The claim that the HPV vaccine causes infertility comes from an economist, with absolutely no background in science, who wrote a lame and eventually retracted article. The claim is based on faulty logic, methodology, and statistics to the point that it was laughable.
I thought I had read it all, but here comes one out of recesses of the anti-vaccine mind – where logic and science disappear into a black hole. Gayle DeLong’s useless article that the HPV vaccine causes infertility – of course, it’s embraced by the anti-vaccine religion because they’ve got nothing else.
The anti-vaccine religion definitely hates the HPV vaccine more than any other one out there – claiming that it causes infertility is just part of the fear, uncertainty, and doubt campaign. They invent more lies about it while ignoring the overwhelming scientific consensus about the vaccine’s safety and effectiveness. But relying upon facts is generally not something found in the anti-vaccine wheelhouse.
Of course, the false claims about the HPV vaccine often rely upon pseudoscience produced by anti-vaccine shills like the oft-retracted Shaw and Tomljenovic, the infamous Lyons-Weiler, and the preposterous Shoenfeld. Because the anti-vaxxers lack any evidence to support their dislike of the HPV vaccine, they require the appeal to false authority to claim that these discredited pseudoscientists’ work is somehow more important than all of the body evidence, from real, respected scientists, that supports HPV vaccine safety and effectiveness.
So, let’s take a look at this new study from a non-scientist claiming that the HPV vaccine causes infertility. I almost thought about ignoring it, but it’s just too funny.
I know I cut and paste this section to every article I write about HPV vaccines, but it’s the first step to HPV vaccine myth debunking. Some readers may be coming here for the first time, and they ought to know just how the HPV vaccine prevents cancer.
However, I try to update this section when necessary with new information about either the disease or the vaccine. If you’ve read this section 47 times, just skip down to the next section where I discuss the key point of this article.
Genital and oral human papillomavirus (HPV) infections are the most common sexually transmitted infections (STI) in the USA. HPV is generally transmitted from personal contact during vaginal, anal, or oral sex.
It’s important to note that there are more than 150 strains or subtypes of HPV that can infect humans – however, only 40 of these strains are linked to one or more different cancers. Of those 40 strains, most are fairly rare.
HPV is believed to cause nearly 5% of all new cancers across the world, making it almost as dangerous as tobacco in that respect. According to the CDC, roughly 79 million Americans are infected with HPV – approximately 14 million Americans contract a new HPV every year. Most individuals don’t even know they have the infection until the onset of cancer. The CDC also states that over 43,000 HPV-related cancers are diagnosed in the USA every year. It may be several times that amount worldwide.
There were two HPV vaccines on the world market before 2014. GSK, also known as GlaxoSmithKline, produced Cervarix, a bivalent (protects against two HPV strains) vaccine. It has been withdrawn from the US market (although available in many other markets), because of the competition from the quadrivalent (immunizes against four different HPV strains) and 9-valent (against nine HPV strains) Gardasil vaccines.
Merck manufactures Gardasil, probably the most popular HPV vaccine in the world. The first version of the vaccine, quadrivalent Gardasil, targets the two HPV genotypes known to cause about 70% of cervical cancer and two other HPV genotypes that cause genital warts. In Europe and other markets, Gardasil is known as Silgard.
The newer Gardasil 9, approved by the FDA in 2014, is a 9-valent vaccine, protecting against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. It targets the four HPV strains found in the quadrivalent version, along with five additional ones that are linked to cervical and other HPV-related cancers. Both versions of Gardasil are prophylactic, meant to be given to females or males before they become exposed to possible HPV infection through intimate contact.
Gardasil is one of the easiest and best ways to prevent a few dangerous and, to abuse the definition slightly, common cancers that afflict men and women. Without a doubt, the HPV vaccine prevents cancer.
Currently, in the United States, the Advisory Committee on Immunization Practices (ACIP) recommends that preteen girls and boys aged 11 or 12 are vaccinated against HPV. The immunization is also recommended for teenage girls and young women up to the age of 26 who did not receive it when they were younger, and teenage boys and young men up to the age of 21.
Let me sum this all up so that if you come away from this section with nothing else, you get this summary. HPV is a sexually transmitted disease. HPV causes 43,000 cancers a year in the USA alone. The HPV vaccine prevents becoming infected by HPV, which means you are protected from these cancers.
Real medical journals.
