Duane Gish is a young earth creationist who made a name for himself going around the country debating scientists about evolution, and “winning.” Of course, deciding who has “won” a debate is always unclear (as Americans are about to be reminded of again in the upcoming general election) – typically both sides declare victory. But I think it is fair to say that Gish generally rode rough-shod over his opponents, who often naively assumed that because they were right they would easily win.
Gish was an excellent debater, however. (I’ll resist calling him a master debater – OK, there, I said it). He knew his strategy, which relied primarily on what came to be known as the Gish Gallop. He would throw out, rapid fire, many tidbits of misinformation, half-truths, and misdirection, all throwing doubt on the validity of evolutionary theory. His opponents would never have the time to deal with them all, for it takes much more time to correct misinformation than to generate it. Gish would bury his opponents in crap, who never had the time to dig themselves out.
Incidentally – scientists have learned from this experience not to engage cranks in open-ended debate. You need to have moderated debate that can keep focussed on specific questions.
In the Web 2.0 world of blogs and forums, there is a new version of the Gish Gallop that skeptics rapidly become familiar with once they start duking it out with nonsense on the intertubes. The supporters of pseudoscience, science denial, and conspiracy theories often have websites to go to that provide large amounts of dubious information. Proponents of nonsense can then cut and paste large volumes of this low-grade and misleading information into the comments of blogs or onto forums – overwhelming their opponents with sheer volume. This often ends discussion, as it would take an intimidating amount of time to deconstruct the misinformation that took a moment to copy and paste. (Sometimes a skeptic or a team of skeptics will take the time to do so – or will debunk a representative sample in order to discredit the whole – a good strategy.)
My entry last week was on some common misconceptions about vaccines that appeared in the SGU forums. Such posts commonly attract the attention of the anti-vaccine league, and some “boilerplate” antivaccine misinformation is sure to appear in the comments. Sure enough, poster “in4mdconsnt” did just that. Rather than leave another comment that would have had to be longer than the original post, I promised to deal with it in my post for this week – so here it is.
Vaccine effectiveness is based on the theory that if anti-bodies are produced in response to the antigen injected, then a person confers immunity from said disease. This is the basic premise for vaccination. “Vaccine”, a peer read review, found this to be false. When immunized children get the disease from which they are immunized against, antibody titers have been performed to determine the level of antibodies in the affected child’s serum and they find consistently that the presence or absence of antibodies had nothing to do with resistance to the disease. “Antigen-specific antibody titers do not correlate with protection.” Vaccine. 2001 Oct 15;20 Suppl 1:S38-41. PMID: 11587808.
This superficially sounds reasonable and may take in the unsuspecting reader. He lays out a premise and then proceeds to show that the premise is false and gives a full reference. However, both the premise and the reference are misleading.
The premise is only partly true – vaccines present one or more antigens (a substance capable of producing an immune response) to the host with the purpose of producing an immune response to a disease organism so that if later exposed the immune system will be primed and will be able to fight off the infection quickly. Part of immunity is to have circulating antibodies to the antigens (usually proteins on the surface of viruses or bacteria). But this is only part – and not the most important part.
Antibodies are called humoral immunity, but there is also cellular immunity. Antibodies are made by B-cells which are in turn regulated by T-cells. The most important goal of immunization is to create memory B-cells – cells that can crank out antibodies on short notice. They (not the antibodies themselves) are what give the vaccinated immune system memory for the infectious organism and what allow it to mount a vigorous and rapid response upon the next exposure.
However, it is difficult to measure B-cells with a specific affinity. It is easy to measure antibody titers. So titers are used as a marker for immunity – even though they are not a direct measure of vaccine-induced immunity.
What about the reference cited? It is a common hallmark of intellectual sloppiness or dishonesty to cite a reference that does not support the claim for which it is cited. It is assumed that most readers will not check up on every reference. Such is the case here. In4mdconsnt did not give the title of the paper being cited, probably because that would have raised a red flag. It is What are the limits of adjuvanticity. The paper does not provide any data to support the quote that was referenced.
The abstract of the paper mentioned as background information that antibody titers are a poor correlate for vaccine protection. The authors are talking about the difficulty in measuring reliably the amount of vaccine protection – they were not claiming that vaccines do not work or do not produce antibodies. They are concerned about this because the topic of the article is the degree to which adjuvants (other substances added to vaccines) increase the immunogenicity of vaccines – how can we measure how effective adjuvants really are?
Actually the quote contradicts In4mdconsnt’s position – how can you have a poor correlate to protection unless there is protection? The premise of that statement is that vaccines work; the challenge is in measuring the strength of their protection so that we can assess the effectiveness of the various strategies used to make vaccines even more effective, such as adjuvants.
Now, notice how much longer it took me to adequately address the misinformation presented in that short paragraph, that was clearly clipped from an anti-vaccine website.
The next section offers us some new strategies of misdirection:
The second premise for vaccination is herd immunity. Herd Immunity was developed by A.W. Hedrich in 1933 who said when 68% of children under 15 were immune to measles, epidemics did not occur. His research was based on natural (getting the disease)immunity, not artificial, (vaccination), immunity. More facts: “Outbreaks have occurred in 100% vaccinated populations.” Morbidity and Mortality Weekly Report. US Government 12/29/89/38(S-9):1-18.
“80% of Measles is contracted in vaccinated people.” Morbidity and Mortality Weekly Report. US Government 6/6/86/35(22):366-70.
“[Pertussis] infections are common in an immunized population…more prevalent than previously documented.” 98% were vaccinated in this population. He Q, Vijanen MK, Arvilommi H et al. Whooping cough caused by Bordetella Pertussis and Bordetella parapertussis in an immunized population. JAMA. 1998;280:635-637.
