The Problem of Wasted Souls


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Why Swine Flu Pisses Me Off

or The Inability to Use Logic and Statistics is Killing Us All

Update 2010-09-22: Statistically, the H1N1 vaccine turned out as safe as a normal vaccine according to a recent study.

I’ve just about had enough of the hysteria over swine flu. And before you all chime in about how the government is brainwashing everyone into taking the vaccine, I’m not talking about the vaccine. I’m talking about the vaccine propaganda – on both sides!

Before you lay an egg and send me a diatribe about how I’m killing the children, read the rest of the essay.

I’m not saying that the pro-vaccine OR the anti-vaccine folks are right. I don’t know who’s right. What I’m saying is that neither the main stream media nor the alternative media are exercising the level of comprehension and communication necessary to help us make an informed decision. One of my friends on Facebook has been posting links to various articles about the vaccine because she wants people to be informed and make their own decision. I completely agree with her desire!

The problem I have is two-fold. First, that the sites she posts don’t provide the information in a format useful for making decisions. Secondly, most people simply don’t seem to understand enough about logic, statistics, and the scientific method to make decisions for themselves.

For an example of these problems, let me share some information from articles.mercola.com, a popular website based on the number of links I’ve seen posted to Facebook. For the purpose of this discussion, I’m going to walk through the article at http://articles.mercola.com/sites/articles/archive/2009/10/31/CDC-Says-Kids-That-Die-From-Swine-Flu-Have-Coexisting-Bacterial-Infections.aspx and highlight the areas with which I have problems.

The article starts with a short summary of a Star Tribune article found at http://www.startribune.com/lifestyle/health/virus/63531287.html?elr=KArks7PYDiaK7DUvsMs_5PyOiUiacyKUnciaec8O7EyUs. The Star Tribune article mentions a CDC report (with no citation) that appears to be referring to this page http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5834a1.htm.

So my first complaint is that there are no citations or references in the Star Tribune article. In a regular newspaper, that’s acceptable, but the web is literally built to support cross-linking cited material. News sources online should start doing so to provide an easier way to track down their source material. But anyway…

Here’s my first quote from Mercola:

So far we know that, of the 36 children who died from H1N1 between April and August of this year, 30 had some form of chronic health condition, and all of them had a co-occurring bacterial infection.

Dr. Mercola appears to be basing his comment on this line from the Star Tribune report:

A recent study by the Centers for Disease Control and Prevention (CDC) found that of the 36 children who died from H1N1 from April to August, six had no chronic health conditions. But all of them had a co-occurring bacterial infection.

In fact, the CDC paper says this:

Among 23 children with culture or pathology results reported, laboratory-confirmed bacterial coinfections were identified in 10 (43%), including all six children who 1) were aged ≥ 5 years, 2) had no recognized high-risk condition, and 3) had culture or pathology results reported.

So, the CDC is saying that 43% (10 of 23) of children tested had bacterial co-infections. Of the six children who were under 5, with no known risk factors, and tested for co-infection, all six had infections. Dr. Mercola is simply repeating the incorrect information from the Star Tribune without reading the source material. That’s not science or reporting, that’s rumor mongering.

Let’s back up for a second and look at some of the pointed questions that Dr. Mercola wants the CDC to answer:

How many pediatric deaths occurred in children who:

  • Were positively lab confirmed as H1N1?
  • Had underlying chronic immune and brain dysfunction?
  • Were fully vaccinated according to CDC recommendations?
  • Had received influenza vaccine this year?
  • Had received seasonal influenza vaccine in previous years?
  • Received Tamiflu or another anti-viral prior to death?
  • Had a coinciding bacterial infection with H1N1?
  • Were never vaccinated – totally unvaccinated?

These are in fact good questions. I don’t have answers for all of them, but if you read the CDC report, we do have answers for some.

How many were positively lab confirmed as H1N1?

From the CDC report:

This case series included data reported to CDC on all deaths associated with laboratory-confirmed 2009 pandemic influenza A (H1N1) virus infection occurring in persons aged <18 years through August 8, 2009. Laboratory confirmation was defined as a positive test for 2009 pandemic influenza A (H1N1) virus by reverse transcription–polymerase chain reaction (RT-PCR).