That HPV vaccine causes infertility paper – the meta look
The anti-HPV vaccine paper, published by the Journal of Toxicology and Environmental Health A (see Note 1) by Gayle DeLong. Basically, DeLong claims that birth rates in women aged 25-29 fell from 2007 to 2015 as a result of HPV vaccines. Most of the readers will start laughing hysterically just from that claim, but I’ll get to it a bit later. Because there are no spoilers here.
As you all know, I take a meta, 10,000 meters, look at an article I read – are the authors credible, is the journal respectable, and a few other points that really have nothing much to do with the results themselves.
So let’s start with Gayle DeLong. She is not a scientist – she has no background, education, or experience in any field related to vaccines like virology, microbiology, epidemiology, public health, immunology, or other critical fields of biomedical science.
But not a single nanosecond of her education is in any area of biomedical sciences that are germane to vaccines. None. She may claim she’s done “research,” but as I wrote before, to become an expert is not a 2 hour (or, giving her the benefit of the doubt, 100 hours) on Google – to be a true expert takes tens of thousands of hours of scientific research.
Vaccine research takes hard work, a thorough understanding of medical statistics, plus expertise in a large number of biological fields. I have no clue why people like DeLong (and every other anti-vaxxer) think it’s easy, but it’s not. I am convinced that DeLong and her minions believe that vaccines are manufactured in a garage with a blender, a handful of viruses, some aborted human fetuses, a dollop of glyphosate, and then, without any testing, is sold for billions of dollars to unsuspecting parents. Well, DeLong is WRONG.
Furthermore, and maybe I’m speaking from my bully pulpit here, but do autistic individuals really want to be cured? Many of us argue that autism isn’t a disease, it is just a part of the range of human personality and behavior. And trying to “cure” autistic children with pseudoscience and cult science is borderline abusive. No, it’s abusive, period.
Finally, DeLong was once a board member of Safe Minds, an anti-vaccine group that pretends to care about autistic children, but it is just a front for lies about vaccines.
The riveting Orac recently wrote (see Note 2) about this article and DeLong. His pithy comments about her need to be quoted here:
We’ve met Gayle Delong before, first in 2011 when she published a paper that was the ecological fallacy writ large trying to show that vaccines cause autism. Then, a year later, she published an equally risible paper about “conflicts of interest” in vaccine science that was really an attack on the Vaccine Court. Then, in 2014, Delong blamed her breast cancer diagnosis on dealing with her child’s autism and made it clear that she viewed autism as worse than breast cancer. Another thing that you need to know about Gayle Delong is that she is not a scientist, physician, or epidemiologist
…None of that’s stopped her from bravely paddling up the river of pseudoscience in topics where she has no expertise.
So not only has she tried quack treatments for her children, but she thinks that autism is worse than breast cancer? This is a horrific person on so many levels, and this is further evidence that she is not trustworthy with regards to anything in vaccine science.
But let’s move on from DeLong, although, her involvement negates any conclusion one can make.
A couple of other major issues should make every science-supporting reader just shake their heads and wonder why the Journal of Toxicology and Environmental Health A published this awful article. First, let’s look at the acknowledgments section:
The author thanks David Geier, Sabastiano Manzan, Jonathan Rose, and Paul Turner as well as Sam Kacew (the editor) and three anonymous reviewers for insightful comments. Any errors are solely the responsibility of the author.
Hang on, let my head hit the desk a few times. David Geier? The man who was charged by the Maryland Board of Physicians for practicing without a medical license? No, these accusations didn’t result from some oversight on Geier’s part, he is not a physician, never studied to be a physician, and knows nothing about medicine. He, with his father, pushed unethical “treatments” for autism, mainly chemical castrations.
In other words, DeLong is using the criminal David Geier as someone to thank? Did the editors of the journal spend a minute or two “researching” David Geier?
Maybe you’re wondering if the other people she thanked were real scientists who know something about vaccines. That would be wrong. Sabastiano Manzan is also an economist at the same school as DeLong, and he also lacks any scientific background. Jonathan Rose is DeLong’s husband and is a history professor. In other words, she utilizes the expertise of a quack, an economist, and her historian husband to review her condemnation of the cancer-preventing HPV vaccine.
I shouldn’t go on, but I will.
HPV vaccine causes infertility – the pseudoscience
Before I really hit a few points, let’s start right at the top. DeLong looked at birth rates for women 25-29 from 2007 through 2015. User Falls Angel responded with this comment (in an unrelated article) with an important criticism:
The HPV vaccine did not come out in the US until 2006. The upper age limit is 26. Therefore, the number of 25 to 29 year olds who could have received the vaccine in 2007 is only 60% of the total (basically just women ages 25, 26 and 27). Not until 2009 were all women in that cohort eligible to receive the vaccine. What a messed up study!
