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Ethics, evidence based medicine, Lasso of truth, snake oil, vaccines

Autopsy of Toronto Star HPV article and the real dark side of Gardasil they missed

Today the publisher of the Toronto Star, Canada’s largest newspaper, wrote that the article “A wonder drug’s dark la-fi-mh-how-a-major-newspaper-20150213-001side” will be removed from the online site. This is 15 days after it was originally published. It obviously still lives on in print and in screen shots, but now at least no anti-vaccine groups will be able to use the article in links.

The retraction is the right thing and while I’m bothered it took 15 days I am chalking that up to the Star’s investigative team actually doing the research they neglected the first time ’round the barn. I say that because if they had actually researched HPV vaccination they never would have led with “A wonder drug’s dark side.” After all a drug that has the same side effect profile, the exact same side effect profile, as placebo can’t really have a dark side.

But delay aside, I am more troubled by the retraction’s carefully walking the line of being a real apology and a real retraction (or as a doctor friend of mine said, “Even in defeat they didn’t admit defeat”):

No drug is absolutely safe for all people in all conditions of health. Now that tens of millions of young women have taken the vaccine, it is conceivable that very rare reactions may emerge that weren’t identified earlier.

All vaccines, including Gardasil, have side-effects. The better known they are, the more safely the vaccine can be deployed.

This is what the article sought to achieve as well as to note that acknowledged risks are not always properly communicated

People who know more about journalism might see this as trying to appease some egos in the newsroom, but all I can do is view this statement as a doctor who knows the data and it smacks of the same issues in the original article. Unscientific what ifs and non-existent communication issues. Doctors and nurses can’t possibly communicate side effects that don’t exist. What exactly does the Toronto Star think we should be telling our patients, that 2.3% women will have side effects, which is the exact same rate as placebo? 

And then there is the “it is conceivable that very rare reactions may emerge,” which keeps up the doubt narrative. How “conceivable” is this risk that it is worth putting on the front page of the largest newspaper and then defending? The massive wealth of data on Gardasil safety (and much of it not from Merck, the manufacturer) includes almost 1 million girls in Denmark and Sweden, the 80% or more of pre teens, teens and young adults in Australia who have received the vaccine, and the ongoing long-term post marketing surveillance of over 360,000 doses in the United States and has yet to identify risk. Thus the Star is alluding to a theoretical risk that must be less than 1 in 1 million. It’s a bit like writing an article on the dark side of shark attacks, knowing there is a 1 in 3,700,000 chance of being killed by a shark in one’s lifetime. Except the title would be, “Shark attacks, the dark side of swimming in Canadian lakes.” Falling back on “anything is possible” is sloppy.

So the question I want answered (and yes, I know I’m a mere rural doctor) is how did this happen? Since the Star isn’t forthcoming, let’s assemble the forensic evidence:

Problem #1: Failure to investigate sources

One of the leading stories from a girl who was diagnosed by a chiropractor and had chelation therapy, which is the DEFINITION of dangerous snake oil. Did the reporters not know how to Google? Not know that chelation is not recommended for any vaccine adverse events? I mean if you are an investigative reporter you investigate things, including (and probably especially) the motives of people coming forward with claims of injury.

The imbalance of how the anecdotes vs the science is a distraction from the real issue of not actually investigating the anecdotes. I’m going to assume that an anti-vaccine agenda didn’t play into the failure to follow-up on the sources, but the cynic is me is left to wonder as no explanation has been forthcoming who is friends with whom?

Problem #2: Transparency is for everyone except the Toronto Star

The publisher, Cruickshank, stated on the CBC that “doctors” brought these girls forward, but no one ever says who these doctors are. I suspect if they were respected allergists or rheumatologists or infectious diseases experts then there would be no retraction. However, if the diagnosis of vaccine injury is coming from chiropractors (or really anyone) offering chelation therapy then, well, maybe you had such a hard on for the story you didn’t really look into their credentials?

Problem #3: Their medical expert fell through

Dr. Harper, the medical expert, has written that Gardasil’s competitor is “safe and effective” and her work with the competing vaccine was never disclosed. Didn’t the reporters not wonder at all about that? She also never actually said that Gardasil was the cause of injury or that it is dangerous. She alludes to possible long-term safety concerns, but her statement is vague enough as written that it could be interpreted by an OB/GYN (i.e. me) as vaccine safety, neglecting Pap smears, or waning immunity (which his really not a scientifically sound argument, but people still make it). The Star could easily have stood by their story if Harper’s statements had been further clarified to say “yes, vaccine-related injury.”

Of course I haven’t even touched on getting a second opinion. I spoke with an investigator on the same study as Dr. Harper who did not share her concerns. I spoke with one of the heads of vaccine research at Kaiser Northern California who did not share Dr. Harper’s concerns. I’m not a reporter and that took me all of 20 minutes to gather that information. Yes, I’m connected but I have a full-time job and it isn’t chasing down sources.