The case series (in other words, the report on that page/URL) covers the deaths of 36 people under age 19 and all were lab confirmed as H1N1 infections. Table 1 in the CDC report even lists the number of days after illness onset when the lab test for H1N1 was performed. (There are two children with a test date of “unknown”. I take this to mean that the test was positive but the duration of illness was not established for some reason. Don’t mistake this for meaning that the test wasn’t performed.)

How many had underlying chronic immune and brain dysfunction?

Not surprisingly this is exactly the type of data that the CDC is interested in collecting and analyzing. They helpfully included Table 2 in their report that lists:

High-risk medical conditions No. of patients (%)
Neurodevelopmental condition§ 22 (61)
Chronic pulmonary condition 10 (28)
Congenital heart disease 3 (8)
Metabolic or endocrine condition 2 (6)
Immuno suppression 2 (6)
Any high-risk condition 24 (67)
Multiple neurodevelopmental conditions 13 (36)
Neurodevelopmental condition with chronic pulmonary condition 9 (25)
As defined by the Advisory Committee on Immunization Practices. Conditions were not mutually exclusive; the majority of children had multiple conditions.
§Neurodevelopmental conditions included cerebral palsy, developmental delay, autism, congenital neurologic disorders, and other chronic central nervous system disorders.

How many were fully vaccinated according to CDC recommendations?

The CDC report did not include this information. It seems unlikely that medical personnel would spend their time checking on the total vaccination status of a dead child.

How many had received influenza vaccine this year?

The text of the CDC report states:

Of 25 children for whom information was available, 13 (52%) had received at least 1 dose of the 2008–09 seasonal influenza vaccine, including 11 children with high-risk medical conditions.

Since the report covers deaths through August, the H1N1 vaccine wasn’t publicly available (I believe), so the seasonal vaccine is the only one that is relevant.

How many had received seasonal influenza vaccine in previous years?

This information was not available from the CDC report. Dr. Mercola doesn’t directly explain why he thinks this would be relevant. A justification for relevancy would be nice since flu vaccines are matched to annual expected flu strains and do not necessarily confer protection in following years.

How many had received Tamiflu or another anti-viral prior to death?

Another example of information that the CDC is very interested in. From the same Table 2:

Antiviral Treatment No. of patients (%)
None 12 (39)
≤ 2 days after illness onset 4 (13)
> 2 days after illness onset 12 (39)
Timing of treatment initiation unknown 3 (10)
Unknown 5 (14)

How many had a coinciding bacterial infection with H1N1?

Yup, we revisit Table 2 yet again…

Invasive bacterial coinfection No. of patients (%)
Yes 10 (28)
No 13 (36)
No specimens collected 8 (22)
Unknown 5 (14)
Defined as laboratory detection of a bacterial pathogen in a specimen from a normally sterile site or a postmortem lung biopsy.

How many were never vaccinated – totally unvaccinated?

Another item not available from the CDC report.

So, of the 8 questions that Dr. Mercola is “calling out” the CDC for withholding information, the CDC actually provided answers proactively to 5 of those questions. Of the remaining 3, existing medical guidance doesn’t cover why that information should be gathered, so it’s not surprising that it wasn’t reported. Of course, that doesn’t prevent him from throwing in the final jab – “someone ought to be able to compile these statistics”.

Let me take a detour here to cover another unspoken assumption that seems to drive the “calling out” syndrome. The CDC does not actively handle these cases. The cases are handled by local staff at whichever hospital admitted the ill person. The CDC publishes standardized forms and guidance, which the staff at these hospitals are expected to fill out and submit. Now, since the CDC is effectively a passive aggregator of information, they can only work with what they receive. Just as any organization has some workers who are careful and comprehensive and others that are less motivated, it’s to be expected that the information the CDC has to work with may in some cases be incomplete. That’s not a sign that they are an evil corrupt mastermind withholding information – it’s a sign that they operate in the real world just like the rest of us.

Anyway, back to Dr. Mercola! Another question that we already have an answer for!

I’d also like to know how many flu deaths might be attributed to antibiotic-resistant staph infections.

I know this routine is getting boring, but allow me to quote the CDC report again…

Of the 23 children with culture or pathology results reported, 10 (43%) had a laboratory-confirmed bacterial coinfection, including Staphylococcus aureus (five, including three methicillin-resistant S. aureus), Streptococcus pneumoniae (three), Streptococcus pyogenes (one), and Streptococcus constellatus (one).