The cohort used by DeLong didn’t actually include women eligible for the HPV vaccine over that time! This is a fundamental, amateur error by someone who is clueless about vaccines. Frankly, this journal ought to retract this article based on this point alone.
But there’s more. DeLong seems to not understand or examine confounding variables. Confounders are variables that can lead to a spurious association. For example, a lot of studies claim that diet sodas lead to weight gain, which appears to be biologically implausible. However, many of these studies ignore confounding variables, such as those who drink diet sodas may actually consume more calories per day. Or they may exercise less. Or something else. The point is you need to examine those confounders or the study is invalid.
If we are going to undertake a large epidemiological study, we would want to design it in a way to either reduce the effect of or account for the confounding variable. User Mike Stevens pointed out several of these variables (yes there was an extensive discussion of this paper on another article I published) that make the study almost invalid:
1. Women who access sexual health and contraceptive services are both more likely to get vaccinated and more likely to use contraception. 2. Educational attainment, racial and socioeconomic factors, which influence both birth rate and vaccination rates. 3. Women who choose to become pregnant are more likely to be in stable, long term relationships and less likely to want protection against STIs. 4. Religious ideology – some fundamentalists oppose both contraception and vaccination.
In other words, DeLong was looking for data to support her conclusion – let’s dig into birthrate data and make a spurious association with the HPV vaccine while completely ignoring the other dependent variables. She just wanted to believe that the HPV vaccine causes infertility. And science be damned, she was going to manipulate the data in any way, ignoring confounding variables, to get the result she wanted
Real scientific data from the CDC (pdf) shows that the birthrate for this cohort of women has been dropping steadily since the mid-1990s, over a decade before the HPV vaccine became available in the USA. Maybe I missed it, but when I read the article, I found no explanation, because, DeLong employs pseudoscience, not real science, to support her pre-ordained conclusion. That’s just pathetic.
In fact, many researchers believe that the falling birthrate in that group is related to financial situations. The job market for millennial college graduates is rather weak. Did DeLong look at that? Did she examine the income and education of the group? No.
Then there’s one other problem that makes me want to scream – she employs one of those thoroughly debunked myths about the HPV vaccine:
Reports of young women experiencing primary or premature ovarian failure (POF) after receiving the vaccine were noted (Colafrancesco et al. 2013; Little and Ward 2012, 2014). POF—defined as the onset of menopause before the age of 40—is sometimes referred to as premature ovarian insufficiency and thought to be extremely rare.
Let’s look at this two ways. First, the evidence that there is a causal relationship between the HPV vaccine is just not there. The studies DeLong references in that quote are case studies, which rank near the bottom of the hierarchy of biomedical research. There is no possible way to use them to show any type of biologically plausible link between the vaccine and POF. But DeLong wants to use this nonsense as support for her findings.
Secondly, DeLong ignored the huge body of evidence that includes massive, multi-million patient studies that have not detected POF after receiving the HPV vaccine. None. In fact, a review of HPV vaccine research did not find any relationship between the vaccine and POF.
I am not a statistician, nor do I claim to be one. Orac does a huge service to the pro-vaccine community by picking apart the statistics of all of these garbage anti-vaccine studies, and he makes it seem that DeLong just threw a bunch of stats at us to confuse us. Orac wondered why DeLong didn’t even bother to look at contraceptive use:
In any case, I can see only two explanations for Gayle Delong’s not having done this analysis, given that the data appear to have been available. Either she was clueless and didn’t even consider it as a covariate, or she did some exploratory analyses and with contraceptive use included the effects that she saw disappeared. After all, they weren’t very robust; so I suspect that it wouldn’t take much.
But there’s one point I noticed while reading the article – I didn’t see a statistical difference between pregnancy rates after 1, 2, and 3 doses. If you’re going to publish in a toxicology journal, the basis of all toxicology is a dose-response analysis. In other words, if one dose is bad, then three doses should be worse. Yet we don’t observe that here, probably because the HPV vaccine is not linked to birthrates.
