Goodnight, Kitten
Posted on July 15, 2016 1 Comment
I didn’t have a lot of pets growing up. What pets I had were a combination of dogs we inherited or just randomly adopted (or they adopted us), and a cat or two that liked to be around us. Mom had some parakeets once, but then she lost it when they died. There is also the story of me adopting a baby chick that grew up to be a rooster.
When I started dating my wife ten years ago, we mutually adopted a little cat. My wife already had a 14 year-old Maine Coon with an attitude. The Little Cat was our little girl, a sign that our relationship was going somewhere. When we brought the Little Cat home, the Big Cat almost packed up and left. Seriously, he was pissed. But they grew to respect each other and live in harmony.
Big Cat passed away about six years ago, and Little Cat became the alpha cat of the house. She then got a little brother that ended up dying in an accident. After him, she got two sisters. Along with the dog and the Guinea Pigs in my office, they all got to give the house a lot of life. They gave us a lot of love, too. And we got a good bit of laughs from all their shenanigans.
Unfortunately, the Little Cat developed cancer on her neck. After a few months of trying different things, the tumors got so big that they got in the way of her eating, drinking, and breathing. The humane thing to do was to euthanize her. So we took her to the veterinarian last week and said goodbye to her. It was very, very hard to do. We miss her dearly.
How could you not love her?
I’ve always been amazed that we humans come to be so close to these furry animals. They truly do become our family. The Little Cat was truly our little girl, a symbol that our dating did progress to our current marriage (six years and counting)… That we are both committed to this home, to ourselves, and to these kittens.
Goodnight, kitten. I hope you’re enjoying a big batch of catnip with the Big Cat and the Boy Cat… And all other cats who’ve moved on.
Up in a high place
Posted on July 14, 2016
The first time I went to High Rock was when I first moved to south-central Pennsylvania in 2000. I was a stranger in a strange land, but sitting atop that high place allowed me to see that it was not much different than other places I’ve been to. It was very green, yes, but the houses were still houses, and the people were still tiny compared to the size of the world.
The second time I went up there was when I was dating my wife. We went up there and took some pictures of us goofing off as we laid on top of the rock.
The third time I went up there was a few days ago at sunset. The clouds were rolling in, so I got some nice shots of the sunlight coming through the clouds. I had forgotten how much people liked to write stuff up there. Although there was a sign to not spray paint or write anything, there were still plenty of things written, old and new.
Of numbers and proportions
Posted on July 11, 2016 4 Comments
Last week, after the events in Dallas, Texas, where 5 police officers were shot dead, the Chief of Police in El Paso, Texas, decided to make a statement. Unfortunately, he decided to label the “Black Lives Matter” (BLM) movement as a hate group. This is unfortunate because we’re at a point in history where there needs to be a discussion between two groups: Police Departments and the people they serve. Community relations in many police departments are in trouble — to say the least — and work needs to be done to repair the bad feelings floating about.
Today, the Chief issued a statement to clarify what he meant. As usual, we all misunderstood him:
“The remarks I shared after Friday’s press conference were made during an emotional time, I hope everyone can respect that. I am a police officer first and foremost and it truly pains me any time an officer is killed. As Police Chief, the most difficult part of my job has been to notify wives, mothers, fathers and children that their loved one has been killed. I have had to bury five officers during my tenure and I will never forget their faces.
Having to endure that and hearing and seeing the negative actions that are taking place at some “Black Lives Matter” events truly disturb me. For example, in New York City, the protestors were chanting, “What do you want?” and the response was “dead cops.” At another protest in Minnesota, the protestors were chanting “pigs in a blanket fry them like bacon.” In Harlem and in Dallas “Black Lives Matter” supporters were cheering after police officers were killed. Is anyone stepping up and condemning or even attempting to stop these activities or this kind of rhetoric? NO! These actions directly and indirectly influence people looking to take part in negative activities. Our City supports the initial cause for the creation of “Black Lives Matter” but we do not support violence in any shape or form.
Our police forces need to know they have support and wanting “dead cops” is not acceptable. I grew up in the 60’s when racial tension was at its height and Martin Luther King was marching and NOT condoning violence in any manner. What is going on today is wrong! I work very hard to ensure accountability among my officers, our discipline boards include police administration as well as civilians. We do not accept negative actions on the parts of our officers and have put procedures in place to protect our community members as well as our officers.
