Anti-vaccine activists constantly look for any science that seems to support their beliefs about the safety and effectiveness of vaccines. Lately, they have gravitated to the writings of Peter Doshi, who has made a career talking about vaccines. Although Doshi lacks the credentials in any area of science related to vaccines – immunology, microbiology, virology, public health, epidemiology – the anti-vaccine forces embrace him like he’s a Nobel Prize winning scientist. Which he is not.
Let’s take a look at Doshi’s credentials and what he’s written about vaccines, specifically the flu vaccine.
Argument from Authority
Before we look at Peter Doshi, we need to start by looking how the anti-vaccine crowd depends on authorities, especially false authorities. Vaccine deniers rely upon the Argument from Authority, a logical fallacy which provides an argument from an authority, but on a topic outside of the authority’s expertise or on a topic on which the authority is not disinterested. Furthermore, the works of authorities, no matter how eminent or influential, is always judged by the quality of their evidence and reasoning, not by their authority alone.
Duesberg has also claimed that AIDS in Africa is largely misdiagnosed, and is not really AIDS but merely the accumulated affects of malnutrition and disease. AIDS deniers, like Duesberg, have little or no scientific evidence for their disputing that HIV causes AIDS, they are considered crackpots at best and harmful to the research to treat and prevent AIDS. A true scientific skeptic does not accept the statements of an authority figure just because they are an authority, but on the body of evidence, along with the qualifications, of said authority.
Another example of a false authority, specific to vaccines, is Tetyana Obukhanych, an immunologist who has become the darling of the anti-vaccine forces. The science deniers use Obukhanych’s anti-vaccine words as gospel, more so because she has the authority of a degree in immunology. However, she never did any research to support her beliefs, so the evidence does not support her actually being an expert in the field of vaccines.
Science deniers attempt to create a false equivalence, or even this false democracy of science, by cherry picking some “authority” that supports their point of view. Of course, they ignore the vast majority of “authority” figures who are on the other side of the fence. Once again, one authority person does not outweigh the vast numbers that are usually on the other side of the argument.
All about Peter Doshi
Recently, the vaccine denier zombie memes have resurrected an “authority” named Peter Doshi, who has made a recent career of denying some aspects of vaccinations, specifically flu immunizations. An article in one of the crank online “medical” websites, NewsMax Health, that is being passed around again by the vaccine obstructionists, relied upon some statements by Doshi “of the Johns Hopkins School of Medicine.”
Promoting influenza vaccines is one of the most visible and aggressive public health policies in the United States, says Doshi of the Johns Hopkins School of Medicine. Drug companies and public officials press for widespread vaccination each fall, offering vaccinations in drugstores and supermarkets. The results have been phenomenal. Only 20 years ago, 32 million doses of influenza vaccine were available in the United States on an annual basis. Today, the total has skyrocketed to 135 million doses.
“The vaccine may be less beneficial and less safe than has been claimed, and the threat of influenza seems to be overstated,” Doshi says. Mandatory vaccination polices have been enacted, often in healthcare facilities, forcing some people to take the vaccine under threat of losing their jobs.
Even when the vaccine is closely matched to the type of influenza that’s prevalent, which doesn’t happen every year, randomized, controlled trials of healthy adults found that vaccinating between 33 and 100 people resulted in one less case of influenza. In addition, says Doshi, no evidence exists to show that this reduction in the risk of influenza for a specific population — here in the United States, among healthy adults, for example — extrapolates into any reduced risk of serious complications from influenza, such as hospitalizations or deaths, among seniors.
