The importance of relative risk in understanding vaccine effectiveness

A while back I noticed that Greg Beattie was deceiving his readers about pertussis vaccine efficacy by misrepresenting NNDSS data.

Yes, the same Beattie with the bogus claim that vaccines did not reduce infectious diseases. He dresses this up with misleading graphs comparing mortality from vaccine preventable disease to the introduction of X vaccine. These graphs are also bogus in that he omits the impact of vaccine introduction. The stunning success of the vaccine itself and the elimination of infection is always absent from his peculiar artwork.

Beattie’s claim back in 2012 was that the pertussis vaccine failed because high numbers of notifications had been vaccinated against pertussis. This is thunderously misleading in that it’s at the same level as dismissing seat belt safety because most fatalities on our roads involve seat belt wearing occupants. He also avoided explaining all reasons as to why notifications were high. Increased awareness, testing and follow up, pockets of low vaccination driving an epidemic, low booster uptake.

You can check the post here to follow my review of the same data table Beattie used. But it’s pretty simple. By 2011 close to 95% of 0-4 year olds were fully vaccinated by age 2 [NCIRS]. Using the table provided it turns out those not fully vaccinated made up 27.2% of notified infections. Fully vaccinated notifications equal 56.7%.

Relatively speaking a child fully vaccinated against pertussis has a notably reduced chance of being infected. Conversely, the small number who are not fully vaccinated have a frightfully high chance of being infected. To be sure, if 56.7% of notifications collected over 2008 – 2011 are from fully vaccinated children one can argue the vaccine could (and needs to be) more effective. But when the 5% who are not fully vaccinated make up 27.2% of infections, then the claim the vaccine is not effective is patently absurd. A dangerous and irresponsible lie.

Basically this is a story of relative risk being falsely presented as absolute risk. Choose some data and omit other data and the claim looks sound. But the post itself is limited in examining Vaccine Effectiveness vs Relative Risk (Risk Ratio – see screenshot). Understanding related and relative data sets is crucial in grasping how vaccine efficacy can be misrepresented. Regrettably many falsehoods peddled by the anti-vaccine lobby stem from such misrepresentation.

Fortunately an excellent piece addressing this was recently published on The LymphoSite by kill3rtcell. Headed But most of the people who got the disease were vaccinated for it! the post comprehensively addresses vaccine effectiveness, risk ratios and even provides interactive calculators. These crunch values of vaccine effectiveness, vaccination rates and resultant cases in the unvaccinated or vaccinated.

Do head over and read what is an excellent contribution to the deconstruction of misinformation peddled by antivaccinationists.

The screenshot below helps explain what this post accomplishes.

relative risk

© kill3rtcell – The LymphoSite

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Parrot Pareidolia?

You may swear this parrot was a female model.

And indeed be right.

Or if you would swear this female model was a parrot…

Pareidolia parrot

Then enjoy the brilliant work of Italian body painting artist, Johannes Stoetter.

Video at YouTube here.

False Balance: Where dissidence does not belong

Due weight.

Two simple, but arguably very important words in that they can be found in the Editorial Guidelines of the British Broadcasting Corporation. Journalistic guidelines regularly refer to due impartiality, and rightly so. Consumers subject to the bias of reporters are in for something like the pure fancy that comes from End Time Radio, Natural News or (where “freedom of choice is not free”) Vaccination News.

Under Impartiality – Breadth and Diversity of Opinion, the BBC Guidelines include:

4.4.1

Across our output as a whole, we must be inclusive, reflecting a breadth and diversity of opinion.  We must be fair and open-minded when examining the evidence and weighing material facts.  We must give due weight to the many and diverse areas of an argument.

Under Impartiality – News, Current Affairs and Factual Output:

4.4.12

News in whatever form must be treated with due impartiality, giving due weight to events, opinion and main strands of argument.  The approach and tone of news stories must always reflect our editorial values, including our commitment to impartiality.

The reason I’m focusing on the BBC is because of a direct link to false balance. Australia’s ABC have no parallel and our Australian Broadcasting Standards don’t contain specific attenuation of minority views getting a free ride on the coat tails of the prevailing or scientific consensus. That’s not to say either set of standards is not a useful device in underscoring or complaining about the mess of false balance. It’s just that the BBC have shall we say… history.

Presenting Wonders of the Solar System in 2010, Professor Brian Cox was explaining the impact Jupiter’s gravity has on Earth. He delightfully included in his narration, “Despite the fact astrology is a load of rubbish…”. Dedicated followers of woo complained. One stressed Cox didn’t allow the “alternative opinion”. And before you smirk dear reader, it is that astrologers use “observation and knowledge built over thousands of years”. Oooh yeah. They haz Appeal to Antiquity.

Cox provided a statement to the BBC, which they decided not to publish.