Now is the time to mourn the loss of the police officers and the individuals that have fallen as part of the tragic shootings across America. There needs to be discussion and scrutiny of the real issues to better address this situation”
I made a comment about how people have come out and called out any BLM members on not saying inflammatory things. This is the comment I got:
This is the kind of thing that I usually hear about vaccine-preventable outbreaks. The antivaxxers will say something like, “If vaccines are so good, then why were there so many vaccinated kids part of the outbreak?” The question that needs to be answered in these kinds of situations is not what the absolute number is. These kinds of things require proportions.
According to the US Census, 13.3% of the US population are African American only. According to the Washington Post, 124 of 515 fatal police shootings so far in 2016 had African Americans as the victims. That’s 24% of all shootings. In 2015, the number was 258 of 990 shootings. That was 26% of all shootings.
While Audrei up there was somewhat correct in her numbers, in that there were more Whites being killed than “BLACK” citizens, the proportions tell the true story. If all things were equal, then we’d see that about 13% of shootings involved Black victims. But things are not equal, are they? For some reason — or a myriad of reasons — Blacks are being shot and killed at about double the rate as other ethnic groups.
That’s for a discussion at a later time, and possibly a different setting.
Public Health is in a bit of a pickle over the nasal flu vaccine
Posted on June 29, 2016 4 Comments
About a week ago, the CDC Advisory Committee on Immunization Practices voted to not recommend the use of the Live-Attenuated Influenza Vaccine (LAIV). This vaccine is given as a spray up each nostril and it is sold as FluMist in the United States. Here’s what the reasoning was:
“In late May, preliminary data on the effectiveness of LAIV among children 2 years through 17 years during 2015-2016 season became available from the U.S. Influenza Vaccine Effectiveness Network. That data showed the estimate for LAIV VE among study participants in that age group against any flu virus was 3 percent (with a 95 percent Confidence Interval (CI) of -49 percent to 37 percent). This 3 percent estimate means no protective benefit could be measured. In comparison, IIV (flu shots) had a VE estimate of 63 percent (with a 95 percent CI of 52 percent to 72 percent) against any flu virus among children 2 years through 17 years. Other (non-CDC) studies support the conclusion that LAIV worked less well than IIV this season. The data from 2015-2016 follows two previous seasons (2013-2014 and 2014-2015) showing poor and/or lower than expected vaccine effectiveness (VE) for LAIV.”
If you’ve been a reader of this blog for a while, you should know that I don’t think there are any sacred cows when it comes to vaccines. In essence, I don’t blindly defend vaccines, contrary to what the antivaxxers claim. You should also know that we — epidemiologists — kind of saw this problem coming, especially after the Center for Infectious Disease Research and Policy published a report where the main conclusion was that we need a game-changing vaccine against influenza because what we have right now is not nearly as good as we need it to be. I mean, for crying out loud, a 3% effectiveness?
Effectiveness, by the way, is the real-world protection a vaccine provides. Efficacy is what the clinical trials (under near-perfect conditions and with a very homogenous population) tell you about the vaccine. Here’s a really good presentation from WHO on how these two concepts are used in vaccine policy.
Anyway, this recommendation against the LAIV puts public health in a bit of a pickle because it’s a vaccine that, for the most part, is marketed for use with children (although it can be used for anyone between 2 and 49 years of age). Because it doesn’t involve a shot with a needle, a lot of parents ask for it for their children, and a lot of children are okay with taking it.* Also, because many schools have policies against forcefully restraining a child, they’re more amenable to giving the LAIV over the injected vaccine. (Some kids are much stronger than they seem when it comes to holding them in place for a needle in the arm.)
In other words, no fuss, no muss.
So what does public health do now? Do they continue with the vaccine clinics in the fall as scheduled knowing that there will be people who will not want the injectable vaccine for their children? Do they cancel the clinics and just hope that parents will talk it over with their pediatricians on whether or not to get the LAIV although it’s not recommended? And what about insurance companies? Will they pay for the LAIV when it is not recommended this upcoming season?
What’s really complicated is that this all has to be communicated to everyone in a way that is understandable. We in public health need to explain efficiency and effectiveness, the science of the flu vaccine in general, the science of the LAIV versus injectable vaccines, and why the LAIV may come back next year. Sprinkle on top of that the fears that antivaxxers bring to the party and…
And it’s going to be an interesting flu season.