Well, this sounds provocative. So let’s start at the top. First, let’s look at Doshi’s background. According to a report written for the National Academies of Science (and having absolutely nothing to do with vaccines), Doshi is
…a postdoctoral fellow in comparative effectiveness research at the Johns Hopkins University School of Medicine. His over-arching research interests are in improving the basis for credible evidence synthesis to support and improve the quality of evidence-based medical and health policy-related decision making. In 2009, he joined a Cochrane systematic review team evaluating neuraminidase inhibitors for the treatment and prevention of influenza. Rather than focusing on publications, the review evaluates regulatory information, including clinical study reports. He received his A.B. in anthropology from Brown University, A.M. in East Asian studies from Harvard University, and Ph.D. in history, anthropology, and science, technology and society from the Massachusetts Institute of Technology.
For those of you who don’t know anything about scientific research (that would be every vaccine denier I’ve met), a post-doctoral fellow is not on the faculty. Yes, he’s at Johns Hopkins School of Medicine, but he does not practice medicine, nor does he do any clinical research. He is not a faculty member, and, except for guest lecturing, does not teach medical or graduate students.
As a post-doc, he is doing research which extends from his Ph.D. research at the MIT. Moreover, he doesn’t have a science research background, it appears that his background is in the history of science, a fine field of much interest to many real scientists, but it isn’t hard science, that is developing a hypothesis based upon observations, then testing the hypothesis using the scientific method, and finally publishing it.
On the scale of educational background, Doshi would not qualify as a “scientist”, but people can claim whatever they want. As I’ve said, it’s evidence that matters. All of Doshi’s research are criticisms of vaccines, not based on his personal leadership in a clinical trial, but merely on his opinion. And he seems to enjoy attacking Big Pharma, a trite strawman argument.
So using the Peter Doshi vaccine study as a “proof” that vaccines are bad because Doshi is a leading authority on vaccines and the flu? That isn’t going to fly. Doshi is not even close to having credentials of a real vaccine researcher.
The question is not whether the virus as it currently is constituted is a pandemic threat but whether it will become one. There are many reasons to think this can happen and happen soon. When and i it does, there will be no time to prepare, so waiting to do so is not prudent, although that is what Doshi is advocating. As we have emphasized here many times, and will do again, the way to prepare for an influenza pandemic is to strengthen a community’s social service and public health infrastructure. Concentrating on vaccines and antivirals is not a useful way to prepare because if there is no pandemic (we should be so lucky) it would be wasted and the use of either requires an infrastructure to distribute them. Instead the task before us is one of community mobilization but requires a proper appreciation for the nature of the threat.
Doshi’s view is very unhelpful in that regard, but not because he objects to scaring people as a tactic. I consider it a bad tactic, too. It is unhelpful because it doesn’t do what it should: provide people with a sane appreciation of the risk so they can start to develop the kinds of relationships, structures and orientations that will respond to widespread community illness by encouraging and allowing neighbor to help neighbor.
Worse yet, Doshi has attended crank science meetings, which push an antivaccine agenda without any pretense of using real science. For example, he attended and presented at a meeting sponsored by the National Vaccine Information Center (NVIC), a renowned vaccine denier group with a laughably obfuscating name. Maybe Doshi isn’t in agreement with NVIC principles of denying vaccines for children, but attending the meeting seems to indicate some level of support.
However, this is what makes science so energizing. Real scientists, who do real work with viruses and who actually have an education in real biomedical sciences, are actually trying to discover a flu vaccine that works better against all types of flu, mainly by trying to uncover the common antigen. This is hard work, not in the purview of pontificating fake-scientists who think that cherry-picking data and publishing it, makes them knowledgeable.
Doshi also vastly overstates the the risks of the flu vaccine while understating the benefits in saved lives. A real epidemiologist might have provided a better analysis of risk versus benefits, a hallmark of understanding evidence based medicine. In fact, a true skeptic weighs the evidence on the risk and benefit sides of the equation, then determines the value of the benefit to risk ratio.
One last thing. Peter Doshi is an HIV/AIDS denier, and has made his “belief” (unsupported by any science whatsoever) public by signing a petition along with some 2000 other scientists, artists, engineers, government lackeys and other individuals with no scientific background in virology and immunology (like Doshi himself).