I apologise to the astrology community for not making myself clear. I should have said that this new age drivel is undermining the very fabric of our civilisation.

This example of how complete nonsense is put forward as equal, or even superior, to schools of thought and theories that are in fact completely settled opens the December 2011 BMJ Editorial by Trevor Jackson, When balance is bias. [Dropbox] [BMJ 2011;343:d8006 doi:10.1136/bmj.d800].

The BBC asked Prof. Steve Jones, emeritus professor of human genetics at University College London, to review the BBC’s impartiality and accuracy of their coverage of science. As one might guess from scanning Australian and British journalistic codes with their liberal peppering of “impartiality”, it was the impact of “due impartiality” that worried Jones. He found the guidelines:

… had a distorting effect, creating a sense of equivalence where there was none, and privileging maverick and dissident views so that they appeared as valid as established scientific fact.

Jones found in areas of science that journalists risked giving the impression there were two equal sides to a story when there were certainly not. By insisting to bring “dissident voices” into settled debates within science, the BBC was guilty of giving an unbalanced view to these same areas.

Jackson’s editorial notes the disastrous effect Andrew Wakefield’s fraudulent paper had on the uptake of MMR is in part due to media impartiality. The BMJ reported in 2003 on a study that indicated the media effectively misled the public.

The BBC reported in part:

Most people wrongly believed that doctors and scientists are equally divided over the safety of the measles, mumps, and rubella (MMR) vaccine, according to new research carried out during the high profile public debate over the vaccine last year.

At the height of the media coverage the impression was created that medical scientists were split down the middle over the vaccine’s safety, including reports of links with autism, say the study’s authors, from Cardiff University.

The report found that 53% of those surveyed at the height of the media coverage assumed that because both sides of the debate received equal coverage, there must be equal evidence for each.

It said only 23% were aware that the bulk of evidence favoured supporters of the vaccine. The authors said their survey would revive the debate about media coverage of MMR and how journalists deal with “minority voices” within science.

The belief that scientists were divided over the safety of MMR was a direct result of journalists seeking balance and led to what we now know as false balance. Face palmingly, head deskingly, infuriatingly, unacceptably in the case of vaccines, it is still underway today. Even worse journalists are dusting off long settled topics and where they should be stressing deception, suggest “debate”. In the video below an individual who is effectively a public health menace was appallingly labelled as an “expert”.

Even if these terms are not utilised in the straight out fashion Channel 7’s Weekend Sunrise recently did, everything is in place for the public to be misled into thinking actual scientific dissent exists over the safety and benefit of vaccination. Indeed today, the moral bankruptcy that accompanies antivaccinationists exceeds those who were taken in by Wakefield. The science is clear. There is no debate to be had. This places the antivaccinationist in a very unique position. A position of denial and deception buttressed by repeated claims of corporate conspiracies and so-called natural alternatives.

This latter rubbish is fed to the public because the natural enemy of the anti-vaccine commentator is scientific consensus. Given an opportunity to deceive the public the antivaccinationist can now introduce a host of irrelevant and false claims which in the context of an interview will create doubt in the minds of the public. In the video below Weekend Sunrise have an unqualified, science illiterate, conspiracy theorist effectively presenting nonsense in response to advice from the Director of Australia’s National Centre for Immunisation Research and Surveillance.

Thanks to Channel 7 and @sunriseon7 members of the public may well have been misled. Farmer’s wife Meryl Dorey wants to “extend the hand of friendship” to the NCIRS and conduct a study into vaccinated vs unvaccinated. Yes that meaningless, shrivelled old cherry again. Quite simply it leaves a scam artist looking as though they have skill when they don’t and offering one side of a balanced debate, when in fact that debate simply doesn’t exist. There is certainly no need for an impossible study, but the public cannot know this.

The previous point is one scientists need to keep in mind when asked to appear alongside unqualified saboteurs of public health. There’s nothing that can be said in a few minutes that can assuage the damage done by elevating a skilled prevaricator to your own level in the eyes of the public.

Trevor Jackson concludes in his BMJ editorial:

Meanwhile, some science journalism will continue to be weighed in the balance and found wanting.

Until the notion of due weight becomes just as, if not more, important than impartiality in journalism and science reporting, we need to ask ourselves if those without any weight or those advancing scam debates deserve to be heard at all. Clearly, and helped along by the precedents outlined here by reasonablehank, the answer is no.

Channel 7 have previously presented a scientist “debating” a proven anti-vaccine zealot. True, these enemies of reason are challenged by journalists as to the flaws in their beliefs. Yet that is not the issue. The more often members of the anti-science lobby are given a pedestal from which to preach, the larger will be the percentage of the community that believes a genuine topic of scientific dissent exists. As with climate science, fluoride in drinking water, evolution, conventional medicine and more. In the case of vaccination there simply is no debate.

Vaccination saves lives.