Update – Elisabeth M Bik criticizes the paper too
I was pointed to a PubPeer (a great website where scientists critique published articles) discussion of the DeLong article, which brought up a point that many of us missed. Dr. Elisabeth Bik stated that:
The 2 groups also differ in a very important confounding factor, i.e. % college degree. The HPV vaccinated women had a significantly higher percentage of college degree than the non-vaccinated group. This is a huge confounding factor. Women with a college degree have babies at a higher average age (30.3y) than women without a college degree (23.8y). Here is a graph based on 2016 data from the National Center for Health Statistics illustrating this difference:
The author limited her study to women aged 25-29, which is below the average age that women with a college degree have their first baby. If you limit the study group to women <30 years old, that means that the average women with a college degree did not have their first baby yet. This age group is chosen too narrow to make any correlations with the vaccination status.
This is not only a “huge” confounding factor, but it is also one so obvious that many of us missed it. The more important point is that DeLong tries to claim that the HPV vaccine causes infertility whereas there seem to be more important factors that affect the rate of pregnancy by age – like a college education.
Dr. Bik also pointed out one other concern that should be emphasized:
The author does not give any possible explanation for the mechanism at which the HPV vaccine might cause a lower pregnancy rate.
To establish causality, one needs to provide powerful evidence of both correlation and biological plausibility. Because of her awful analysis, like ignoring confounders, she did not establish a correlation that clearly shows that the HPV vaccine causes infertility. In fact, her data shows what we already know – pregnancy rates are affected by education, income level, age, everything but the HPV vaccine.
Finally, she provides no information that would allow any rational human being to accept that there is some biologically plausible link between the HPV vaccine and fertility. None.
As another PubPeer commenter wrote:
The HPV immunization is comprised of naturally-occurring HPV antigens. POI/infertility is not a condition associated with HPV infection (although cervical cancer leading to infertility certainly could be related). There is no plausible mechanism to explain why a vaccine containing HPV antigen would be able to cause POI/infertility, while the wild-type virus cannot.
Of course, as I mentioned above, well-done studies have not shown any link whatsoever between the HPV vaccine and POI. And those studies were actually run by people who understand public health issues – epidemiologists, not an International Finance researcher.
Obligatory cute photo with baby and puppy. Photo by Picsea on Unsplash.
UPDATE 10 December 2019
This was a garbage study written by DeLong who has zero expertise or knowledge about anything relevant to vaccine science. Well, apparently the editors at the Journal of Toxicology and Environmental Health A agreed with Dr. Elisabeth Bik, this old dinosaur, and a bunch of other intelligent people, and they decided to retract the article.
And this now adds to the long list of anti-vaccine “scientific research” that has been retracted and tossed into the dustbin of useless junk on the internet.
The dedicated people at Retraction Watch have looked into the retraction of this article and stated that, according to the publisher, the reason for the retraction was:
All of the post-publication reports we received described serious flaws in the statistical analysis and interpretation of the data in this paper, and we have therefore taken the decision to retract it.
Hey editors, we said this a year ago.
Summary
Let me put this simply – this article, which tries to show that the HPV vaccine causes infertility, is pure, unfettered rubbish. The science wouldn’t meet the standards of a high school science journal.
The Journal of Toxicology and Environmental Health A did the right thing by retracting this heaping pile of putrid equine manure? Before I updated this article today, I originally wrote:
I think we should start the countdown to retraction.
Well, it took way too long to get there. Sadly, this detritus was used by anti-vaxxers to claim that the HPV vaccine was “dangerous,” and the damage is already done. But now you know, this was bad science, and now it will be marked with the retraction statement.
One last thing. The anti-vaccine forces love to pull out the trope that “XYZ vaccine causes infertility.” As we showed here, their claims about the HPV vaccine are completely and utterly false. But now they are using this to attack the COVID-19 vaccines. Of course.
Notes
There are two versions of the Journal of Toxicology and Environmental Health, A and B. A focuses on “current issues,” whereas B focuses on “reviews.” These are, by far, the oddest names for mainstream journals I’ve ever seen.
Yes, I know that I occasionally write about a topic that Orac just did, it is not proof of anything, including the oft-repeated claim that Orac and this ancient feathered dinosaurs are one and the same individual. Though we do have long reviews of the Walking Dead universe – we should publish those. Maybe the old dinosaurs it talking to himself.
This article was originally published in June 2018. It’s been updated to include Dr. Elisabeth Bik’s critique of one huge confounding factor. I’m still embarrassed that I missed it the first time around. I also did some minor copyediting and reformatting, just because I can.
Lifetime lover of science, especially biomedical research. Spent years in academics, business development, research, and traveling the world shilling for Big Pharma. I love sports, mostly college basketball and football, hockey, and baseball. I enjoy great food and intelligent conversation. And a delicious morning coffee!
