Skeptical Raptor's Blog hunting pseudoscience in the internet jungle

Improved high dose flu vaccine for seniors

flu-vaccine-seniorIt’s that time of year again, early autumn, when flu experts recommend getting the seasonal flu vaccine, especially for children and individuals over 65. Of course, if you don’t think you should get the vaccine, there’s a description for a person like you.

One of the issues that has been observed in the past is that the traditional flu vaccines may not have a high effectiveness in older adults. In fact, recent research shows that, in patients over 65 years old, the effectiveness of the flu vaccines can be as low as 9% for some strains of the influenza A virus (but still strong effectiveness for that group for other strains of influenza A and all strains of the influenza B virus).

The lower effectiveness may not be a result of the vaccine itself, but because older individuals may require more antigen to induce a proper immune response. Because of these observations, Sanofi Pasteur developed a high dose version of their Fluzone vaccine specifically for seniors. The new high dose vaccine contains 60 μg of each of the three hemagglutinin antigens per vaccine dose compared to the 15 μg per antigen in the standard Fluzone dose.
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Poll–Will you and family members get the flu vaccine?

 

President Obama getting his flu vaccine because he really can’t get sick

President Obama getting his flu vaccine because he really can’t get sick

It’s that time of the year. It’s time to get your seasonal flu vaccine, so will you get it? Will you make your significant other get it? Will you take your children to the pediatrician to get it? Or will you fall for the lies and myths, pretend like you are a superior genetic human being and will never get the flu? Time to vote and drop an explanation in the comments, so that the world can read them!

 

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Dumb Asses who don’t get the flu vaccine

flu-shot-mythsEvery flu season, I resurrect this hysterical and snarky by Infectious Disease specialist Dr. Mark Crislip which was originally published in A Budget of Dumb Asses, which accurately states that healthcare workers who refuse to get a flu vaccine are Dumb Asses. Yes, complete and utter Dumb Asses. Even though this broadside against vaccine deniers is about the flu vaccine, it’s all right to search and replace flu with say meningitis, pertussis, measles or anything. And just because it’s about healthcare workers, it’s all right to replace that with your neighbor, co-worker, or some other anti-scientific antivaccination Dumb Ass.

The upcoming 2014-2015 flu season is just starting, and many physicians and clinics (along with many pharmacies, government flu clinics, and other places) have this season’s flu vaccine. One of the best ways, if not the only real way, to prevent contracting this year’s flu is by immunization with the seasonal flu vaccine.

And it’s time for intelligent, reasonable, and rational people to get their flu shots. We’ve dispensed with many of the myths that are cherished by vaccine refusers, and many reseachers have shown that getting the flu vaccine can improve health outcomes.

Warning: this is funny (unless you’re a vaccine denier, in which case you have no sense of humor, irony or sarcasm, something probably gained by getting vaccinated). So, if you’re reading this list while sipping on coffee, I take no responsibility for damage to your computer, smart phone, or tablet if you snort out your drink. Them’s the rules. 
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Success and Failure of Anti-Vaccine Legislative Efforts, 1998-2012

vaccination-ideasThis article was written by Dorit Rubinstein Reiss, Professor of Law at the University of California Hastings College of the Law in San Francisco, CA. She has written a valuable review of the recently published article, “Power and Persuasion in the Vaccine Debates: An Analysis of Political Efforts and Outcomes in the United States, 1998-2012”.

Dr. Reiss writes extensively in law journals about the social and legal policies of vaccination. She is also member of the Parent Advisory Board of Voices for Vaccines, a parent-led organization that supports and advocates for on-time vaccination and the reduction of vaccine-preventable disease.

The article reviewed here examines how the success of the anti-vaccine movement in achieving its legislative goals changed over time. The authors use the term “vaccine critiques”, and I will follow their terminology, though I think the anti-vaccine label fits many of the actors they describe. The peer reviewed article does two extremely valuable things: describes patterns, and suggests a causal explanation. While the authors are, justifiably, confident in their descriptive analysis, they appropriately warn us that their conclusions about causation are tentative. Their points are, however, very plausible.

