Showing posts with label anti-vaccine movement. Show all posts
Showing posts with label anti-vaccine movement. Show all posts

A randomized controlled trial of parachutes had a surprising outcome. Anti-vaxxers, take note.

One of my themes in this column over the years has been that you need to be skeptical of many of the claims out there about science and medicine. A healthy dose of skepticism can be a good thing, especially when someone is telling you something that seems surprising.

On the other hand, anti-science forces often pretend that they too are just being skeptical, or “just asking questions,” when what they’re doing is actually science denialism. Denialism is what someone is doing when the science is basically settled, but they refuse to accept it.

Let’s consider perhaps the clearest example of denialism, and the one that causes the most harm to public health: vaccine denialism. The anti-vaccine movement, which has grown alarmingly fast during the Covid-19 pandemic, insists that vaccines don’t save lives, and even more they insist that vaccines cause neurological damage. The latter claim is a favorite of Robert F. Kennedy Jr., as he’s proclaimed in multiple books and articles, and of his VP running mate Nicole Shanahan as well.

The claim that vaccines cause autism was first promoted in a bogus 1998 article in The Lancet by Andrew Wakefield. That article was later shown to be fraudulent, and the journal retracted it, but not before it spawned the modern anti-vaccine movement and made Wakefield one of their heroes. I’ve written many columns on this topic, and others have written far more, but the movement persists.

Scientists and doctors have pointed out, over and over again, that vaccines have saved millions of lives, and are one of the greatest medical advances in the history of civilization. The rapid development of the Covid-19 vaccine was a triumph, and it undoubtedly saved tens of millions more lives.

In defending their denialism, anti-vaxxers frequently ask this question: “where are the randomized controlled trials for vaccines?” They imply that scientists haven’t run such trials because they (the scientists) know that vaccines don’t really work.

That’s nonsense, of course. Scientists have conducted hundreds of studies, involving millions of people, showing how vaccines prevent disease and death.

But we don’t have any randomized controlled trials for childhood vaccines, and we never will, for an obvious reason: it would be deeply unethical. Let me explain.

A randomized control trial (an RCT) works like this: first, you identify a large group of people whom you want to treat, say by giving them vaccines. Then you divide them at random into two groups: the treatment group, who get the vaccine, and the control group, who get nothing. To prevent bias, you might also “blind” the subjects and experimenters so that no one knows who’s getting treated. For example, you could use shots filled with saline solution for the control group, so they think they’re getting a vaccine.

Once you’ve administered the treatment, you follow everyone for some period of time and see who does better. If the treatment group does better, then we say that the treatment worked.

Obviously, we cannot run an RCT for childhood vaccines, because withholding vaccines from children could grievously harm or even kill them. Instead, we can use data collected over time from millions of children, some of them vaccinated and some not, and measure vaccines’ effects from that. It’s not perfect, but these observational data show overwhelming evidence that vaccines for diseases including measles, mumps, rubella, polio, and smallpox are incredibly effective.

Yet anti-vaccine activists continue to call for RCTs, and they pretend that scientists who point out what I just wrote are not to be trusted.

Now to those parachutes in the title of this piece. We know that parachutes work, right? And yet where are the randomized controlled trials? Maybe we shouldn’t use parachutes until some scientists conduct that study? Hmm.

Well, if you’re thinking of skydiving and wondering about this question, you’re in luck! Because a few years ago, a group of scientists at Harvard, UCLA, and the University of Michigan ran an RCT on parachutes! And they published it, too, in the highly regarded British Medical Journal, now called BMJ.

I’m sure you’re curious about how they did this study, and how it turned out. Well, I’m going to tell you.

It was a small study: they approached 92 aircraft passengers and enrolled just 23 people. They randomized them into two groups, with 12 people wearing parachutes and 11 jumping with just an empty backpack.

What happened? Amazingly, there was no difference! Also amazingly, no one died! How could that be?

Well, reading the details of this (ahem) well-executed study, one learns that “randomized participants ... could have been at lower risk of death or major trauma because they jumped from an average altitude of 0.6 m on aircraft moving at an average of 0 km/h.”

In other words, participants did jump from a plane, but they were jumping from less than a meter off the ground and the plane wasn’t moving. A figure from the study illustrates the experiment:

So as you see, this particular RCT of parachute use didn’t prove anything. Even so, the authors note, tongue in cheek, that “Beliefs grounded in biological plausibility and expert opinion have been proven wrong by subsequent rigorous randomized evaluations. The PARACHUTE trial represents one more such historic moment.”

In case you’re wondering how on earth the BMJ would publish a study like this, I can explain that the date of publication was Christmas 2018. The BMJ has a long tradition of publishing satirical but seemingly serious articles on Christmas, and this was a particularly good one.

On the other hand, though, my larger (and serious) point is that the public shouldn’t lose trust in science. Even when science gets things wrong–and it does–it’s still the best toolkit we have for figuring out whether or not something works, or is true. The recently popular cultural trope that truth is malleable, and that each person can choose their own “facts,” is dangerous. When it comes to scientific facts, that’s just wrong.