These petitions, like a similar one for evolution deniers, are feeble attempts to show support for the denialist side of the discussion. First of all, science is not a democracy, it is not subject to a vote. Science relies on evidence published in peer reviewed journals. Second of all, if we eliminate all of the non-scientists from the list (goodbye Peter Doshi, because you’re no scientist), we’d have a list of a couple of hundred scientists who would make up less than 0.01% of research biologists, meaning if science were a democracy, these deniers would lose in an awesomely huge landslide.
Real vaccine authorities
Of course, there are authority figures in vaccines who have the background, education and expertise that should be appreciated and have provided evidence that overwhelms the biased and evidence-lacking beliefs of non-authorities like Doshi.
Think about that for a minute. A real scientist doesn’t pontificate about helping humanity with fake science, he actually does something about it, and is directly responsible for saving nearly a half a million lives every year. If I were responsible for honoring heroes for saving children’s lives, Paul Offit and Jonas Salk, who invented the polio vaccine, deserve statues in front of every hospital, every medical school, and every city in the world. They are real heroes, who saved millions upon millions of children’s lives.
But despite credentials that are worthy of being considered one of the top scientists on the planet, Offit is vilified, hated and despised by the antivaccine cult. It’s hard to determine the particular reason for this hatred, except that he invented a vaccine, which saved those half a million lives every year, so obviously (to the lunatic fringe) he is completely corrupted by Big Pharma. Instead of seeing the Appeal to Authority fallacies they have with their non-scientists inventing garbage science about vaccines, the vaccine deniers jump all over the Argumentum Ad Hominemto attack Offit. Laughable and pathetic.
Here’s the point: we have evidence that supports the effectiveness and safety of vaccines, almost all vaccines. The evidence is based on clinical trials that are large, well-controlled, and published in peer-reviewed journals. They have been included in well-written systematic reviews. These studies have also been published in important peer-reviewed journals.
And unless you like cherry-picking evidence to support your belief, rather than reviewing all of the scientific evidence and see what conclusion it would support, the antivaccine authority figures lack any standing. The weight and quality of the “evidence” presented by antivaccine so-called authorities is simply too weak to even consider, and it falls far short of evidence presented by the pro-science vaccine supporters. In other words, the vaccine “authorities” are actually authorities about vaccines.
The Peter Doshi flu vaccine study isn’t worth much, but if you’re going to use it as your argument for authority–it’s not going to work.
The vaccine was introduced in 2009, and it has been part of many flu vaccines since that time. There has been some discussion about the effectiveness of the vaccine, but most studies showed it to be very efficacious.
A systematic review, considered the pinnacle of the hierarchy of scientific evidence, was recently published in the journal Vaccine, included well designed studies to examine the effectiveness of the H1N1 flu vaccine in both children and adults. The investigators identified 38 studies published between June 2011 and April 2016 that met the inclusion criteria for this meta-analysis – that is, any paper that focused on the H1N1 vaccine effectiveness during the 2009 pandemic. The data included data from over 7.6 million patient records derived from several different study designs.
This review also examined the differences between adjuvanted, that is, those vaccines that contain an adjuvant to boost the immune response to the flu antigens, and unadjuvanted (no adjuvants) versions of the H1N1 flu vaccine. The children’s version of the vaccine only included adjuvanted version.
The results of the study were clear. The pooled adjuvanted H1N1 flu vaccine efficacy in 1126 children was around 86% – this is an impressive number. In the pooled data for the adjuvanted and unadjuvanted versions of the vaccine, results showed that there was moderate protection of around 49% efficacy in people older than 18 years. Similarly, in individuals older than 50 years, the data showed the vaccine efficacy for the adjuvanted vaccines was approximately 46%.
This lower efficacy in older adults has been observed in other flu vaccine studies. Although there’s no conclusive reason why there is a lower efficacy, there have been several hypotheses offered including a less fit immune system for individuals, or that the population of older adults may have already have some immunity to H1N1 through previous pandemics or circulating H1N1 subtypes.