Peter McIntyre and Meryl Dorey on Weekend Sunrise

http://www.youtube.com/watch?v=6-E4OChkXw4

Medical Observer Interview: Dr. Ken Harvey

Former editor of the Medical Journal of Australia and GP Dr Annette Katelaris interviews Dr. Ken Harvey.

Dr. Harvey originally graduated from the University of Melbourne. Initially specialising in infectious disease and medical microbiology Ken’s interest in antibiotic resistance led to a study of the forces that drive prescription. Ken moved to the School of Public Health at La Trobe University to continue his work on medicinal drug policy.

He now holds the position of Adjunct Associate Professor in the School of Public Health at La Trobe.

INTERVIEW – CAMs regulation and pharmaceutical industry influence – Assoc Prof Ken Harvey – Obserations

Noted public health advocate Associate Professor Ken Harvey on what’s lacking in regulating complementary medicines, and the influence of the pharmaceutical industry on ‘the hand that writes the script’.

Ken talks about his extensive role in prodding Australia’s regulator of complementary medicines and shortfalls in the present system for regulating these “listed” therapeutic products. He is also asked about the personal impact of holding shonky products, advertising and ultimately – dishonest, unforgiving individuals – to account. Ken’s interest in information technology makes him a welcome source of advice to overhaul the TGA’s Electronic Listing Facility.

For a self confessed “stubborn bastard” in chasing blatant advertising breaches, it’s clear that Australian consumers are in Ken’s debt. Ken holds life membership of the Australian Consumers Association, Choice, and is also a member of their Policy Advisory Group. Dr. Harvey is Chair of Health Action International, Asia Pacific (HAIAP). He was a member of the WHO expert group that drafted their Ethical Criteria for Medicinal Drug Promotion. [22 page PDF]

mp3_mic
INTERVIEW AUDIO

Or direct download MP3 here. 21 min 13 sec. 21.4 MB
Listen or download file at chirbit.
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Interview Source – © Medical Observer, Sound Cloud. Published August 26th, 2013.

 

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Measles Goddess’ Wrath Hits Victoria

Victorian Chief Health Minister, Rosemary Lester offers 30 seconds of wisdom concerning the present measles outbreak in Victoria:

Or download MP3 here

As an outbreak of measles reaches 10 cases in Victoria we can be certain of one thing.

The misinformation peddled by antivaccinationists over the years will be underscored as just that. Misinformation. From ridiculous to dangerous these snippets of so-called wisdom have included claiming “measles” means “a gift from a goddess” in ancient Sanskrit, to measles being the cause of the growth spurt that happens to correlate with the most common age for childhood infection.

In the first instance a check of the link to Sitala Mataji – originally the smallpox goddess worshipped in Pakistan, Northern India, Nepal and Bangladesh – shows the divine influence to be malignant. Just as Sitala was burned by a carelessly forgotten stove, she randomly picks children in anger and burns them from within to punish the mortal.

Meryl Dorey of the Australian Vaccination Network argues that as just one of the diseases that have “beneficial aspects… prevention may not necessarily be in the best interests of the child”.

Dorey would tell her audience using large slides:

Called “gift from a goddess” in Sanskrit measles can help to mature the immune system, may help to prevent auto-immune illnesses such as cancer, asthma and allergies later in life

In reality the Sanskrit word, “masuurikaa” translates variously as smallpox, measles, eruption of lentil shaped pustules, lentil, and procuress (female procurer). There is absolutely no evidence that infection with wild measles primes the immune system against cancers or allergies. Such claims belong firmly alongside the lie that certain potentially fatal and disabling diseases are “rights of passage”. Regarding pertussis and measles Dorey famously informed a national T.V. audience:

My mother used to put me with all the neighbourhood kids when they got these diseases so we would get them and get them over with and be immune. And there was no fear, there was no worry about it. We just got them, and we were supposed to get them and we did, and we were healthier for them. Now we have a medical community that’s saying if you get measles, if you get whooping cough you’re going to die from it. Well, where is the information from that? You didn’t die from it thirty years ago and you’re not going to die from it today.

In fact with measles the risk of encephalitis is at least 1,000 times greater from measles infection than from vaccination. Prior to the success of mass vaccination:

Measles was once a common childhood disease in Australia, and medical practitioners were well acquainted with the “fever, generalised maculopapular rash, cough and conjunctivitis” syndrome that equated to a measles diagnosis. Measles complications, particularly bronchopneumonia and otitis media in children, were commonplace. With so many cases in the community, relatively uncommon severe complications, including acute encephalitis (1 in 2000 cases), subacute sclerosing panencephalitis (1 in 25 000 cases), and death, were also encountered.

There is nothing “marvellous” about measles as suggested by a despicably misleading book. Aside from the sliding scale of disability cruelly dealt by encephalitis one or two fatalities per thousand infections is normal.