Parachutes work, and not using them would be exceedingly risky. Vaccines aren’t quite as guaranteed as parachutes, but they come pretty close.

It's time to shut down the Disinformation Dozen


I’ve been writing about anti-vaxxers for a dozen years now, warning of the threat to public health that they represent. Today, though, the threat is far greater than it was in the past, because we're in the midst of a deadly pandemic, and vaccines are our only tool out of it. Merely educating the public on the benefits of vaccines isn’t working in the face of a deluge of misinformation from anti-vaxxers. It’s time to take away their platforms.

A new report from the nonprofit Center for Countering Digital Hate (CCDH) reveals that 65% of the anti-vaccine disinformation online can be traced to just twelve people. This offers hope that we can actually do something: by removing a tiny number of accounts, millions of lives can be saved. The social media platforms have the power to do this, and they could do it virtually overnight.

(No, I’m not calling for censorship, and no, they don’t have any 1st amendment rights to spread their lies. I’ll get to that below.)

A bit of background: the modern anti-vax movement started in the late 1990s, focusing primarily on childhood vaccines, especially the vaccines against measles, mumps, and rubella, and using (initially) a fraudulent study published in The Lancet to scare people about a non-existent link between vaccines and autism. That study was eventually retracted, and the lead author, Andrew Wakefield, lost his medical license after his fraud came to light.

But the damage was done. Anti-vaxxers and the misinformation they spread on social media caused vaccination rates to drop in the US and the UK, and in other countries, and diseases such as measles, which we had essentially eliminated in the US, started to re-emerge. Tragically, some people died of completely preventable diseases. One thing we’ve learned from the past 20 years is that once anti-vaxxers start spreading their misinformation, it’s incredibly difficult to correct the falsehoods.

Anti-vaxxers today have turned their social media efforts towards attacking the Covid-19 vaccines. (They actually started attacking the vaccines before the vaccines even existed, a kind of reality-twisting that would be funny if it weren’t so tragic.)

Covid-19 has already killed millions, and millions more may die before we get it under control. The only realistic way to end the pandemic is through vaccination. Fortunately, we now have multiple highly effective vaccines, as I’ve written about several times in the past year. Unfortunately, a large segment of the population has been grievously misled, and many people say they will never get vaccinated. The pandemic might persist for years, hurting all of us, if these people continue to refuse vaccines.

The anti-vax movement constantly spreads lies, rumors, and misinformation in an effort to scare people away from vaccination. I won’t repeat the lies here, because merely stating them gives them more credibility than they deserve. But the anti-vaxxers and the social media platforms that spread their messages must be stopped. As President Biden said this past Friday, “they’re killing people.”

One particularly unfortunate development in the US is that the anti-vax position has become hyper-political. Even though Trump has claimed credit for developing the vaccines, and even though he and his family were vaccinated as soon as the vaccines became available, many leaders of the Republican party and on right-wing media such as Fox News have embraced anti-vaccine positions, and have told their millions of followers to refuse vaccination. Logically, it makes no sense that vaccine refusal has become a political issue, but it has.

The good news is that we might actually be able to stop the anti-vaxxers. The CCDH report on the Disinformation Dozen shows that these 12 people, who collectively have 59 million followers, are responsible for 73% of the anti-vax content on Facebook and 65% of anti-vaccine messages on other major platforms, including Twitter, Instagram, and YouTube. This in turn means that if the social media platforms will simply shut down their accounts (and other sites that they control, such as the misleadingly-named Children’s Health Defense and National Vaccine Information Center), we will see a dramatic reduction in false vaccine information, virtually overnight.

So who are the Disinformation Dozen? Here they are:

  1. Joseph Mercola
  2. Robert F. Kennedy, Jr.
  3. Ty and Charlene Bollinger
  4. Sherri Tenpenny
  5. Rizza Islam
  6. Rashid Buttar
  7. Erin Elizabeth
  8. Sayer Ji
  9. Kelly Brogan
  10. Christiane Northrup
  11. Ben Tapper
  12. Kevin Jenkins

I’ve written about Mercola and RFK Jr. before, multiple times, but not the others. I’m intentionally not providing links to their anti-vax accounts, which include Facebook, Instagram, Twitter, YouTube, and dedicated websites, because any links simply add to their influence. Mercola, for example, has become wealthy by selling dietary supplements with unproven and often bogus health claims, and by pushing anti-vaccine myths, as I wrote all the way back in 2010. Perhaps if people realized this, they wouldn’t be so quick to believe him.

It’s time to de-platform the anti-vaccine Disinformation Dozen. In our current world, this can only happen if the companies themselves–Facebook, Instagram, Twitter, and Google–delete their accounts. One might expect that these companies would have already done this, based on their own policies, but as the CCDH report states:

“Despite repeatedly violating Facebook, Instagram and Twitter’s terms of service agreements, nine of the Disinformation Dozen remain on all three platforms, while just three have been comprehensively removed from just one platform.”