This post proceeds in three parts: describing the patterns the authors found, describing their causal conclusions, and asking for a wish-list of further research (an easy enough and somewhat unfair things to do when you don’t have to actually do it).

Note: the authors have expressed their willingness to provide the full paper to individuals, upon request. I recommend it. The paper also states that the database will be made available on request.
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One mother’s crusade against antibiotics–it’s complicated

antibiotics

This is a guest post by Karen Ernst, who is the parent-leader of Voices for Vaccines, a parent-led organization that supports and advocates for on-time vaccination and the reduction of vaccine-preventable disease. Karen is the mother of three boys and the wife of a military officer, living in Minnesota. 

I could be the mother-in-charge of the such the anti-antibiotic movement.* I’m the perfect candidate. When my son was five years old, he had an honest-to-goodness severe reaction to amoxicillin.

It all began with a sinus infection. The doctor prescribed him his second course of amoxicillin, and he took it for nine days without incident. But on day ten, his body sprouted hives–big, ugly, firm hives. I kept a watchful but not worried eye on his bumps as they sprouted here and there around his body.

And then a hive appeared on his forehead. Because the pediatrician’s office was about to close, I called the nurseline, and she told me to watch and make sure his breathing was okay. I watched as long as I could, growing increasingly worried as the hives did not go away, and finally decided to bring him into the ER when a hive appeared on his lip. (Our insurance makes urgent care nearly impossible to use.)

The ER doctors and nurses were kind and assured me that it was good I had brought him in–better safe than sorry when it comes to allergic reactions appearing so close to an airway. The doctor agreed that his hives seemed unusual–firm and concerning–so they gave him a dose of a steroid and told me to give him Benadryl.

The hives went away for two days, but they came back, and with them came joint pain. My son began limping around the house and reported that his knees ached. So back to the ER we went. This time around, the doctor (a different doctor) was less concerned and told me that we just needed to wait for the amoxicillin to work its way out of his system.

But another two days later, he was laying in bed crying, unwilling to put weight on his legs.  By the time we arrived at the ER, I ditched the car at the front entrance and carried him in. He was screaming in pain. The triage nurse was so alarmed by his screams that she brought us straight back to an exam room and grabbed a doctor. After tests and examination, the doctor diagnosed a serum sickeness-like reaction to the amoxicillin he had taken. He was prescribed a full round of steroids and a prescription-strength antihistamine, which we filled at 3 am before leaving the hospital.

Frightening things happen to children, but I tell this story not because it is exceptionally frightening. I tell it because of what did not happen. I did not go on a crusade against amoxicilin or antibiotics. While this son has never received a -cillin antibiotic** again (nor have I because I, too, am allergic), my youngest son has. I do have a fear of giving my younger son amoxicillin, but I always discuss that fear with a pediatrician prescribing it and ask them to help me put the risk into perspective. I know that my oldest son’s reaction was a very rare occurrance.

In the same way, real reactions to vaccines occur. I’m not talking about the ones promoted by the anti-vaccine rumor mill. Autism, asthma, being cross-eyed, and being short are not caused by vaccines. But allergic reactions or other reactions can occur, albeit very rarely.

penicllin-vaccine

David Salamone suffered one such rare reaction. The Oral Polio Vaccine, which was the vaccine of choice to prevent polio in the last half of the 20th Century, can cause full-blown polio in one out of every 2.4 million people who receives it. David Salamone was the one.

In the PBS NOVA special “Vaccines: Calling the Shots,” David Salamone explains how he feels about vaccines:

I’m not against vaccinations. I’m pro-vaccinations. We had thousands of people contracting polio prior to the vaccination. We came out with the vaccination, and that number decreased significantly. So less people are getting sick, less people are getting affected, and that’s a good thing.

