Violent metaphors

This afternoon Ms. Couric’s show “Katie” featured the “HPV Vaccine Controversy” as part of its “Big Conversation”. The segment focused mainly on the vaccine Gardasil, which is administered to girls and boys around the age of 11, in an effort to immunize them against HPV before they become sexually active and likely to contract the virus.

Although Couric herself claims that she is personally “not anti-vaccine”, her show was extremely biased against the scientific consensus. She kept referring to the vaccine as “controversial” when there are no legitimate scientific studies showing it to be dangerous. I’m used to getting upset at journalists who give false equivalency between the scientific consensus on an issue on the one hand and a fringe belief on the other. But this was beyond the pale; Couric’s program didn’t even aspire to that “balance”.

She featured five guests opposed to the vaccine: two mothers who believed that their children were hurt or injured by the vaccine, along with one of those children, an anti-vax journalist, and a physician.

Who was present to represent the actual scientific consensus? One physician. One. (She did an excellent job and you can read more from her here). Oh, and a mother at the very end of the program stated that she had done her research on the vaccine, waited a few years beyond what was recommended, and then had it given to her daughter. Her daughter attested that she had experienced no ill effects.

So if we’re doing a simple numbers tally, that’s 5 anti-vax guests and 3 pro-vax guests. Hardly an unbiased presentation. As Orac put it:

“Yes, the entire segment was structured as a “he said, she said” tour de force of false “balance.” On the one hand, we have two anti-HPV mothers, one who thinks that the HPV vaccine killed her daughter and the other who thinks it injured her and as a result helped form a website that spreads the vilest, most idiotic pseudoscientific fear mongering about HPV imaginable. On the other side, there was a lone pediatrician trying to promote science-based medicine and a mother who had her daughter vaccinated and didn’t regret it. Somewhere in the middle, but not really given what she says, is Diane Harper, represented as having been integral to the development of Gardasil. In reality, Harper is on the anti-HPV side and, being represented as the definitive Gardasil authority, weighs heavily on the message, even though she doesn’t get the last say.”

In case you think we’re all being too harsh on Ms. Couric, there’s more to the story.

Journalist Seth Mnookin, who wrote “The Panic Virus”, a book on the anti-vaccine movement, was contacted by a producer of the show a year ago to come talk on the show about the anti-vaccine movement. He was initially encouraged by their overtures:

“The producer seemed to have a true grasp of the dangers of declining vaccination rates and she stressed repeatedly that her co-workers, including Couric herself, did not view this as an “on the one hand, on the other hand” issue but one in which facts and evidence clearly lined up on one side — the side that overwhelmingly supports the importance and efficacy of vaccines.“

But ultimately, they decided not to include him, and instead produced a show giving considerably more weight to the anti-vaccine side.

Why did they do this? Was it possible that they thought more people might watch if it was framed as a “controversy”? Or did they simply misunderstand the importance of studies of hundreds of thousands of people who received the vaccine with no ill effects? I don’t have a good answer to that question, but the outcome doesn’t reflect well on Ms. Couric as a journalist, or her producers.

Other criticisms of the program

-Orac provides a blistering and detailed analysis of the show and the people who appeared on it in opposition to the vaccine.

-Tara Smith explains why Dr. Diane Harper’s statement “that Pap screening is “100% accurate” so no HPV vaccine is really needed” is so problematic.

–Alexandra Sifferlin asks “Is Katie Couric the next Jenny McCarthy?”

In light of this, how should parents make decisions on vaccines when you have two experts on the show who disagree?

First, understand that I sympathize with any parents who watched the show and are conflicted about vaccines. You want what’s best for your kids, period. And there are so many contradictory pieces of information out there, it’s no wonder you have questions and doubts. How can you possibly evaluate any given source on vaccines, when you don’t necessarily have a degree in biology or medicine yourself? It’s really tough.

My position on this subject is obvious (the science is unambiguous), but you absolutely need educate yourself on the subject. My best suggestion on how to do this would be that you learn about how science works as a process. What does it take to get a study published in a medical journal? What is peer review? What are clinical trials, and why are they important? What is the expertise and background of people making different arguments about vaccines? Be skeptical, be critical, and as much as possible, read actual scientific studies. I linked to a few on this issue below.