This isn’t a free speech or First Amendment issue; private companies aren’t required to provide a platform for anyone. And I’m not calling for the Disinformation Dozen to be arrested or legally punished for spreading misinformation, even though it is harmful, and even though they are indirectly killing people by their actions. But private companies can kick anyone off their platforms, whenever they want, and if these companies care at all about public health, and about the health of their own customers, they’ll delete all the accounts associated with these 12 people.

Finally, let me get a bit philosophical. It’s astonishing that we’ve created a society where we appear to be powerless to stop the spread of lies and distortions that are actually killing people. Our technology allows anti-vaxxers to reach millions of people and to convince those people to take actions that harm not only themselves, but all of us, because they’re allowing the virus to spread and mutate. It appears that our governments simply don’t have the power to force Facebook, Twitter, YouTube, Google, and Instagram to shut down these accounts, so instead we rely on the whims of a tiny number of people who run those companies.

Should governments step in here and force the companies to take action? I don’t know, but so far the companies themselves have failed to take action on their own. Germany and France seem to have the best solution so far: by requiring vaccines in order to eat at restaurants and travel on planes and trains, they’ve convinced large swaths of their populations, including formerly vaccine-hesitant people, to get vaccinated. The US, by contrast, has 50 different policies for 50 states, including some policies that are straight-up anti-vaccine. There must be a better way.

Measles is back. Blame the anti-vaxxers.

In the year 2000, the CDC announced that measles had been eliminated from the U.S. This was a fantastic public health achievement, made possible by the measles vaccine, which is 99% effective and which has virtually no side effects.

Unfortunately, measles is back. Just last week, the CDC announced that we've had at least 695 cases this year, the most since 2000, primarily from 3 large outbreaks, one in the state of Washington and two in New York. Because the CDC's surveillance is far from perfect, the true number of measles cases is likely much higher. And we're only four months into the year.

Also this week, UCLA and CalState-LA had to quarantine over 700 students and staff members who were exposed to measles from an outbreak in the Los Angeles area. At UCLA, one student who had measles attended multiple classes while still contagious, exposing hundreds of others to the highly contagious virus, according to a message from the university's chancellor.

No one has died as of yet, but if we don't quash these outbreaks, it's only a matter of time before someone will die. Measles has a fatality rate of 0.2%, or 2 deaths per thousand cases. That may sound small, but it's truly frightening when you consider that the U.S. had an estimated 500,000 cases per year before the vaccine was introduced in 1963.

Given the risks of measles, and given the remarkable effectiveness and safety of the vaccine, why don't people vaccinate their children? The primary reason is simple: it's the highly vocal, supremely confident, and utterly misinformed anti-vaccine movement. Anti-vaxxers spread their message daily on Facebook, Twitter, websites, and other media outlets. (I will not link to any of them here because I don't want to increase their influence.) They have launched systematic efforts throughout the U.S. and in other countries to convince parents not to vaccinate their children, claiming that vaccines cause a variety of harms, none of which are correct. (I won't list those here either, because even mentioning them gives the claims credibility.)

In one of the two outbreaks in New York, anti-vaxxers distributed highly misleading pamphlets in an effort to convince parents in an ultra-religious Jewish community not to vaccinate their kids. The anonymously-published pamphlet was "filled with wild conspiracy theories and inaccurate data," but it seems to have worked, as least among some of the parents.

The anti-vax movement is also behind the state-by-state effort to allow parents to opt out of vaccinations for their children in public schools. We're finally seeing some states roll this back, but it is still far too easy for parents to claim an "ethical" or "religious" exemption, allowing them to put their unvaccinated kids in school and thereby expose countless other children to measles and other preventable diseases. (I put those words in quotes because there is no valid ethical or religious objection to vaccines. All major religions strongly support vaccination.) Anti-vax websites provide how-to instructions telling parents how to get exemptions for their kids, and a small number of anti-vax doctors (I'm looking at you, Bob Sears) readily dispense large numbers of anti-vax exemptions. This needs to end.

The modern anti-vaccine movement started in 1998, with a fraudulent paper about the measles, mumps, and rubella vaccine, published by a former doctor who lost his medical license after the fraud was revealed. The lead author was eventually revealed to have taken large sums of money (unbeknownst to his co-authors) from lawyers who were trying to build a case to sue vaccine makers. That same ex-doctor, who I also won't name here (his initials are AW), is now a hero to the anti-vax movement, and he travels the world spreading his toxic message. He's even made an anti-vax movie.

I sincerely hope we won't see any children die before the anti-vaccine movement finally goes away. For any parents who are thinking that they won't vaccinate their kids, I urge them to read the heartbreaking words of Roald Dahl (author of Charlie and the Chocolate Factory, The BFG, and many other wonderful books), whose oldest daughter Olivia died of measles in 1962, at the age of seven:
"...one morning, when [Olivia] was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn't do anything.
'Are you feeling all right?' I asked her.
'I feel all sleepy,' she said.In an hour, she was unconscious. In twelve hours she was dead.The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her." 
The measles vaccine was a miracle of modern medicine, and it's been administered safely to hundreds of millions of people. Measles is a dangerous illness, but we can prevent it. No parent should have to go through what Roald Dahl went through.