*This is anecdotal because I’m not able to get the numbers right now. But, trust me, A TON of parents ask for the spray over the shot for their kids.
The fight against inanimate objects
Posted on June 27, 2016 6 Comments
The US Representative (Scott Perry) for my district had a “town hall” over Facebook the other night. He was sitting in his Washington office and took questions from people watching the live feed. On the one hand, I’d like to give him credit for taking questions from his critics (like myself). On the other, he answered a question about gun control by reading “facts” from an infographic.
Yes, we’ve reached the level of laziness in Washington where politicians don’t research things themselves (or even have their staffers do it for them). Mr. Perry went to a pro-gun website, printed out their infographic, and read from it online. He tried to convince us that some developed nations have higher levels of violence although they have strong laws against gun possession by individual citizens. He also tried to convince us that, according to the infographic, guns are used over 80 times more often to defend people from crime than to kill someone.
Right. Because a survey conducted in 1995 from a pro-gun group in which merely mentioning that you had a gun is considered an instance of “using” a gun to protect yourself should be trusted today in 2016. (The survey had some fatal flaws, by the way.)
During the discussion, someone mentioned that we shouldn’t “punish” an “inanimate object” (i.e. guns) for what people do with them. I was relieved to hear that someone was thinking of the guns. I mean, who is going to lobby and advocate for the guns if not Mr. Perry in Congress?
I’m being sarcastic, by the way.
I’m getting exhausted of telling people who are so enamored by guns (aka “ammosexuals“) that no one it trying to take their guns away. No one is going to take them away. They will not see any police force come and take their guns en masse. That is not what “gun control” is all about. But they won’t listen to reason.
It’s also exhausting to hear ammosexuals say a variation of “Chicago/Baltimore/New Orleans has the highest gun murder rate although they have strict anti-gun laws.” It’s almost as if they think we’re idiots and don’t know that these cities are surrounded by states or jurisdictions with loose gun laws. It’s as if they think that guns are either born legal or illegal (or they come over the border?).
All guns start off as legal guns until something happens that has them land at the scene of a crime. Unfortunately, they also often land at the scene of a suicide. Very rarely, but just as tragically, they land in the hands of someone willing to mow down dozens of people at a time. And very, very rarely, but incredibly tragic, they land in the hands of children.
So, one more time, I’d like to explain to any ammosexuals that “common sense” gun control is asking for gun to be kept away from people with known factors that place them at higher risk for using guns violently. Pennsylvania currently does this by making it illegal for certain people to own a gun. This way, if someone really wants a gun, they’re going to have to break the law.
“But don’t criminals not care about the law? So they’ll just go get a gun anyway?”
Well, yeah, but this assumes that everyone is a criminal. This assumes that John Doe who’s a habitual drunkard will decide to go one step further and go get a gun illegally because he absolutely MUST have a gun. That’s not the case. People who use guns in places like Chicago or Baltimore got their guns from places nearby (I-95 takes you up and down the coast pretty fast, and Chicago is a short drive away from Indiana, Michigan, and Wisconsin. In Indiana, you don’t need a background check to buy a gun from a private dealer. The same goes for Wisconsin. In Michigan, you can purchase a long gun without a background check, while purchasing a handgun requires a permit (which requires a background check).
So you can see how someone involved in criminal activity can jump in their car and go to another state to buy a weapon… Or how someone living in those other states and wanting to do “business” in Chicago can get a gun quite easily. Or they can have someone get the gun for them. Hence the need for a more federal (universal) approach to background checks. And people caught illegally owning a gun? The punishment should be so painful as to make them think twice before doing it again, and anyone else thinking of doing it should also have to think twice.
Sadly, we have a Congress that has been bought and paid for by special interests (e.g. NRA) so that nothing — absolutely nothing — gets done in terms of gun control. Many politicians there, and from both sides of the political spectrum, are afraid of messing with those special interests or somehow “infringing” on the 2nd Amendment. They ignore the fact that rights come with responsibilities, and that there are plenty of other rights (e.g. voting) that are very well regulated.
The Rorschach Test of anti-vaccine beliefs
Posted on June 15, 2016 1 Comment
You have probably heard by now about a documentary spliced together by known anti-vaccine fraud Andrew Wakefield. I write that it was “spliced together” because so much of it is non-linear. There’s no introduction, thesis statement, and supporting facts. It’s all a hodge podge of talking heads, testimonials, spliced sampling of a recorded conversation of a CDC scientist who never steps in front of the camera, and plenty of imagery of how evil vaccines can be.