The authors concluded the following:
We further explained the overall inverse gradient between effectiveness and age by comparing adjuvanted versus unadjuvanted vaccines in each age band. Our results show that adjuvanted vaccines were significantly more effective in children than unadjuvanted vaccines in preventing laboratory confirmed influenza illness by almost a twofold difference in effectiveness. A similar pattern was also seen for hospitalization.
However, in adults there were fewer apparent differences between the performance of adjuvanted and unadjuvanted vaccines for both outcomes. The higher effectiveness in children of adjuvanted vaccines compared to unadjuvanted vaccines noted here has also been seen in efficacy studies of seasonal trivalent influenza vaccines (TIV) in young children up to 72 months of age, in whom efficacy against PCR-confirmed influenza was 92% for adjuvanted vaccines versus 45% for unadjuvanted vaccines.
The authors also asserted that this data is important for public health policy with respect to the H1N1 flu:
Evidence from modeling studies suggests that children are a credible target group for pandemic vaccination, along with patients who have high-risk conditions.
Once again, this is robust and exciting evidence of the effectiveness of the H1N1 flu vaccine against that flu subtype. The flu vaccine is often the ignored vaccine for children, probably because of enduring myths that the flu isn’t that dangerous or that the flu vaccine isn’t very effective. The H1N1 flu is dangerous, and it can be effectively prevented by the vaccine. So please, protect your children (and yourselves) with this vaccine.
When it comes to the influenza vaccine, there are a number of myths that surround the flu vaccine, pushed by vaccine deniers and, often, by vaccine supporters. The two most prevalent seems to be that the flu vaccine isn’t very effective, and the flu isn’t that dangerous. But a new peer-reviewed article has been published that focuses on these two myths. Based on the evidence, flu vaccine effectiveness prevents pediatric deaths. Period.
There have been numerous articles about flu vaccine effectiveness over the years – it’s rarely 90% or greater. The major reason for this is that all of the health organizations across the world have to meet 8-10 months before the flu season to determine what subtype(s) of flu virus will be most common in the northern or southern hemisphere. In some years, the flu virus will mutate between the time to decide on the right antigen and the vaccine is manufactured and shipped.
Generally, the vaccine is very effective against influenza B, mainly because this subtype of flu tends to mutate at a much lower rate than other flu viruses. On the other hand, the vaccine tends to have somewhat lower effectiveness against influenza A, mainly because of its higher mutation rate, and because it can infect (and mutate) in many other animals, especially birds, which have regular contact with humans.
But in no case is the effectiveness at 0. There seems to be a reliance on the Nirvana fallacy – if it’s not perfect, it’s worthless. Yes, the flu vaccine effectiveness is far from perfect, it ranges from 40-65% most years. But does that mean it’s worthless? Absolutely not. The flu vaccine prevents a lot of pediatric deaths, something we need to carefully examine.
Flu vaccine effectiveness – the publication
In a paper published in Pediatrics by Flannery et al., the authors reviewed laboratory-confirmed influenza-associated pediatric deaths since 2004 to determine the relationship with flu vaccination status. What they found was that the vaccine was much better at preventing pediatric death than not vaccinating at all – this may seem obvious, but it’s better to have statistically valid data published in a top rated journal.
The researchers conducted a case-cohort epidemiological study that compared vaccination uptake among laboratory-confirmed influenza-associated pediatric deaths with estimated vaccination coverage among pediatric cohorts in the United States. The study design allows the researchers to determine the actual flu vaccine effectiveness in preventing pediatric deaths.
Using data from July 2010 through June 2014, there were 358 laboratory-confirmed influenza-associated pediatric deaths reported in children aged 6 months through 17 years. The researchers were able to determine vaccination status for 291 of these deaths. Here are their results:
Of the 291 deaths with known vaccination status, 75 (26%) received the vaccine before onset of the flu, and 216 (74%) were unvaccinated.