Now, if you’re like me, you’re getting tired of me calling out the guy who’s doing the calling out. I’m sorry, but it seems like the only way to drive home my point – namely that sites like mercola.com are NOT about informing people, they’re about something else. What exactly that “something else” is will be left as an exercise to the reader. Onward!

From a little further down in the Mercola article:

Turns out obese people are admitted 6x more often than those of normal weight. And obesity plays a significant role in the risk to children and pregnant women as well, something that has never been discussed by the media, the CDC or the public health officials.

Again, Dr. Mercola is “calling out” the CDC for “never discussing” something. But wait, what’s this? A quick search on the CDC site finds us http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5810a1.htm that includes the following section:

Medical risk factors for severe infection are similar to those identified previously in studies of seasonal influenza (12). In one case series of 179 patients hospitalized with laboratory-confirmed novel influenza A (H1N1) virus infection, 117 (65%) patients had a medical risk factor previously associated with severe infection in studies of seasonal influenza (e.g., chronic heart, lung, renal, liver disease; cancer or immunosuppression; or pregnancy) (12,18; CDC, unpublished data, 2009). Deaths caused by novel influenza A (H1N1) have been reported among pregnant women. In one case series, the incidence of hospitalization for confirmed novel influenza A (H1N1) virus infection among pregnant women was four times higher than that of the general population (19). Obesity (defined as body-mass index [BMI] ≥30) or morbid obesity (BMI ≥40) has been noted among hospitalized patients in some case series (20,21). However, the majority of these patients had other medical risk factors, and investigations to determine whether obesity or morbid obesity is an independent risk factor for severe infection are underway.

So, far from not discussing it, the CDC mentions it specifically in a publication from August 2009 (the Mercola article is from October 2009). They even state that studies are underway to determine how much of the risk is due to the obesity vs. the other medical risk factors.

Next, I’d like to look at a section from Dr. Mercola’s article which I will reproduce in full because the tone of the section is as important as the factual content:

You Take Your Chances Either Way…

I also want to stress that you must remember that you are taking your chances either way, whether you get the flu shot or take your chances with the flu.

This year, flu deaths are trumpeted across the world, and yet people are also dying and suffering life-altering disabilities shortly after receiving the flu vaccine, whether it be the seasonal- or the H1N1 vaccine. (They’re claimed to be nearly identical anyway, so why would it matter which it is?)

For example, here are just a few recent stories that receive nowhere near the same amount of attention. In fact, most if not all, are being portrayed as unfortunate coincidences that have nothing to do with the fact they just received a flu shot, and no further investigations are made:

Remember, the medical industry ACCEPTS these occasional deaths as collateral damage during mass vaccinations and other drug interventions.

The question is, do you?

Now, I need to introduce a concept from logic known as “post hoc, ergo propter hoc”. Sorry for the Latin, but loosely translated it means “After this, therefore because of this”. An example may be the best way to get at what is being expressed… If we have two events, event A and event B, and event B happens after event A, the claim “event A caused event B” is “post hoc, ergo propter hoc”. While many times in life such a sequence may be true (“I tripped on the stairs; shortly thereafter I had a broken wrist.”) we can imagine examples where it is not true (“I tripped on the stairs; when I got to my car my window was busted and my stereo was stolen.”). The fact that we can find an example where “A before B” doesn’t equal “A caused B” means that we cannot use this type of reasoning to determine causation. And in fact, if you consider all the possible events (such as the last rainstorm to pass through Tokyo) that happened before you were reading this post, it should be clear that the vast majority of them did not cause you to read this post (unless you live in Tokyo and decided to read my blog because it’s raining 😉 ).

So, with that detour behind us, let’s get back to Dr. Mercola.

This year, flu deaths are trumpeted across the world, and yet people are also dying and suffering life-altering disabilities shortly after receiving the flu vaccine, whether it be the seasonal- or the H1N1 vaccine.

The emotional implication of this sentence is that people are dying and suffering disability because of the flu vaccine. But as our detour just showed, the fact that events happened in sequence doesn’t mean that the first caused the last. They do make good emotional fodder though. In fact, if you reword this to say “people are also dying and suffering life-altering disabilities shortly before receiving the flu vaccine”, the new version of the sentence is exactly as true as the original version was (though with perhaps a different emotional result?).