It’s like having a fever and having a nightmare where Andrew Wakefield’s feet chase you around to shove something in your brain.
I had a chance to watch the documentary the other day, and let me just say the following: You get from it what you go into it with. That is, if you are a rational human being who has some understanding of basic science and can see bullshit when it is being served to you, then you see the documentary for the filth that it is. If you, on the other hand, are the kind of person who believes in monsters under the bed, massive government conspiracies from a government that can’t fix potholes or respond well to a natural disaster, and believe in the appeal to ignorance (if we don’t know it’s safe, then it must be unsafe), then you see Andrew Wakefield’s and Del Bigtree’s documentary as the seminal documentary to end the debate over the association between vaccines and autism.
Except that it’s not evidence. There’s nothing there. Nothing from that documentary holds up to what we know about vaccines and/or autism. If there is such a thing as “click bait” for the real world, where instead of page views you get cash from ticket sales, this is it. The documentary is sold and presented for parents who are frustrated about their children having a medical condition or their children being autistic (autism is not a medical condition). They want someone to pay for what, in their mind, is a “curse,” and they want vaccines to be the culprit because vaccines are so ubiquitous in the United States that almost everyone who is autistic or has one of those medical conditions has been vaccinated.
The documentary is kind of a Rorschach Test for the viewer. You really do see what your mind wants you to see. As an epidemiologist, there was no evidence there — nor has there ever really been — of a causal association between vaccines and autism. As a person with a college degree and a master’s degree, the science doesn’t hold up. I’m not going to lie to you to tell you that there were plenty of times when I just rolled my eyes, and there were others when I wanted to reach through the screen and put my finger to the mouths of the talking heads and say, “Shh! Shh! You don’t have to keep lying. You have your cash.”
As a non-sociopath, it hurt me to see so many parents being lied to. They were allowed to continue to believe that the best public health intervention of our era is what is causing them distress. (Because it is all about the parents. How the children feel being called, well, being called ugly names, that was all left out.) These parents keep being fed lies in the hope of an eventual cure that is not coming. People that sell fake cures in the United States and elsewhere are known as frauds, and there are legal consequences to what they do. Yet Andrew Wakefield and others continue to sell fake medicine, or fake hope. It’s all fake, all of it.
You know what, on second thought, there is a method to this madness. As I wrote above, this is real-life click bait. The imagery, the splicing of audio recordings, the careful selection of who says what… All of that is intended to get people to pay cold, hard cash to get into theaters to watch this. It is not intended to give anyone hope, even if it does. It is not intended to reveal some grand conspiracy, because there is none. And it is not intended to inform science and medicine about a link between vaccines and autism, because all possible combinations of research into the subject are pretty much done.
Cash is what these people wanted, and cash is what they got from my friend who paid for my ticket in the hopes of convincing me of that link. Sorry, dude, there is none. As I and others have pointed out, we will continue to vaccinate in order to protect the youngest and most vulnerable among us. Furthermore, we will continue our collective efforts to make people understand that autism is not a curse or a disease, and that autistics have always and will always be part of our lives.
Then again, you don’t have to take my word for it. Here are other reviews of the mockumentary:
The fear a 12 year old Mexican can raise
Posted on June 5, 2016 16 Comments
I think I’ve told you this before once or twice, but let me just repeat the story again. When I was a kid, I was always interested in all things having to do with science and technology. Dad was a car mechanic, his two brothers fixed televisions and radios. They learned their respective trades through books and manuals that my grandfather bought for them on his trips to the US. So I learned from them how to look at complex systems, see what’s broken, and go on a course of action to fix it.
Later, when I expressed interest in science some more, mom bought me a microscope. I must have been in 4th grade then. I went to public school in Mexico from first to fifth grade. Starting in sixth grade, we moved to the States. Anyway, I had that microscope and would put things under the lens only to be amazed time after time. There were living organisms in drops of water, even potable water. There were these neat crystals in a few grains of common sand. Leafs were made of small units that I did not fully comprehend.