Here we see an excellent example of cherry-picking – giving us selected factoids that only tell part of the picture. It is helpful to be alert to cherry-picking, the biggest clue is often that the fact presented dance around the central question but never directly address it. The real question is – are immunized individual and populations more resistant to infections such as measles than unvaccinated populations? We are not getting this data.
What the quoted data does tell us is that vaccines are not 100% effective – which is known and not disputed. That “80% of measles is contracted by vaccinated people” is a classic abuse of statistics. If the vast majority of the population is vaccinated then even a small failure rate may result in more infections than in the smaller unvaccinated population. This statistic does not tell us about the relative risk of getting measles among the vaccinated and unvaccinated. It does not address the actual question – do vaccines work. When someone offers you these tangential statistics – they are trying to deceive you (or they themselves have been deceived and haven’t realized it).
Here is some more complete information from a recent CDC report:
Measles, a highly contagious acute viral disease, can result in serious complications and death. As a result of a successful U.S. vaccination program, measles elimination (i.e., interruption of endemic measles transmission) was declared in the United States in 2000. The number of reported measles cases has declined from 763,094 in 1958 to fewer than 150 cases reported per year since 1997. During 2000-2007, a total of 29-116 measles cases (mean: 62, median: 56) were reported annually. However, during January 1-April 25, 2008, a total of 64 confirmed measles cases were preliminarily reported to CDC, the most reported by this date for any year since 2001. Of the 64 cases, 54 were associated with importation of measles from other countries into the United States, and 63 of the 64 patients were unvaccinated or had unknown or undocumented vaccination status.
The most important numbers are 763,094 cases of measles in 1958 (before the measles vaccine), and 150 per year since 1997. Vaccination is the only plausible explanation for this dramatic decline. Also note that in the first half of this year 63 of the 64 reported cases of measles were among those not known to be vaccinated.
There are reported outbreaks within vaccinated populations – because of the vaccine failure rate. But even then, if the population is highly vaccinated, the outbreak will typically be short-lived. That is the point of herd immunity – outbreaks cannot sustain themselves in the population.
Also, as measles vaccinations decline, infections are again increasing. The UK has seen a huge return of measles following the MMR-autism scare provoked by Andrew Wakefield’s dubious study. This year the US has seen, so far, 127 cases in 15 states – almost all occurring in pockets with low vaccination rates. That’s right – in populations lacking herd immunity there have been increasing outbreaks, involving mostly those who have not been vaccinated.
The data are crystal clear – the measles vaccine works. It reduces the risk of getting measles. Vaccinated populations display herd immunity and are resistant to outbreaks, which burn out more quickly when they do occur.
However, by cherry picking and misrepresenting the data, you can seem to support almost any desired conclusions – an the fancy references will make it seem like the data backs up your position.
Next we see another strategy for misdirection – lying:
As far as vaccine research; vaccine research is the only so-called scientific research that does not hold itself to the standards of level 5 research. Often new batches of vaccine are evaluated for safety by testing them against the old vaccine, or against a false placebo like aluminum salts. This is not only dangerous, but dishonest when our federal government guarantees that a new vaccine is safe and effective. The public is unaware that double blind studies, nor randomized control trials are being done on vaccines. Furthermore, vaccines like Gardasil for example, have not been clinically tested with other vaccines that young girls receive and therefore, have no idea how the reactivity of these vaccines will manifest themselves.
First, I don’t even know what “level 5 research” is. The only levels of quality with which I am familiar are those proposed for formalized evidence-based medicine. In this scheme level 1 is the most rigorous and reliable evidence (“Level I: Evidence obtained from at least one properly designed randomized controlled trial”). Level III is the lowest. There is no Level V.
That aside – the entire claim is a fabrication. Vaccines are held to exactly the same standard as all pharmaceuticals. The FDA requires pre-human animal testing, and then Phase I-III human testing for both safety and effectiveness. There is also post-market safety monitoring.
Don’t take my word for it – go to PubMed and type in “vaccine” and “double-blind” and then read the first 30 or so titles of the published studies that come up. There are plenty of double-blind studies with vaccines – and the FDA requires it for approval.
It is also not true that vaccines are not tested with other vaccines. Subjects in vaccine trials will have had other vaccines, so by definition the new vaccine in question is being tested with other vaccines. So we have a very good idea about cross-reactivity with other vaccines.
What can I say – the claim that vaccines are not tested is just a lie – plain and simple.
In4mdconsnt insists he is not anti-vaccine (they all do, it’s lame) but then concludes:
In conclusion, I don’t believe we can currently say, without a shadow of a doubt, that vaccines are safe and effective. Furthermore, I am not ready to test the hypothesis that the benefits out-way the risks on my children.
What does “without a shadow of a doubt” mean? There is no 100% metaphysical certitude in medicine. What we can say is that there is a very high standard of evidence for safety and effectiveness for vaccines. The data (while no scientific data is 100%) is overwhelming. There is still a large amount of room for further research and refinements – vaccines can be made safer and more reliably effective. And research is ongoing to do just that. But lack of perfection does not equal useless, and lack of perfect knowledge does not equal complete ignorance.
The bottom line is very different from what In4mdconsnt and other anti-vaccinationists would have the public believe, as is reflected in their misleading propaganda. The evidence is clear that vaccines, while not perfect, are very safe and very effective. They prevent millions of serious infections. As vaccines have come into use, infections decline. Where scaremongering has reduced vaccine compliance, infection outbreaks are returning. The pattern is replicable.
But the antivaccine lobby has learned to use the internet to spread their misinformation. They are hitting the public with a 21st century version of the Gish Gallop, with the ease of cut and paste and the speed of the internet – leaving skeptics to clean up their mess.