The overall vaccine effectiveness against death was 65%, which means the vaccine prevented pediatric death in 65% of the population.
The vaccine effectiveness against death in children with high-risk conditions was 51%
This data clearly shows a difference between vaccinated and unvaccinated groups with respect to pediatric death.
Flannery et al. conclude that,
Influenza vaccination was associated with reduced risk of laboratory-confirmed influenza-associated pediatric death. Increasing influenza vaccination could prevent influenza-associated deaths among children and adolescents.
Flu vaccines save lives
This is robust and high quality evidence that the flu vaccine prevents pediatric deaths. Most children who die from the flu are unvaccinated, that is clear from this analysis. The job of vaccines is to prevent infectious diseases that harm our children (and adults) – the flu vaccine isn’t perfect, but for minimal risk, it prevents a lot of deaths. It does save lives.
Generally, when I write about vaccines, it’s about protecting children’s lives from vaccine preventable diseases. That itself is a noble goal for vaccines. But in case you didn’t know, there is also a CDC schedule for adult vaccines, which is as important to adults as they are to children.
Vaccines have one purpose – to protect us and those whom we love from potentially deadly and debilitating diseases. Many of us in the blogosphere have talked about the children’s schedule a lot, often to debunk claims of people who are ignorant of science, and think that the children’s vaccine schedule is causing undue harm. Yeah our intellectually deficient president, Donald Trump, thinks he knows more than the CDC, but that’s a problem shared by many vaccine deniers.
Just in case you were wondering, there is more to adult vaccines than just flu vaccines. There are several other vaccines indicated for adult use, including those adults with underlying health issues like diabetes, HIV and heart disease – unfortunately, the uptake for adult vaccines is depressingly low. Let’s take at the low uptake and the recommended adult vaccines schedule.
Go ahead and Google “useless flu vaccine.” You’ll see over 100,000 hits for that search term, some from reliable sources on vaccines. However, the vast majority are from anti-vaccine websites, some trying really hard to appear legitimate. Sure, the flu vaccine is not perfect (no vaccine is), but it’s effectiveness is not 0. I don’t get the argument that vaccines are in some fake binary world – it’s either 100% perfect or it’s useless.
There are reasons why flu vaccine effectiveness varies from year to year. Part of it is that various national public health agencies, like the CDC, meet 10 months before the flu season to determine which influenza subtypes will be prevalent during the winter. It’s not guesswork, it’s based on epidemiological models and new mutations in the virus, but it’s not 100% perfect.
To classify it as the “useless flu vaccine” betrays one essential fact – the flu is dangerous, and any protection against the disease is critical.
During the first week of January 2017, there were 141 deaths from flu in the USA. And there’s been over 500 deaths from the flu since the start of the flu season. If you think a useless flu vaccine does nothing to prevent a harmless disease, you’d be wrong on both points.
Not to be overly dramatic, but maybe it’s time to put some names and faces to individuals who have died recently from the flu. Because these senseless deaths should make you stop. They should make you feel sad. They should motivate you to get yourself and your loved ones vaccinated.
Maryland – A 17 year old high school was battling the flu when she died of cardiac arrest.
Of course, there are hundreds of other stories. Yes, many who died have underlying medical conditions, or are very young or elderly, but are their lives less precious than all others? Maybe your child, whom you failed to vaccinate, passes along the flu to her grandmother – is that acceptable?
There are dozens of individual stories about children, teens, parents, grandparents, diabetics, healthy young adults, and little babies who have died from the flu this year. It’s a serious and dangerous disease that many of you dismiss as “nothing more than a little sniffle.” The flu isn’t the common cold, which isn’t dangerous – they are two different diseases.
