MD said:

    This is where a PhD may not understand what good medicine is. With any clinical intervention wouldn’t you want as an individual to know that it worked? With most issues, there is a symptom expressed by the patient and say that is a cough in a patient with a pneumonia the intervention has an obvious clinical endpoint as to efficacy. PREVENTIVE IMMUNOTHERAPY which is what vaccination is, has been built on a 50 year old paradigm and never looked at for improvement because we didn’t have the science as easily accessible and available to the patient as we do now (costs and conveninece still an issue). So, maybe its my bias as a physician but if someone is going to offer me a service or product, I want to know that its working in me individaully. The current paradigm is like having a to pay for insurance but being told that the documentation of your coverage will likely show up in case of accident but we won’t give it to you now.

    I think you’re being a bit harsh here.

    In principle, how can anyone ever demonstrate that vaccination is protecting a specific person from infection by a specific pathogen?

    In population terms, we can show that vaccination significantly decreases the incidence of the relevant diseases.

    We can show that a person is immune to deliberate infection (if we want to throw our ethics out the window, but this is Jenner’s original demonstration).

    Of course, we can measure circulating titres of Igs and show that these increase upon vaccination. But how can we demonstrate conclusively that vaccination has prevented a person from succumbing to the millions of pathogenic organisms that might be encountered in the course of, say, a typical month? Bearing in mind, of course, that one can be exposed to pathogens and not suffer the disease even if one is not immune, simply by the role that chance plays in the process of infection.

    The efficacy of vaccination can really only be demonstrated at a population level, not an individual level.

  93. Nigel Depledge

    Ted Fogarty MD said:

    The whole concept of herd immunity is on the basis of the sloppy infectious nidus leftovers in the population that aren’t immune despite having been vaccinated or never got vaccinated. I am not saying its not an important concept in general but its exonerating the sloppiness that we have been trained to believe is the only way to do this for decades. It also means some people are getting vastly overvaccinated and some are even still undervaccinated. This whole blog is about science right?

    OK, this does raise an interesting point, that was not clear to me in your eartlier posts.

    Obviously, the ideal situation would indeed be one where we can test the immunity of everyone who has received a vaccination, and re-vaccinate only those who are not immune, and also to refrain from vaccinating those with a high risk of an adverse reaction (instead relying on herd immunity to protect them).

    This would be especially valuable if the diagnostic kit costs less than the vaccination. As you have stated elsewhere, it would require a shift in the “one size fits all” thinking that pervades most public healthcare initiatives.

  94. James

    Since “finding someone to blame for my child’s autism” counts as bias in my book, any of the studies put forward so far in support of these claims have been tainted by association.

    Genuinly independant studies have all shown absence of any link between autism and vaccination. End of story.

    Ted Fogarty: You raise valid criticisms of technique in public health measures, but none of them could possibly justify the blanket abandonment of vaccination that one side of the debate is calling for.
    You address a number of US specific issues that I cannot comment upon because, not to put too fine a point on it, the US health system is insane and the UK’s NHS is not.
    Over here the final decision is based on the opinion of doctors and healthcare profesionals, NOT the lobbying of elected officials.

  95. Mike

    Hello “Grump”,
    perhaps you should change your name to Dick.

    Cheers!

  96. Keith

    the Antivax movement means that parents can lay their children to rest after they have died of preventable childhood diseases, taking comfort in the knowledge they they never developed autism from the evil of the vaccine.

    Fucking morons.

  97. Keith

    The antivaccination movement means that parents can lay their children to rest after they have died of preventable childhood diseases, taking comfort in the knowledge that they were never left autistic due to the evil of vaccination.

    Not vaccinating your child is tantamount to child abuse.

  98. Toni

    I am a nurse that recieves on a regular basis, adverse effects of vaccinations. (these don’t get reported) The reports come from the hospital to our GP practice. So 12 years ago I decided to have a long hard look at vacinnations (not on the internet by the way). It is not the fact that vaccinations work/ or how they work/ how they protect against disease/ that they produce ‘herd immunity’. It is what is in the vaccinations- eg- antibiotics, formaldehyde, thiomersal- don’t even look up whats in Gardisal. How can you possibly scientifically say that this is safe? Now we are vaccinating babies against Hep B? Honestly…does that make sense- read the product insert for Hep B and ask if this is safe for a 3 day old baby.

  99. Toni

    and to keith above-

    “Not vaccinating your child is tantamount to child abuse”

    say that to my cousin that ‘did the right thing’ and vaccinated her child. She has been looking after her child that is disabled (she’s permanently a 2 yr old) for 12 yrs- as a direct result of MMR at age 12 months- proven in court and yet to be compensated- Is she a child abuser also?
    Think about your strong words- please- theres always both sides of the story!

  100. Todd W.

    @Toni

    Formaldehyde – This is used during production but is diluted out for the final product. The amount in any final product is less than the body creates itself. Also, the formaldehyde in vaccines is chemically the same as that produced by the body, and is not the same that is used for embalming or used in the production of various construction materials.

    Thimerosal – Removed from nearly every vaccine, and those that still use it generally have thimerosal-free versions available. The total amount of thimerosal exposure is less now than in the past several decades. The removal of thimerosal was a political move due to public pressure based on poorly conducted science. There was no evidence to show that thimerosal, in the amounts in vaccines and other medicines, was dangerous or posed a health risk. Please read the FDA or CDC articles on thimerosal.

    On Hep B – from the CDC:

    Transmission: Contact with infectious blood, semen, and other body fluids from having sex with an infected person, sharing contaminated needles to inject drugs, or from an infected mother to her newborn. (emphasis mine; cdc.gov/hepatitis/)

    And from the Wikipedia article on Hep B:

    HBV can be transmitted between family members within households, possibly by contact of nonintact skin or mucous membrane with secretions or saliva containing HBV. (emphasis mine; en.wikipedia.org/wiki/Hepatitis_B)

    You don’t need to be having sex to get it. So, yes, it does make sense to vaccinate infants.

    How can you possibly scientifically say that this is safe?

    Because well-controlled studies have shown that the benefits from the vaccines outweigh the risks of injury from the vaccine, and that the risks from the vaccine are significantly lower than the risks from the diseases being prevented. If you have some scientific studies that are well-controlled and show that the risks of the vaccines outweigh the benefits, please provide a link or citation.

    I am a nurse that recieves on a regular basis, adverse effects of vaccinations. (these don’t get reported) The reports come from the hospital to our GP practice.

    Why aren’t you reporting them? Just because medical practitioners are not currently required by law or regulation to report adverse reactions like manufacturers are doesn’t mean you shouldn’t. You and/or your practice are dropping the ball, here, and not doing your part of post-market surveillance.

    Also, what is “a regular basis”? How often? What are the adverse effects, including the seriousness and severity of the effects? What percentage of individuals out of the total population serviced are coming in with adverse effects? What percentage of the total population serviced does each type of AE (e.g., fever vs. swelling vs. encephalopathy) represent? When you took a look at vaccines, what kind of controls did you employ to prevent bias?

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