To help me comprehend all that, mom and dad bought me books. I had encyclopedias and textbooks on science, and I absorbed them all in full. There were many times when I cut short play time outside with my friends to finish up reading about a topic of interest. However, because we were not well-off, I didn’t get a chance to fully take advantage of my intellectual curiosity. There just wasn’t enough money to send me somewhere with a better science and technology curriculum. Even when we moved to the States, public school was more about the basics (and a lot of Texas history on how “the Mexicans” killed all those innocent Americans at The Alamo).
By the way, I was fully bilingual by the sixth grade. Not only was English taught in school, but we lived on the border and I had American cousins. English was not a foreign thing to me.
I’m telling you all this in order to set-up the story of Marco Arturo, a 12-year old child prodigy from Mexico, and the irrational, xenophobic, and bigoted reaction he’s getting from the anti-vaccine crew. See, Marco posted a video about how vaccines cause autism…
Or, rather, how they do not. That video now has 7.2 million views. (For comparison’s sake, Andrew Wakefield’s chock-full-o-lies “documentary” on vaccines and autism has only been seen by about 30,000 people, and I’m being generous in that estimate.)
How did the antivaxxers take it? Well, here you go:
That post from “Levi Quackenboss” is discussed here and here. In essence, the replies attacks on Marco from the antivaxxers have resorted to personal attacks, to questioning if he is even a real person, and to wonder how in the world a Mexican kid could know English and be so well-versed in science and technology.
Yeah, I kind of wondered that myself. Oh, wait.
In my experiences with the antivaxxers, I have come to find out that they have a very egocentric view of the world. It’s all about them, them, them. If they experienced something, then everyone must have experienced the same thing. If their child was diagnosed with autism after the vaccines, then it must be the vaccines, and everyone getting vaccines will be autistic. (And the way they characterize autistics? Come on!) If they were not as eloquent and understanding of science as Marco is now, then Marco must be fake. He must be being coached.
And, even if he was being coached, there is nothing in any of his statements about vaccines and autism that are wrong. As much as they try to attack him, they can’t poke a single hole in his science. There simply is no evidence that vaccines cause autism, and whatever “evidence” is being bandied about is all about character assassination, conspiracy theories, and conflicts of interest. It really makes me sad for the antivaxxers they are so insecure in their beliefs that they are now allowing a 12 year old child from Mexico to live rent-free in their minds.
Finally, the undertones of racism. “Quackenboss” claims that kids in Mexico can’t possibly be as bright as Marco. And, if they are, they are being coached as part of some multi-national conspiracy. They claim that Mexico is pretty much a slum where children can’t be bothered with science and technology. As I sit around at my ancestral home in Chihuahua,* I see that this is not true. Yes, Mexico has a lot of challenges, and children here deserve better, but there are many of us who are lucky enough to have parents who instill in us a sense of wonder about nature and then foment that wonder with books and tools and great people/mentors to lead us on our way to discover more and more.
So kudos to Marco Arturo. I see a bright future ahead as a science communicator, scientist, and fighter of the good fight.
*I’m down here because dad is having some health issues. More on that when we’re ready to be more public about it.
Where have they seen me before?
Posted on May 31, 2016 1 Comment
Right before I started the doctoral program, I had enrolled in a certificate program for leadership in public health. It was aimed at professionals who worked full time, but it had a couple of shortcomings. First, the assignments required working in groups at a time when there wasn’t a particularly good online/remote way of doing it. Second, the assignments themselves were not very clear. Third, the in-person classes took places at all sorts of weird places around the state. Finally, the person coordinating the whole thing and giving the in-person lectures was, in my opinion, not an effective teacher.
When I started to fall behind on an assignment, I emailed the coordinator for clarification on a couple of points. Their response? Well, their response was a rant about how I didn’t pay attention in class, was always distracted, and how I played with my toy (i.e. the iPhone) instead of paying attention. Yes, they repeated the paying attention thing twice while never answering my questions about the assignment.
I let that email sit for a while as I had other things to take care of. When I got back to it, I decided to thank them for their feedback and move on. But before I completely abandoned the whole thing, I asked for the opinion of some of the other students. Magically (not), what I mentioned to other students got to the ears (or eyes) of the teacher. This resulted in yet another email rant about not bringing matters up to them when I should have.
Sigh.