Next, let’s look at the stories Dr. Mercola introduces with this paragraph:

For example, here are just a few recent stories that receive nowhere near the same amount of attention. In fact, most if not all, are being portrayed as unfortunate coincidences that have nothing to do with the fact they just received a flu shot, and no further investigations are made:

Now, as much as it pains us to admit it, sometimes things are “unfortunate coincidences”. The human mind seems built to seek causation at every turn, but a fervent desire to find a cause doesn’t make the first presumptive cause-candidate we find the real one. For an excellent look at how humans fool ourselves with our endless quest for “the cause”, I recommend “Fooled by Randomness” by Nassim Nicholas Taleb.

First up:

  • Five people recently died after getting flu shots in Korea

The link takes us to http://joongangdaily.joins.com/article/view.asp?aid=2911318, what appears to be a Korean-based news site. I encourage you read the whole article for yourself, since I can’t reproduce it here due to copyright. I will however, summarize the deaths here:

  1. An 80 year old diabetic woman collapsed and died after being transported to the hospital.
  2. A 51 year old man died of untreated coronary disease.
  3. Three other deaths are mentioned with no explanation of the circumstances.

Personally, I just don’t find it that surprising that an 80 year old diabetic woman and a 51 year old man with heart disease died. We literally know nothing about the other deaths, so there’s nothing to discuss. Let’s turn our eyes towards Korea for a moment. South Korea’s population is approximately 48.5 million and their death rate is approximately 5.94 per 1000. (Both stats are from the CIA World Factbook at https://www.cia.gov/library/publications/the-world-factbook/geos/ks.html.) These numbers imply that about 288,090 Koreans will die this year. That averages out to 5,540 per week if we naively assume that the deaths happen evenly throughout the year. Add in the risk factors for diabetes or heart disease and I’m not surprised that there were two people who died within close proximity to the time they received the flu shot. But “A before B” doesn’t mean “A caused B”…

Next:

  • The New York Times mentions an 8-year-old boy from Long Island who died roughly a week after receiving a seasonal flu vaccine

It’s true the New York Times article at http://www.nytimes.com/2009/10/16/health/16vaccine.html?_r=3&th&emc=th does mention the death. I’ll quote the entire reference here to save you the time of clicking the link if you want:

Some anti-vaccine groups are also highly organized and quick to respond to openings to promote their message. For instance, this week, an 8-year-old boy from Long Island died roughly a week after receiving a seasonal flu vaccine, though officials from the New York State Department of Health denied a connection.

Almost instantly, on a memorial page on Newsday’s Web site for the boy, Sean Weisse, a message from an anti-vaccine advocacy group appeared: “We are so sorry to hear about Sean. My understanding, and forgive me if I’m wrong, is that this was a vaccine-related injury. If so, we would like to help you. Best regards, Stan Kurtz, Generation Rescue, Jim Carrey and Jenny McCarthy’s Organization.”

As we should always do, let’s try to find the original source report. The news appears to have been reported by NewsDay.com at http://www.newsday.com/long-island/suffolk/state-probes-unexplained-death-of-kings-park-boy-8-1.1524114 and a follow-up article here http://www.newsday.com/long-island/suffolk/officials-encephalitis-suspected-in-li-boy-s-death-1.1557564. Unfortunately, NewsDay is a subscription site, but I did find what appears to be a cut-n-paste of it into a forum at http://www.swineflu.org/forum_posts.asp?TID=28494&PID=209203. Also, DailyMe appears to have syndicated the second article at http://dailyme.com/story/2009101500005269/state-probes-unexplained-death-kings-park.html. The critical bit:

[Health department spokeswoman Claudia] Hutton said the boy was given a regular seasonal flu shot in a private physician’s office, but results from blood and spinal fluid tests show that it is “extremely unlikely” that the vaccination caused his illness later.

“There is always a very remote chance, but it is so remote that it is almost a scientific certainty that it is not vaccine-related,” Hutton said. “It is just a very sad family tragedy.”

It’s certainly sad to hear of the loss of an 8 year old, but our grief can’t change reality. If tests indicate the cause of death was not flu virus, we need to look elsewhere. Again, “A before B” doesn’t mean “A caused B”.