Yes, we all admit that the flu vaccine is far from perfect. But it is extraordinarily safe, and if it reduces your risk of catching the flu by 70% or 50% or even 30%, it’s worth getting, not only for yourself and those whom you love, but also to protect those who are at risk from the flu.
So is it a useless flu vaccine? Only if you think 500 deaths is acceptable – most rational people wouldn’t.
Alternative facts, what most of us would call outright lies or misinformation, are the new standard of truthfulness coming out of the Donald Trump administration. It started when Kellyanne Conway, one of the numerous Trump talking heads who think Americans are stupid, said, “You’re saying it’s a falsehood. And they’re giving … alternative facts.”
Alternative facts seem to be pretty close to the Nazi propaganda technique, called the Big Lie. It is about the use of a lie so colossal that the public would not believe that someone would have the audacity to distort the truth so impressively. Except, I’m going to reiterate most Americans (an non-Americans) aren’t that stupid. And sorry for going Godwin so early in the article, but sometimes, it is necessary to point out the obvious.
I’ve been fighting alternative facts as skeptic for nearly three decades. It started when I got into an argument with a school board candidate in California who said that “evolution is just a theory.” Now, those of you with scientific understanding accept that a theory, at least in science, is approximately equal to a fact. What he should have said is, “evolution is just a fact,” but instead he was making “theory” a pejorative which implied evolution wasn’t a fact.
He and I must have argued for 20 minutes, when he finally claimed that science was a religion that required faith, which, of course, is the exact opposite of what science represents. I told him that he apparently lacked any education in science, so why should he be on the school board. He lost, though I take no credit for it.
Over the years, I have evolved (pun intended) into other areas of scientific skepticism, like GMOs, vaccines, and alternative medicine. See, even the junk medicine quacks grasped that “alternative” label long before Donald Trump walked into the national spotlight.
Let’s look at my favorite alternative facts of science.
Immune system myths are one of the common claims of the junk medicine medicine crowd, especially the anti-vaccine activists. The pseudoscience of the immune system is pernicious and possibly dangerous.
It’s frustrating that the pseudoscience from the junk medicine crowd claims that this supplement or that food is critical to boosting the immune system – hang out for a day on Facebook, and you’ll probably see way too many memes saying that all you have to do to boost your immune system is eat a blueberry kale smoothie. I still see that dumb banana claim that it cures cancer.
The problem with these immune system myths is that they overlook or ignore a basic physiological fact – the immune system is a complex interconnected network of organs, cells, and molecules that prevents invasion of the body by hundreds of thousands, if not millions of pathogens and other antigens every single day.
And no matter how much individuals try to trivialize the complexity of the immune system, it does not make it so. One can claim all day long that downing a few tablets of echinacea will boost the immune system to prevent colds (it doesn’t), it doesn’t make it scientifically accurate. Nor does it create an accurate description of the immune system.
There has been a general misconception that flu vaccine during pregnancy was not safe. Whether this was based on the general concerns about vaccines or something specific is difficult to determine. One of the worries was that getting a flu vaccine during pregnancy may cause a higher risk of autism in the baby.
The ignorance of the anti-vaccine cult is so annoying, because I have to spend valuable time trying to clear up their myths, tropes, and outright lies. An anti-science website, Health Impact News, recently published an article discussing a flu vaccine study from 2012. I don’t know why it took them this long to use this as an “anti-vaccine” study, but I don’t think keeping up with primary research is high on their list of goals.
I’m going to look at a few of the points the anti-vaccine crowd tried to make, refuting them one by one, by looking at the original article published in the relatively high impact factor journal, Clinical Infectious Diseases. The TL;DR version is that they didn’t get anything right. so, here we go into the fray.
Here we go again. Just like the popular zombie TV shows, the flu vaccine myths continue to rise from the dead, scaring people away from protecting themselves from a dangerous disease. And just like Rick Grimes, it’s my job to help my fellow skeptics stop this zombie outbreak and safeguard the innocent from the brain eating tropes of the antivaccine crowd.