The anti-vaccine movement is not fueled by people whose children have suffered real vaccine reactions. Children who have suffered allergic reactions or other rare side effects to vaccines and are unable to receive more vaccines deserve the protection of a highly vaccinated population.

The anti-antibiotic movement doesn’t exist because we give antibiotics to sick children to treat illnesses that we can observe. Vaccines are trickier. We give vaccines to well children, and we cannot observe with our own eyes how these vaccines protect our children. We can’t see our children’s immune mount a defense against attenuated vaccine antigens and create memory cells to defeat possible encounters with fully virulent viruses. But we can watch as our children do not get measles, diphtheria, and other diseases that were once the scourge of childhoods across our country. Let’s make sure they are not a scourge again.

*Legitimate reasons to oppose the overuse of antibiotics exist. As the CDC tells us, antibiotics are inappropriate for viral or non-bacterial infections. Antibiotics save lives by curing bacterial infections.

**Technically, this class of antibiotics are called Penams or Penicillins. There are over 25 different antibiotics in this class, and generally, a reaction to one probably indicates a reaction to all of them.

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Mumps vaccine effectiveness and waning immunity

MMR-vaccine-mumpsIn a previous article, from our vaccine legal expert, Dorit Reiss, we learned that there’s a whistleblower lawsuit against Merck regarding the possibility that the company may have engaged in some inappropriate actions in determining the effectiveness of the MMR vaccine (for mumps, measles and rubella), specifically the mumps component of the vaccine. As Reiss stated, despite the suit (and recent ruling which just whether the case could go forward) being a boon to the antivaccination crowd, so far no facts have actually been presented.

In essence, the whistleblowers claim that Merck, the manufacturer of the MMR vaccine, through either direct falsification or poor study design, may have overstated the effectiveness of the mumps component of the vaccine. Merck had been claiming that the vaccine was approximately 95% effective (meaning at least 95% of children given the vaccine were protected against the disease).

So let’s be clear about this so-called whistleblower lawsuit–no evidence has been presented, and that evidence hasn’t been cross-examined. And one more thing–courts do not decide science, it’s not their role. Science is not a debate, it is a cold evaluation of evidence. And in science, the weight of the evidence is both in quality and quantity. Unless you’re a complete anti-science cult member, whatever this court decides, whatever malfeasance was practiced by Merck, whatever the whistleblowers have to say, the scientific evidence tells us that the mumps vaccine component is highly effective and extremely safe.
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The anniversary of September 11–my personal experience

For a moment, I want to step away from my typically snarky commentary about things I see in the pseudoscience world. I want to talk about my own experiences on that day, which, in retrospect, ended up being a closer call than I ever wish to have.

You see, on September 11, 2001, I was taking a morning flight from New York’s JFK airport to my home. I had spent the weekend in New York City with my girlfriend–we had good food and drinks with her brother and her sister-in-law, and we all got good seats for the hit musical on Broadway that year. Even after 13 years, I’ve never seen the movie based on that musical nor listen to the songs, despite how funny they are. It’s because, to me, that musical is intimately tied to 9/11.

 

Credit to Wikimedia Commons, 2011

Credit to Wikimedia Commons, 2011

On Monday, September 10, I had to go down to Wall Street (in a building close to the World Trade Center) to meet with a group that was doing an analysis of one part of the medical device industry, and we spent all day examining numbers, evaluating companies, and discussing future technology. It was highly analytical, and something I enjoy doing.

I also met with a hedge fund operator in the Twin Towers, whom I had befriended in a previous job. His whole investing strategy was to root out liars and frauds in the small medical companies, then short the stock (that is bet that the stock price will drop and profit from it). He had an amusing and colorful internet nom de plume, which I remember to this day.

After the meetings, I was originally going to stay in the Marriott Hotel on Wall Street, but I decided to just stay in my more uptown hotel for better restaurants and things to do.

