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Links With Your Coffee - Saturday

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Many of the non-fiction classics of our time (Howard Zinn's history, Lies My Teacher Told Md, and Everything I Needed to Know I Learned In Kindergarten) are a response to this narrow corporate trench of textbook production. In grad school, most of my profs refused to assign textbooks because they saw how riddled with distortion and superficiality they truly were. They also knew that many profs are given "gifts" by publishers in return for assigning books, the same way doctors have prescribed from within the pockets of the pharma industry.

Is there an answer for the beleaguered parent? Sure there is -- use what I rely on to tutor my own kid. Wikipedia.

At the university level, sometimes a truly excellent textbook will slip through the process. For example, this chemistry text. Notice that while the chemistry professors love the book, the students dislike it.

So funny- a nice big Shering-Plough advertisement on the website for the "surgeon/scientist"'s (sorry, what kind of science would that be that he/she's practicing?) caricaturizations of anti-vaccine people. Pathetic.

You seem to be saying that because you saw an ad on his site he is not to be trusted, is that it. Is that all you can offer, a little guilt by association. There are all kinds of loons out there spouting the anti-vaccination rhetoric with nothing more than fear and anecdotal evidence. The one he points to in this specific post is only unique because her reasons are so obviously bogus. The reasons for the anti-vaccination rants from others may sound more sophisticated, but they have one thing in common, no evidence to support the arguments they make.

You seem to be saying that because you saw an ad on his site he is not to be trusted, is that it. Is that all you can offer, a little guilt by association.

I think clownfish was playing the Conflict Of Interest card, rather than the Guilt By Association card.

OK, yes, guilt by association, Norm, or perhaps conflict of interest, as Teodomiro suggested. The point is that I have to go only back as far as, oh, 2 days ago to find something disturbing about one vaccine or another-- NYT article about a second person dying in Minnesota of polio that they acquired from an old version of the polio vaccine they received long ago; 3 major HIV vaccine trials canned last year because the vaccine group was getting infected at higher rates than the [blinded] placebo group [oh #!@%, never occurred to us that bringing more CD4 cells to the genitalia by way of a vaccine might raise ones chances for HIV entry into CD4 cells!!]; various nastiness associated with the old small pox and anthrax vaccines.

As I've said before, I am not anti-vaccine; my child is 100% vaccinated as are the children, as far as I know, of everyone I know. And most people's fears about vaccines do appear baseless. What drives me crazy is when the people going on these bizarre rants about the stupidity of anyone choosing not to vaccinate have no more qualifications than those they're deriding. Here's a news flash: doctors are no more automatically scientists (nor are they, for that matter, statisticians) than civil engineers are quantum physicists. Even if we assume that this "surgeon-scientist" is an M.D.-Ph.D. (and further assume that this Ph.D. arose independently of the M.D. and not through one of the MD-PhD programs, which to put it nicely, is a quite "streamlined" version of a PhD) and we further assume that his field of science is something actually related to vaccine immunology (like, oh, say, immunology?), can we really expect that he's professionally both a surgeon and an immunologist? If I get a law degree and then spend my career as a state congressman, do I still get to call myself a lawyer? I happen to be a big fan of number theory problems. Does that mean my sagely thoughts on Riemann should carry an extra bit of heft?

I am not a scientist, a doctor, or a statistician; I'm an infectious disease epidemiologist, which is actually pretty irrelevant to the field of vaccine safety. I have however spent quite a few years squeezing a pipette in a T cell immunology lab performing clinical trials work at an independent research facility, and these trials have included vaccine safety & efficacy trials. I have seen firsthand the cherry picking of data by pharmaceutical companies. I and my fellow coworkers have been taken out to very nice restaurants. I have seen extremely bright statisticians biting their tongues because it would seem they just thought this MD guy running the meeting must know what he's doing. I would certainly NOT say these companies ignored safety issues, but given the caliber of some of the pharmaceutical monitoring people I interacted with, it's not exactly shocking when I hear about Phase III or IV trials going south and certainly not shocking when I hear about unforeseen consequences 10 or 20 years down the line. You might say so what about the polio thing in Minnesota-- the vaccine has long since been replaced with a safer one-- but, looking at the bigger picture, should such stories really be that comforting to people about to let someone jab a needle in their kid's leg?