One of the biggest things I’ve learned as a teaching assistant and when I taught a couple of courses for lab assistant students is that, no matter how childish the students’ behavior, they want to be treated as adults. It’s also counterproductive to take things personally. Teaching is not a business, per se, but the relationship is very much a customer-provider one. The student is a customer, and they need you to provide knowledge and tools to retain that knowledge.
After that second exchange, I emailed the person back and thanked them again for their feedback. I then explained that I was abandoning my attempt at the certificate. I didn’t give reasons. I just wrote it and that was it. There was no use in trying to argue any point if the answer was going to be yet another rant.
As it turns out, the coordinator of that certificate program has some sort of affiliation with the school of public health. I’ve seen them once or twice at the school. They always look befuddled when they see me. It’s as if they wanted to place me in their minds but cannot. After all, they only saw me in person twice.
Sure, I’d like to walk up to them and show them all the notes I kept from those certificate classes. They’re a lot of notes, and they’re in a notebook at home. Lots of good tips on leadership and management are in those notes. Sadly, they’re not in those emails.
Another day, another bad anti-vaccine study
Posted on May 27, 2016 6 Comments
Let’s say that you think food A caused disease B. To test your theory, you get cases of people who got B and controls of people who did not get B. Then you compare the odds of exposure to A. The ratio between the odds is called the odds ratio, and anything significantly different from 1.0 means there’s some sort of an association (if both ratios are equal, two equal odds divided by each other are equal to one). For these case-control studies, it is very important to choose your cases and controls carefully. If you are not careful, you mess up the odds of exposure, messing up the odds ratio. When that happens, you make it look like two things are associated when they’re not.
This is what we in the biz call “bias.”
Now, let’s say that you’re dead-set on blaming A for B. But, as you get older, you’re more likely to be exposed to A, and you only get diagnosed with B as you get older. Can you see where, even if there is no association between A and B, you could see one because time moves forward? You see an example of this in real life with Nobel Prize awards. You would think that only older adults get Nobel Prizes, or that being old is associated with getting a Nobel Prize. The problem is that all the work you need to do to earn the prize takes time, so you can only get it after working in your field a long time. Very rarely will someone very young get it.
Get it?
So why am I writing all this? I got a tip from Todd W. (you should go read his blog) of a study by some known anti-vaccine luminaries. The study, published in Brain Sciences (an online and open source journal) attempts to link the Hepatitis B vaccine given at a young age (usually between birth and six months in American children, but available to people of any age) and Hyperkinetic Syndrome of Childhood (HKSoC). Guess what the anti-vaccine activist “researchers” found?
Go ahead and guess. I’ll give you a few seconds.
Surprise! They found an association between getting the dreaded “mercury” (aka thimerosal) in Hepatitis B vaccines to a diagnosis of HKSoC later. My guess is that they would have published nothing if there was no observed association, given that at least one of the authors — Brian S. Hooker — has an ongoing case in the vaccine court. In my opinion, it is essential for BS Hooker to find an association between vaccines and almost anything so that his case can have a little more heft to it. A couple of the other authors bill themselves as vaccine experts, although they have some questionable credentials. So let’s start there.
Not too long ago, David Geier (“The Son”) and Mark Geier (“The Father”) got into hot water in Maryland because of The Father’s medical misadventures. For a while, The Father and The Son diagnosed children with autism as having an overabundance of testosterone and treated them accordingly. That is, mistreated them. There is no evidence that testosterone causes any aggravated symptoms of autism. As Todd W. reports:
“Dr. Geier, through his Institute of Chronic Illness and Genetic Centers of America, misdiagnosed autistic children with precocious puberty so he could claim that he was using Lupron on label, rather than for an unapproved, experimental indication (i.e., autism). This also allowed him to bill insurance companies for the lupron. His actions got him into hot water with various state medical boards, starting with his medical license in Maryland being suspended on April 27, 2011. Since then, one by one, 11 of his 12 medical licenses were suspended, an application for a thirteenth license in Ohio was denied, and some of those suspensions became complete revocations. The last actions I wrote about were the revocation of his license in Missouri and suspension of his Illinois license. At the time, the only state left in which Dr. Geier could practice was Hawaii.
As of April 11, 2013, that is no longer the case.