The overwhelmingly positive impact of mass vaccination can be seen in the catch up programme documented here as The Australian Measles Control Campaign, 1998. There are no conflicts of interest declared by the 12 authors.

The Abstract reads:

The 1998 Australian Measles Campaign had as it’s aim improved immunization coverage among children aged 1-12 years and, in the longer term, prevention of measles epidemics. The campaign included mass school based measles-mumps-rubella vaccination of children aged 5-12 years and a catchup program for preschool children. More than 1.33 million children aged 5-12 years were vaccinated at school: serological monitoring showed that 94% of such children were protected after the campaign, whereas only 84% had been protected previously.

Among preschool children aged 1-3.5 years the corresponding levels of protection were 89% and 82%. During the six months following the campaign there was a marked reduction in the number of measles cases in children in targetted age groups.

Six pages in on page 887 of the Bulletin of The World Health Organisation 2001, 79 (9), we find this table:

Notifications_preandpostOzControlCampaignThe authors note that whilst there was no immediate reduction in the number of cases in the six months following the campaign, there was a notable reduction in the age groups targetted by the campaign. Following 1.7 million MMR doses during the campaign, there were 89 Adverse Events Following Immunisation. 80 children followed up recovered without sequelae. Nine could not be followed up due to confidentiality restraints associated with ADRAC. The benefits were not seen in “untargetted” 12-18 year olds.

As one of the largest initiatives in Australia’s immunisation history, the MCC was deemed demonstrably effective. The authors wrote:

Each of the studies in this evaluation confirmed that the campaign was highly successful, particularly among preschool and primary-school children.

Graphed data including the impact of the MCC can also be seen here (Victoria 1962 – 2004) and here (Australia 1991 – 2011). The profound impact of the introduction of a second dose in 1994 is also clear in the second graph.

The two clusters in Victoria currently reflect one distinct arrival from overseas and a source traced to a domestic flight. A disturbing case in S.A. in August 2011 resulted in two distinct warnings stemming from just one overseas arrival. The only reliable defence against jet-setting viruses and wide scale outbreaks is herd immunity.

The need for ensuring oneself is vaccinated against measles goes without saying. Particularly as exposure to someone emigrating or returning from a part of the world where measles is poorly controlled is quite simply a matter of chance. In Measles Immunity in Young Australian Adults, Gidding and Gilbert write in Conclusion:

Based on the most recent national serosurvey data available, there are 2 cohorts with levels of immunity below 90 per cent — those aged under 6 years in 1999 (born in 1994-1999) and those aged 18-22 years in 1996-98 (born in 1974-1980). Only persons aged 30 years and over in 1996-98 (ie born before measles vaccine was available) had immunity levels above 95 per cent.
These results indicate the ongoing need to improve vaccine uptake in infants and suggest that a vaccination campaign targeting young adults would be beneficial.

If we wish to attenuate measles outbreaks to state level – indeed Victoria itself – we can examine a 2005 review by Becker et al. Monitoring measles elimination in Victoria, brings into sharp focus how damaging a drop in herd immunity can be, given that outbreaks – including this one – begin with importation of the virus.

The University of QLD authors sought to use “evidence from outbreak data that Victoria has achieved, and is maintaining, elimination of measles”. They wrote:

Conclusions: The data provide strong evidence that Victoria has maintained elimination of measles over the period 1998 to mid-2003. There is scope to improve the immunisation coverage. It is not clear how much outbreak intervention is contributing to the success in achieving apparent elimination.

Implications: To prevent importations from causing a major epidemic of measles, Victoria must maintain its immunisation coverage and outbreak control at current levels, or better. It is important to monitor the control of measles even when elimination is achieved.

Time and again we see the need to maintain herd immunity via mass vaccination. Lyn Gilbert wrote in June 2011 that researchers have presented evidence that measles has been “effectively eliminated” from Australia, “as well as from Finland, the United States, South Korea, Mexico, Brazil, Canada and Cuba”.

Elimination of measles is a viable goal for a number of developed nations. The stability of elimination has slipped further from our grasp for reasons including increased importation, socioeconomic realities and the feverish efforts of antivaccinationists. Measles is a potentially fatal and entirely preventable disease that also leaves many sufferers with lifelong disability.

It’s a public health disgrace that the measles virus can arrive in Australia to meet willing hosts who have been misled into risking their own or their children’s quality of life. That this is compounded by a demographic that experiences poverty and social trauma is a negative dynamic that health authorities should strive to rectify.

It is important that a calm measured approach is taken in educating the community about the dangers of measles and effectiveness of MMR immunisation. Also, strict and lasting penalties need to be dealt to homeopaths and chiropractors (to name just a few peddlers of alternatives to medicine) who profit from risking the lives of innocent Aussies.

The wrath of the goddess Sitala Mataji is something Aussies can do without.