One final thing-- I don't know how well known this is, but I can tell you that there's a pretty big cultural divide at the big research centers between clinical research departments (where all clinical trials are conducted for new pharmaceuticals, including vaccines) and basic science departments. In clinical research, the PIs are nearly exclusively MDs (as you would expect, given that PhDs are not clinicians); in basic science (where, I think most would argue, the actual science is being conducted) the PIs are all PhDs. Again, this should be no surprise, but you should not underestimate the magnitude of the divide, because under those PIs are the people who do the work, and if you are planning to go to grad school or are a grad student or a post-doc or simply a science-for-science's-sake technician, you are far more likely to shoot for the basic science PI mentor than the clinical research MD mentor (this is by no means absolute, of course). The opposite is of course true if you're planning on going to med school or are in med school or are an MD fellow. Now throw into this the fact that most trials on the basic science side are NIH funded and, increasingly, trials on the clinical side are partly or entirely funded by the pharmaceutical companies who need their drugs approved and you have a situation which, even with the best of intentions (which really does usually seem to be the case), can be a little... murky?

Now, since I seem to manage to make one asshole-ish comment or another every time you post something vaccine related, I will give it a rest.

So you have your own children vaccinated, and the example you give in Minnesota sounds like a medical mistake, not an argument against vaccines. It is certainly not evidence that there is any basic problem with polio vaccine. The other example you cite is a trial, and not something approved for use in the general population. You are not arguing that people shouldn't have their children vaccinated. So what's left, nobody but you is qualified to speak on the subject. No one can understand the basic issues without a PhD and only a PhD approved by you. Whether it is stupid in general not to vaccinate isn't dependent on the qualifications of the person making the claim, it is an empirical claim. Do you have any evidence to offer that PhD immunologists as a group suggest that there is in general any reason not to vaccinate. If not why then do you give cover to rather than condemn Jenny McCarthy and her ilk. Oh I know you do, but it is a milk-toast condemnation compared to the vitriol you reserve for those trying to push back against the anti-vaccination movements and the sickness and death that follow from it. Instead you repeat how smart you are and that only those as smart as you should express opinions.

That you offer red herrings like suggested conflicts of interest without any evidence the alleged conflict is in any way relevant, or that it has in any way influenced what he has written says more about you and the type of arguments you are willing to use. Present evidence that he is wrong, don't attack his character or qualifications. I understand that you are not using the Minnesota polio vaccine case or the HIV trials as evidence that people shouldn't vaccinate their children. So why do you offer them. It seems like a transparent attempt to frighten the very people who are considering not having their children vaccinated. I can't believe you'd be that callous, so feel free to offer an alternative interpretation. The arguments you provided are the same kind of irrelevant arguments that the anti-vaccine crowd offer for not having their children vaccinated and you help to provide cover for them.

No one is claiming that there are never any problems with vaccines or the involvement of pharmaceuticals isn't problematic, but that is not particularly relevant to the broader question.

Norm, first, could you tell me which chapter of Norm's Book of Allowable Conversational Tactics condones statements like this:

So what's left, nobody but you is qualified to speak on the subject.

or this...

Instead you repeat how smart you are and that only those as smart as you should express opinions.

I have apparently not read up enough.

Second, I believe we are arguing two different points. My intention is not to "give cover" to people arguing against vaccination, and neither is it my intention to suggest that only a select group of people is qualified to speak on the subject (though I will admit that I may have unintentionally made it sound so). All I would like is if someone's going to rail against the anti-vaccine movement that they not resort to the wildly misguided hippie, government conspiracy psycho, or religious nutjob caricatures of people who choose not to vaccinate or only partially vaccinate their kids. To me, this is about as effective as a pro-lifer screaming baby killer! at some hapless woman entering an abortion clinic. What good do such approaches to the issue do for level-headed parents who are simply frightened by possible unforeseen consequences for their kids? It would seem to me to be human nature (beneficial or not) to be nervous about products emerging from giant powerful corporations that are intended to bring about lifelong change in one's body being injected into one's children. These fears may not (and in nearly all cases, do not) have any footing in math or science. But, being that we are not automatons, I fail to see how acknowledging these fears amounts to giving cover to the looney bin. On a side note, a pro-vaccine article you linked to a couple weeks ago by a childless med student was perhaps the most level-headed of all such articles I've read here.

Finally, I have nothing against doctors. As trite as it might sound, I will say that some of the smartest, empathetic, and ethically well intentioned people I know are MDs. And I would further say that, from my perspective, it takes a far more special set of [mostly positive] character traits to complete med school than to complete a PhD program.

Lastly, to clarify-- the recent polio vaccine death in Minnesota was not the result of a medical error; however, after reading directly from the source (the Minneapolis Star Tribune as opposed to the brief mention I'd first read in the NYT on Friday), it appears that both of the deaths in the past 4 years were in severely immune-compromised people (though there was no mention if that was a pre-existing condition at the time the vaccine was received).

I hope this clears things up.

What drives me crazy is when the people going on these bizarre rants about the stupidity of anyone choosing not to vaccinate have no more qualifications than those they're deriding.

So according to you a medical doctor has no more qualification than the wife of the Pastor Steven Anderson of Faith Word Baptist Church to comment.

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