What about the parents on this show, whose children were sick or died after receiving the vaccine?

These children’s illnesses and deaths are tragic, and I am so sad for their parents. Unfortunately, just because their children fell ill after receiving the vaccine doesn’t mean that the vaccine is what caused their illnesses. It is very easy to see two events close in time and believe that one caused the other; humans are exceptionally good at identifying spurious patterns. While individual stories of suffering children are heartbreaking, the only real way to know for sure that something caused an illness or death is to test it scientifically in order to rule out all other possible causes.

And that’s just what the CDC does with all potential cases of vaccine injuries; they look at all reported suspected injuries in the population and try to detect statistical patterns, filtering out confounding factors. Did the same kinds of symptoms across the entire population occur associated with a vaccine? Did they occur within the same window of time (say, within 5 days vs. within a month)? Are there any other diseases that the children might have been exposed to that could account for the same symptoms? This has to be done in a large number of people in order to rule out all other possible causes. And unfortunately, you’re far more likely to hear a story about someone who thinks a vaccine hurt them than the many, many people who got one and didn’t experience any bad result.

Now obviously, if the vaccine is causing death, that is horrific. And there have been children who died after receiving Gardasil. But did Gardasil cause those deaths, or did something else do it? The CDC studied all children in the United States who received the Gardasil vaccine between June 2006 and June 2013 and found:

 

“Detailed review of every report of death following a person’s receipt of the Gardasil® vaccine has shown:
There is no pattern of death occurring with respect to time after vaccination

There is no consistent vaccine dose number or combination of vaccines given

There is no diagnosis at death that would suggest that the Gardasil® vaccine caused the death”

Katie Couric did a very irresponsible job reporting on this issue, given that she didn’t mention the fact that the scientific evidence is unambiguous on this point. Based on her reporting, and that of other media sources, I am very concerned that parents might be confused as to what the scientific and medical consensus actually is.

Resources for parents who wish to become better informed on the subject:

—Here is the CDC’s FAQ on HPV vaccine safety.

—Here is the publication from the clinical trials of Gardasil, which was tested for safety and effectiveness in preventing the disease before being distributed in the general population (It’s long, but written in fairly straightforward English without being crazy technical)

—Here is a study done in 2012 testing the effects of Gardasil in 189,629 young women. It’s pretty dense, but again, I urge you to read it for yourself (Here’s my guide on how to read a scientific paper, if you’d like some tips). These are the study’s conclusions:

“The findings from this large, comprehensive study did not detect any evidence of serious safety concerns secondary to HPV4. [HPV4= Gardasil] These findings support the general safety of routine vaccination with HPV4 to prevent cancer.“

—Here is a study published in October of 997,585 girls from Denmark and Sweden who received the Gardasil vaccine. It concludes:

“This European cohort study found no evidence supporting associations between exposure to qHPV vaccine and autoimmune, neurological, and venous thromboembolic adverse events in almost one million adolescent girls”

—Here is a discussion by a lawyer on this blog about what the vaccine courts are, and why the anti-vaccine movement is actually opposed to them.

–Here are the blogs of two physicians who do an amazing job breaking down the issues for laypeople (with the caveat that blogs shouldn’t carry the same weight as primary medical/scientific literature):

Dr. Ben Goldacre

Orac

–And here is the American Academy of Pediatrician’s policy statement on HPV Vaccine Recommendations:

Final thoughts

Mr. Mnookin concludes his post on the topic pointedly:

“But hey, you know, what’s years of data based on hundreds of thousands of verifiable results when you have a single “mom who claims her daughter died after getting the HPV vaccine,” right Katie?”

It’s a good question. Why didn’t Ms. Couric mention any of this research at any point during her show? She instead closed her program by saying:

“We’ve obviously heard 2 different sides…For parents watching, it’s probably still rather confusing…”

Whose fault is that confusion, Ms. Couric?