Although his license listing on the Hawaii state Professional and Vocational Licensing search has yet to be updated as of this writing, searching the state’s RICO Complaint History database reveals that the board revoked his license last month. The case number is MED 2011-79-L (if the link to the PDF doesn’t work, go to the OAH Decisions web site, click on OAH Final Orders and search for “Geier”). According to the Final Order, a petition for disciplinary action against Dr. Geier was filed on July 17, 2012, Geier was notified on November 19, and a hearing was held on February 5 of this year. Dr. Geier failed to appear for the hearing and did not file for exceptions or extensions to delay the hearing.”
Not only that, but The Son (David Geier) was charged with and found guilty of practicing medicine without a license.
In other words, the authors have more conflicts of interests than what they led on in the study’s COI statement:
“All of the investigators on the present study have been involved in vaccine/biologic litigation.”
To say the least.
But what about the study? Is it any good? No, it’s not good. Before I tell you why it’s not good, let’s talk about their conceptual framework. These anti-vaccine luminaries’ theory is that exposure to the Hepatitis B vaccine and the thimerosal therein leads to HKSoC. To test their theory, they used the Vaccine Safety Datalink (VSD), a database maintained by the Centers for Disease Control and Prevention (CDC) where vaccine outcomes are tracked. Basically, if you are part of a healthcare system that reports to VSD, the vaccines you get (their lot numbers, dose, etc.) are reported to the database. If you ever get sick and go to the same healthcare system, those following visits (for whatever cause) are also reported to VSD. Anyone with the time and money can then “dumpster dive” through the data and try to come up with something to publish.
This is not to say that the VSD is a bad idea or a waste of time. Serious scientists who account for all possible sources of bias — and thus all possible confounders — can get a lot from the data in it. It’s actually the reason we know that HPV doesn’t cause all the horrible things that anti-vaccine people attribute to that vaccine, or any vaccine. There are millions of doses given to millions of people and reported in the VSD, and there is yet to be any credible sign of anything really bad coming from all those vaccinations. There is also no evidence of autism rising from increased vaccination. (Note that I didn’t lump autism with “anything really bad” because autism is not bad. I know. I know. Antivaxxers won’t believe this.)
Anyway, as I told you in the opening paragraph, when you choose your cases and controls, you have to choose them at random is possible, and without any kind of bias as to how to classify them, except for whether or not they’re cases or controls. You don’t say, “Okay, you are a case if you have the disease and…” There is no “and.” You’re a case if you have the disease. You’re a control if you don’t have the disease. Injecting any more requirements triggers a bias. Again, if I think that A causes B, and I only choose cases who have been exposed to A, how do I know that B isn’t caused by something else if I left anyone exposed to that something else outside of my study?
But that is exactly what these people did. From their methods section, with my emphasis:
“To locate the initial cases of a diagnosis that fell within the HKSoC spectrum (ICD-9 code: 314.xx), including the following subtypes: attention deficit disorder without mention of hyperactivity (314.00), psychiatrically known as ADD; attention deficit disorder with hyperactivity (314.01), psychiatrically known as ADHD; hyperkinesis with developmental delay (314.1); hyperkinetic conduct disorder (314.2), and other specified manifestations of hyperkinetic syndrome; (314.8) and unspecified hyperkinetic syndrome (314.9), the outcome files were examined. This included both outpatient and inpatient diagnoses. When multiple cases of HKSoC umbrella in a child were discovered, only the initial one was used. Table 1 summarizes the year of birth of the children diagnosed with HKSoC identified in the present study. Among those children diagnosed with an HKSoC identified in Table 1, only children where the HKSoC diagnosis came after they received a HepB vaccine were allowed in the analyses. This step was incorporated to be sure of the necessary temporal cause and effect relationship.”
Read that again. Only children where the diagnosis came AFTER the exposure were allowed into the analysis.
“But Hepatitis B vaccine is given immediately after birth, of course the diagnosis will come after the exposure?” you ask. Well, not for everyone. And even if those numbers are relatively small, it is important to know if and how many cases of HKSoC are occurring in the yet-to-be-vaccinated or unvaccinated.