At this point, the world was perfect for me. New York’s weather was feeling a bit like autumn was just around the corner. I was in a wonderful relationship. And I was going to close on a new house on Tuesday afternoon, so I was in a hurry to get back.
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Merck, Mumps, Motions, Whistleblowers–the actual story

MMR-vaccination-intramuscularThis article was written by Dorit Rubinstein Reiss, Professor of Law at the University of California Hastings College of the Law in San Francisco, CA.

Dr. Reiss writes extensively in law journals about the social and legal policies of vaccination. She is also member of the Parent Advisory Board of Voices for Vaccines, a parent-led organization that supports and advocates for on-time vaccination and the reduction of vaccine-preventable disease.

In August 2010 Stephen A. Krahling and Joan A. Wlochowski (“the relators”), former Merck virologists, filed suit in the name of the United States – a so-called qui tam action, where the prosecution shares any fines or penalties with the two virologists  – against Merck. They claimed that by faking effectiveness testing, Merck misled the United States government as to the effectiveness of the mumps component of its  MMRII vaccine (a vaccine which protects individuals against mumps, measles and rubella). In 2012  a clinic and two MDs filed a class action against Merck claiming violation of the Sherman Act – monopolistic, anti-competitive behavior resulting from the fraud – and violation of various state laws. (U.S. v. Merck and Chatom v. Merck). The suits were handled together.

On September 5, 2014  Judge Jones II. Of the Federal District Court for the Eastern District of Pennsylvania mostly rejected Merck’s motion to dismiss.

This post explains that decision. It begins by explaining some of the legal issue and the factual basis as best as I can, and then explains what the judge decided and what it means.
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Free HPV vaccine causes 61% drop in female genital warts in Australia

gardasil-one-less-advertisingAs I’ve written on many occasions, the HPV quadrivalent vaccine is one of the great achievements of medical science. It protects young men and women against the human papillomavirus (HPV), the most common sexually transmitted infection (STI) in the USA. There are over 170 subtypes of HPV; however, HPV subtypes 16 and 18 not only cause approximately 70% of cervical cancers, but they are linked to most anal (95% linked to HPV), vulvar (50% linked), vaginal (65% linked), oropharyngeal (60% linked) and penile (35% linked) cancers. HPV is estimated to be the cause of nearly 5% of all new cancers across the world.

One of the signs of HPV infection as a STI is the appearance of genital warts, and if there is a drop in the occurrence of genital warts in a population, we can assume that there could be a concomitant drop in the risk of these cancers. And we go back to the HPV vaccine, known as Gardasil or Silgard.

In an article just published in PLOS ONE, General Practitioners (GPs) in Australia are managing 61% fewer cases of genital warts among young women since the introduction of a national HPV vaccination program in Australia, which provides the vaccine for free. Read that carefully, if you’re a vaccine denier, or even more specifically one of those “I fully vaccinate my children, but I don’t think Gardasil is important, because my kids will NEVER be sexually active” types. A 61% reduction.
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Update to the LeRoy (NY) teenagers’ mystery neurological illnesses

oatka-creek-leroy-nyOver the past couple of years, I had written a few articles about a mystery neurological ailment that had struck about 20 teenagers, most of whom were students in high school at that time in LeRoy, NY, a small town about 30 minutes from the city of Rochester. The teens suffered tics and other neurological symptoms that seemed to mimick Tourette syndrome, but was never diagnosed as such.

None of the teens had ever exhibited other symptoms of a neurological deficit, and most of them have subsequently recovered. Two new cases appeared in 2013, but none since.

Numerous individuals, including officials of the Monroe County and New York State Departments of Health, attorneys, antivaccination cultists, and others whose speculation ran from useful to outright delusional.  Many individuals who “diagnosed” the teens without actually ever meeting them (proper diagnosis of neurodevelopment disorders requires one on one assessment, not the famous “let’s diagnose medicine over the internet).
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