Problem #4: Not understanding VAERS

The vaccine adverse events reporting system is contaminated data that requires abstraction by very trained individuals. Just to prove how bad it is one doctor infamously reported that a vaccine turned him into the Incredible Hulk and oner person reported being turned into Wonder Woman (note, vaccine injury is not how I became Wonder Woman). Doctors, lawyers, disgruntled patients – anyone can enter an adverse event.

I am guessing the star’s reporters didn’t understand VAERS and possibly their medical expert or the doctors who brought these stories forwards didn’t tell them otherwise.

Diagnosis: death by confirmation bias

The Star was not wrong to look into these claims. Drug companies do hide their data and produce biased work, but of course selective work isn’t just the purview of drug companies. Anti-vaccine groups fund research and that bias isn’t disclosed. If your source of money is someone who thinks vaccines are like the Holocaust and you are researching aluminum in vaccines and your hypothesis is that this is harmful then to me that screams conflict of interest. And then sometimes researchers are less than honest simply because they want a “big get” or are desperate for tenure. So yes, by all means talk with researchers. Take the data apart and investigate. Ask a lot of people and demand answers. Find out how everyone profits. Everyone. Unfortunately, that wasn’t what happened with the Gardasil piece.

The Star’s investigative team should take a tip from a story in their own paper about a spiritual healer who promised miracles for money

“It’s often the people who are the most desperate for help and they can’t see a solution…so they go to these so-called holy men looking for a miraculous intervention”

There are still a lot of unanswered questions…

Why do people (medical professionals included) refuse to believe the mountain of research about the vaccine’s safety?

Why are anti vaccine groups funding research at a The University of British Columba, research that has been discredited by the WHO? The researchers and UBC make claims that all research is valid and they aren’t responsible for the conclusions people draw, yet these researchers apparently spoke at a vaccine “safety” conference alongside people like Andrew Wakefield.

Why are chiropractors diagnosing and treating vaccine injury?

Why are parents willing to subject their children to dangerous and completely unindicated chelation therapy?

How much money do doctors who offer chelation therapy for HPV “vaccine injury” make from this therapy?

 

There are real dark sides to Gardasil and the Toronto Star missed every one of them.

 

 

Discussion

20 thoughts on “Autopsy of Toronto Star HPV article and the real dark side of Gardasil they missed

  1. I’m another rural doc, though an ex now. I’d add another to your list:

    The understanding of risk. This is an area that most people have great difficulty understanding, particularly when it relates to risks in the immediate future and long-term risks. So, I’d also add the Question: What are the lifetime risks if you aren’t vaccinated with Gardasil?

    Posted by korhomme | February 21, 2015, 11:15 am
  2. Thank you for spending your time and expertise on this and not letting the Toronto Star “go away quietly” from this story. It seems they still don’t get it.

    Posted by bri65 | February 21, 2015, 11:51 am
  3. Reblogged this on travelingeneticist and commented:
    Great Pot by Dr. Jen Gunter on the journalism failure of the Toronto Star on their story and ‘retraction’ piece about the safety of the Gardisil vaccine. This post is scientifically accurate and reflects on the shoddy journalism.

    Posted by travelingeneticist | February 21, 2015, 12:51 pm
  4. I have two concerns to add – in the weird journalism category. It’s bad journalism to use a rogue investigative team and never talk to your own health and medicine reporters. We know this. That kind of “investigative unit” doesn’t respect expertise, even when it’s down the hallway. Second, when experts raise a questions, you don’t respond by trashing them incorrectly as “rural docs,” and then trash someone else with that weird line about rinsing out your mouth in your own swill. Gotta do better.

    Posted by michaelhoad1@gmail.com | February 21, 2015, 1:39 pm
  5. But doc, there were some good things to this. A decade ago, you couldn’t easily find doctors willing to publicly stand against the anti-vaxx movement. Very hard – even for journalists who tried, and I worked with some of the best trying to debunk the autism article. It was frustrating. Bryan Vartabedian @Dr_V used to beg pediatricians to get on social media and take a stand – he used to say the anti-vaxx movement could have been stopped cold if only. To see 65 Canadian scientists get in gear was wonderful. To see you and others get fired up was wonderful. In addition, having a clear explanation of the intricacies of this (VAERS) was fantastic. For those of us who lost the fight 10 years ago, I’m very grateful for what you did.

    Posted by michaelhoad1@gmail.com | February 21, 2015, 1:45 pm
  6. The response of the paper remains a steaming pile. They “remain committed to this line of reporting” which I read as “we don’t actually think we messed up.”

    Notice their congratulatory back-patting where they claim to have received “praise” from unnamed “health researchers.”

    I think they don’t get it. They really don’t understand how they sleepwalked into parroting anti-vax talking points (and that’s giving them a HUGE amount of benefit of the doubt).

    Posted by JJ | February 21, 2015, 6:25 pm
  7. Main Stream Media makes up sensational story to sell papers; doesn’t care about facts or consequences. Nothing new, after all it is about selling newspapers and glory for the paper, not about facts and public good.