Then this is how they got their controls (children without the HKSoC diagnosis), with my emphasis:
“To find control children who did not have an HKSoC diagnosis and only a low probability of getting that diagnosis later as they were followed-up, the control children had to be enrolled continuously from after birth up until they were at least 7.55 years old (mean age of initial HKSoC diagnosis + SD of mean age of initial HKSoC diagnosis). When this rule was applied, it left a group of control children numbering 20,584, with males = 10,303, females = 10,281, and male/female ratio = 1.002. Their year of birth ranged from 1991 to 1993. Thus, the exclusion criteria for the control children (those without a diagnosis of HKSoC) were lack of continuous enrollment, lack of record of the child’s gender, and an age of less than 7.55 years. The year of birth of the control children used in the analyses are summarized in Table 1.“
Reading how they got cases and how they got controls, do you think that they’re cases and controls are comparable in their chances of making it into the study? No. The answer is no. Then, if you remember what I said about the Nobel Prize, and what I’ve told you about the vaccine, and what we see about HKSoC diagnosis… What can you conclude about the vaccine and the chances of diagnosis?
Yes, the older you are, the more likely you are to have been diagnosed if you were going to develop HKSoC. And, the older you are, the more likely you are to have been exposed to more thimerosal because you’re more likely to have all three doses of the vaccine. But these “researchers” didn’t control for that. They didn’t even take into account that maybe there were cases out there who were vaccinated post-diagnosis. By inserting that requirement that you had to be diagnosed AFTER AND ONLY AFTER being vaccinated, they wiped out an entire universe of possible cases that we don’t get to know in this “research.”
So, do exposed cases and unexposed cases have an equal chance of making it into the study? No, because of the requirement of being vaccinated before the diagnosis. And do exposed controls and unexposed controls have an equal chance of making it into the study? No, because most children will be vaccinated (exposed) by age 7, raising the chances of the exposed to be in the study more so than the unexposed.
To seal the deal of doing epidemiology and biostatistics in a really weird way, the only statistical analysis the authors report doing is a Fisher’s Exact Test, which is fine for 2×2 tables, but it’s not really as good as linear regression, especially with all the possible covariates that exist in the databases (e.g. age, gender, ethnicity, location). They did a Fisher’s on the gender strata, but that is as far as they controlled for covariates.
Really sloppy work.
So what do we have in this new anti-vaccine piece of propaganda disguised as “research”? We have:
- Authors with serious conflicts of interest.
- An author whose previous “research” has been retracted because it was just as bad as this one.
- An author who conducted very questionable “medicine” on children and lost his medical license for it.
- An author who was found guilty of practicing medicine without a license.
- And funding by an anti-vaccine foundation, the Dwoskin Family Foundation.
So does the Hepatitis B vaccine cause HKSoC? Not according to this analysis, and using this analysis to say that it does is irresponsible at best and dangerous at worse due to the seriousness of a hepatitis B infection if the vaccine is not taken/given. I cannot tell you what the intentions of the authors were in writing this and submitting it to publication. I can also not tell you why it got published. But I can tell you that, based on the authors’ previous and current anti-vaccine projects, my money’s on them trying to associate yet another vaccine with yet another neurological condition. There’s money in it, after all.
(Featured image via Spry on Flickr, CC BY-NC-ND 2.0)
Guess who got published?
Posted on May 26, 2016 10 Comments
If antivaxxers didn’t like me before, they are probably going to hate me. It’s okay though. I’m a big boy. I can take it.
Anyway, I had the privilege of collaborating with Dorit Reiss on a paper about mandates that require health care workers to be immunized against influenza. I wrote the parts about influenza disease and the vaccine, while Dr. Reiss wrote about the legalities involved in requiring healthcare workers to get their flu vaccine.
When I applied to go to the school of public health for the DrPH, a lot of people reviewing my CV kept asking me if I had any publications. It was kind of embarrassing to tell them that I did not. Why was it embarrassing? It was embarrassing because part of me knew that I had to spread the knowledge that I had gained as an epidemiologist, but the only efficient way of doing that in my position at the department of health was through posters or presentations at conferences.
Of course, there was the blog and the eventual rise of social media. I had plenty of experience in those. But being “competitive” to get into the school of public health required having publications. Lucky for me, I found a professor who believed in me and trusted my experience as a professional epidemiologist. He helped me meet the requirements necessary to be accepted.
Now, at the end of my third year in the doctoral program, I get published in a law journal of all things. In a way, it’s kind of poetic. Mom went to law school in Mexico, and a lot of people said she was a really good lawyer. Certainly, I could never win an argument against her. So big thanks to Dr. Reiss for helping me achieve this professional milestone. Here’s to all the knowledge that many more papers being published will disseminate… And to all the wisdom derived in doing so.
EpidemioLogical 