Occasional reflections on Life, the World, and Mathematics

Posts tagged ‘vaccines’

NHS wants you! (to spread the varicella virus)

I’ve long wondered why children in Britain generally don’t get the chickenpox vaccine. In an article describing a move by drugstores to offer the vaccine for a substantial fee, the BBC quotes the NHS:

The NHS said a chickenpox vaccine is not offered as part of routine immunisations as it would leave unvaccinated children more susceptible to contracting the virus as an adult.

There could also be a significant increase in shingles cases as being exposed to infected children boosts immunity to this.

This is like the cracked-mirror reflection of the usual herd-immunity argument for why, even if you don’t want vaccines for yourself or your children, you have a civic obligation to make yourself immune to avoid transmitting the virus to others. Here they say that children have a duty to suffer with an unpleasant disease, so that they can serve as walking virus reservoirs that will more efficiently infect other children, and boost the immunity of adults.

I suppose there’s a cost-benefit analysis somewhere that shows this is the cheapest approach. And I’d bet that the cost of children’s discomfort is set at zero.

Building confidence in public health

The NHS informs concerned parents about vaccines:

The 4-in-1 pre-school booster is very safe. Before it was granted a licence, the safety, quality and effectiveness of the pre-school vaccine, like all vaccines, was thoroughly tested. It does not contain thiosermal (mercury).

A lot of parents are (probably unnecessarily) worried about thiomersal in vaccines. The reassurance from NHS would probably be more persuasive if they knew how to spell it. (Thiomersal is, confusingly, called “thimerosal” in the US, but not “thiosermal”.)

What does an anti-vaccine activist want?

With the swelling of interest in the anti-vaccine movement, inspired by the recent California measles outbreak, I’ve seen a number of opinions published similar to this one from Ian Steadman in the New Statesman

Then there’s also this to think about: if somebody’s distrust of scientific and/or political authority is so great, for whatever reason – maybe they’ve been scared by sensationalist stories in the media, or maybe they sincerely believe the government has no moral right to dictate health choices to citizens – that they’re willing to significantly increase their child’s risk of catching a (possibly fatal) illness, then calling them names and telling them scientists and politicians disagree with them is probably futile. Arguing that “the science is settled” with someone whose stance is predicated on the belief that the standards of proof used by scientists are flawed is definitely futile.

The article is excellent, but I don’t entirely agree with this sentiment. Living in Berkeley and Oxford, I have encountered some vaccine refuseniks, and it’s not clear to me that they have anything as definable as a belief about “the standards of proof used by scientists”. Rather, I think that they have a desperate need to feel special, protected not by mass vaccination — and definitely not by anything as infra dig as “herd immunity” — but by their special virtue, which may be Christian purity or organic health-food purity. (more…)

Benjamin Franklin’s advice on vaccination

I’ve never seen Franklin brought into the discussion of parents’ refusal to vaccinate their children. This passage from his autobiography made a deep impression on me:

In 1736 I lost one of my sons, a fine boy of four years old, by the small-pox, taken in the common way. I long regretted bitterly, and still regret that I had not given it to him by inoculation. This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it; my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen.

More comments on Andrew Wakefield and the MMR-autism hoax here.

I once was at a parents’ meeting in Oxford where a homeopath had been invited to speak. I was genuinely nonplussed that she was raving against vaccines. Aren’t vaccines the one great success of the homeopathic world-view? Giving a tiny dose of the disease-causing agent to cure (or prevent) the disease. Her answer was incomprehensible to me, but seemed to suggest that the very fact that there was a measurable physiologic effect showed that they weren’t any good (from a homeopathic perspective). And the fact that pharmaceutical firms made the vaccines was all you needed to know about their chthonic nature.

I fled the meeting in revulsion when the homeopath started prating about homeopathic cures for tetanus.

Total Impact: Wakefield edition

So it seems Andrew Wakefield is back in the news. As Phil Plait has described well, the man who has done more to undermine public health than any physician since Martini and Rodenwaldt has been given space in The Independent to accuse the British government of inadequate measles prevention. Because his rantings scared lots of parents off the MMR vaccine, and the NHS didn’t want to provide separate measles vaccines instead.

The pathological self-promoters you will have with you always, so there’s no real surprise there. But it got me to thinking about his future in British medical research. Because some denizens of less enlightened lands may not know how IMPACTFUL British research has become: The prime directive for state-sponsored research under the current government (though I think it started already under Labour) is “impact”, defined as

an effect on, change or benefit to the economy, society, culture, public policy or services, health, the environment or quality of life, beyond academia

because academia is just a province of Faerie, not an actual part of the society or economy. In addition to impact being a crucial part of every grant proposal, and the postmortem on every grant after it’s completed, this definition will guide 20% of the scoring on the Research Excellence Framework (REF) just now getting underway, replacing the Research Assessment Exercise (RAE) last conducted six years ago, because now instead of research being assessed, we agree that it’s all excellent but needs to be frameworked, or something.

So anyway, it’s noteworthy that BENEFIT is only one acceptable form of impact. Any change or effect gets you points for impact, rather in the way the bibliometric citation counting that prevails in many academic fields doesn’t distinguish between citations for your paper providing key insights that inspired follow-on research, and citations that point out yet another bone-headed mistake in the paper that has been confusing researchers and holding back the progress of the field.

What’s more, it’s not clear how anyone would evaluate whether those who benefit from the research are themselves providing a net benefit or harm to society. (Sorry, I mean, to the taxpayer. There’s no such thing as society.) Presumably no one will provide a support letter from bioterrorists, explaining how their headline-generating work would have been impossible without the groundbreaking research of Professor X, but someone like David Li could show evidence that his work formed the industry-wide basis for the multi-billion pound market in mortgage backed securities which (you may have heard) helped to crash the world economy. The fact that he might himself agree that his formula never should have been applied, that the bankers “misinterpreted and misused it“, and that “Very few people understand the essence of the model“, doesn’t detract from the benefit that derived to some people, at least in the short term, and even the worst recession in 75 years certainly counts as a “change in the economy”, demonstrating the IMPACT of the research.

With that in mind, I reveal the hitherto secret Wakefield Impact Case Study, titled “Royal Free Hospital School of Medicine characterisation of risk factors for Autism and Vaccination Policy”. We are confident that the massively impactful Wakefield will quickly be hired by a major research institution and showered with research grants. (more…)

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