    Posted by Skeptic Always | February 22, 2015, 9:32 am
  8. I still think part of the problem is that we, as reporters and the public, don’t understand medical research and the scientific method — and we always fall back on telling ourselves, well, drug companies have been wrong before… and science has been incorrect before (earlier test groups were too small, etc.). Some of us have also had personal experience of doctors getting it wrong (in the 90s, I was put on Paxil for a few months and told I could quit cold turkey — the doctor then told me I was imagining the effects discontinuation “because research shows…”).

    I still suspect the reporters and Stars editors thought they were on to something. And the stories are compelling — my daughter got this STD vaccination at school without my consent and then she died. But they’re not new — at least one of these families was in the news a while back with a lawsuit against Merck.

    It could have been a multi-part series into looking at these concerns about vacines and about these anecdotes and getting solid answers.

    I really do think that some anti-vaxxers really do believe that they’re on to something too. They’re not satisfied with the answers they’re getting and they’re clinging to these alternative views. Maybe medicine isn’t doing a great job at speaking to these people about their fears… Yes, it gets couched in ludicrous conspiracy theory and mistrust of authority.

    Dr. Gunter does a good job here explaining it: they know the vaccines were safe because the placebo had (statistically) the same results. Often we’ll hear ‘no link’ and not know what that really means. How do they know there’s no link? And could they be wrong? But what if you’re a parent and don’t undertand how research works, or why a group of a few thousand is considered representative? Or if you think your own doctor is just taking someone else’s word for it?

    Instead, you just think, these stories show they missed something — and that could be my child.

    I understand how doctors must find these views to be completely insane. And it’s probably frustrating that some dummies don’t understand science. But dismissing them entirely doesn’t seem to be working.

    Posted by Jack2211 | February 22, 2015, 5:12 pm
  9. These have been great pieces, by the way.

    What are Harper’s current claims? She seems to have been saying, best that I can tell from looking at older news stories online, that if the vaccine’s protection only lasts a few years, then giving it early (to teens) and not requiring boosters means that women could be left unprotected against HPV (and that this is a concern if doctors also reduce pap smears or forgoe them entirely — as new cases of cervical cancer might get missed because it’s incorrectly assumed that unvaccinated women aren’t at risk). Did I get that right? Is there anything to this?

    Posted by Jack2211 | February 22, 2015, 5:22 pm
    • @JACK2211:
      Since the HPV vaccine doesn’t protect against all strains of HPV, routine Pap testing will still be necessary. The difference is that premalignant cytology (dysplasia) will be much less common, and the need for followup procedures (such as more frequent Pap tests, colposcopic examination and biopsy and cervical cone excisions) will diminish greatly. If someone advises forgoing Pap tests because they believe that the HPV vaccine will give 100% protection, that person is wrong, and, if a health care professional, committing malpractice.I think Harper’s concerns are misplaced.

      Posted by TBruce | February 23, 2015, 6:21 am
  10. Would you care to tear apart this anti-vaccination post? http://vaccineimpact.com/2015/dr-toni-bark-m-d-do-not-remove-vaccine-exemptions-some-children-die-from-vaccines/
    I have difficulty believing any one who practices homeopathy…but I’m sure you could do a much better job at dissecting this🙂

    Posted by Julian | February 23, 2015, 3:27 am
  11. Thank you, Jen. I guess I count as another rural doctor, though not quite rural in the same sense as you. My kind of rural means 24/7 answering the phone, being ‘it’ for everything—I’ve done major trauma, acute medicine, deliveries, reduced fractures and dislocations, done housecalls on snowshoes, re-captured escaped psychotic patients at 3am (even X-rayed a run-over cat and sewn up a lacerated dog!)—in middle-of-nowhere Canada. Even here we have the trendy parents (always what we call ‘come from aways’) who refuse vaccination for their precious babies. When I was young and energetic, I argued with them as best I could to guide them to seeing sense. Now I’m old and cancerous, I tell them that if they wish to reject modern/western/scientific medicine it is their right, and it is my right to no longer have responsibility for their care. I can only do so much, and I’m running out of steam. Occasionally, I point out that whilst I may still look young and dashing (!), I personally have suffered chickenpox (and the subsequent shingles), measles, mumps complicated by pancreatitis, and so many ear infections as a child that I have no hearing in one ear and about 50% in the other. I’ve seen a child die from chickenpox encephalitis and I’ve had patients deaf and blind from rubella. All of these issues, both mine and my patients’ are now preventable with immunisation. It enrages me to see such narcissistic stupidity as exhibited by those who have ‘done their research’ on the web. To then have it encouraged by a newspaper in search of sales is so irresponsible and reprehensible. I’m glad there are still younger physicians able to muster the energy to fight back. When my leukemia wins out, I will be glad to know that there are those who fight against the return of the dark ages.

    Posted by lancelotgobbo | February 26, 2015, 7:24 am

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