Next:

  • Twenty-five year old woman suffers irreversible disability after receiving the flu shot

This links to an article about the much-publicized case of Desiree Jennings on NFL Juice (http://www.nfljuice.com/2009/10/20/flu-vaccine-ruins-beautiful-redskins-cheerleader/). The NFL Juice “article” is actually a open letter written by Desiree, so it’s instructive to look at some other more factual reports regarding her case…

Let’s start with links to two stories by the local Fox News affiliate. (I hesitate to call Fox News “factual”, but it’s an improvement over an autobiographical letter from Ms. Jennings.)

http://www.myfoxdc.com/dpp/health/101309_woman_disabled_by_flu_shot_reaction_dystonia

http://www.myfoxdc.com/dpp/news/local/101509_celebs_reach_out_to_desiree_jennings_flu_shot_reaction

And an important follow-up from the same news site:

http://www.myfoxdc.com/dpp/health/102109_desiree_jennings_dystonia_explained

A fairly lengthy discussion of the case is also available here:
http://www.examiner.com/x-13791-Baltimore-Disease-Prevention-Examiner~y2009m10d16-Woman-claiming-she-acquired-dystonia-from-a-flu-shot-may-have-it-all-in-her-head

So, in short, there is no reason to believe that Ms. Jennings’ dystonia is related to the flu vaccine shot she received prior to becoming ill. Once again, “A before B” doesn’t mean “A caused B”.

Finally, let’s look at:

  • Last year, a 6-year-old girl from Colorado died after getting the FluMist vaccine

The link here actually takes you to a prior Mercola.com post at http://articles.mercola.com/sites/articles/archive/2008/07/17/u-s-government-ignores-flu-vaccine-death.aspx. The reference article cited on that post is a New York Times story at http://www.nytimes.com/2008/06/28/health/28vaccine.html?_r=1&adxnnl=1&oref=login&partner=rssnyt&emc=rss&pagewanted=all&adxnnlx=1214780824-HQxTevHGRadEcXj3yPXrDA.
Unfortunately, the story of Hannah Poling is a testament to all the questions we don’t have answers for yet. Hannah’s story mixes mitochondrial disorders and autism – two conditions about which we know startlingly little. I encourage you to read the entire New York Times article, because it gives a sobering glimpse into the battle that scientists are fighting to try to understand both of these conditions. I’ll post a few excerpts here, but please, read the whole thing…

Study after study has failed to show any link between vaccines and autism, but many parents of autistic children are convinced that vaccines — usually given around the time autism becomes apparent — are to blame.

Parents and a small group of doctors have offered a variety of scientific explanations in recent years to try to explain why they think vaccines may cause or contribute to autism. Among the first was that the measles vaccine caused a low-level measles infection that affected children’s brains. The science underlying that theory has since been discredited.

The next theory was that a mercury-containing vaccine preservative, thimerosal, poisoned their brains, causing autism. Multiple studies have failed to find any relationship between thimerosal exposure and autism, and nearly seven years after the preservative was removed from childhood vaccines, autism rates seem unaffected.

The Poling case, however, offered advocates a new theory: that vaccines may cause or contribute to an underlying mitochondrial disorder, which in turn causes autism. Although autism is common among children with mitochondrial disorders, several experts in the disorders dismissed the notion that vaccines may cause the disease, which is widely understood to have a genetic origin.

“After caring for hundreds of children with mitochondrial disease, I can’t recall a single one that had a complication from vaccination,” said Dr. Darryl De Vivo, a professor of neurology and pediatrics at Columbia University who will present at the meeting on Sunday and is one of the premier experts in the field.

“There is no test available right now to screen for mitochondrial disorders that is anywhere near sensitive or specific,” Dr. Cohen said, “so the whole concept of screening prior to vaccination is a fantasy.”

“We’re talking about two things we don’t understand very well, mitochondrial disorder and autism, and putting them together,” Dr. Insel said. “It’s like two drunks holding each other up.”

I can’t fault Dr. Mercola for being upset that we don’t have answers to these questions. But blaming vaccines is to claim to have an answer when we don’t have one yet. Plausible reason for caution, yes – especially if your child has been diagnosed with mitochondrial disorder. But my personal feeling is that Dr. Mercola goes past the point of reasonableness in the tone of his comments. And in fact, the CDC recommendations for live seasonal flu vaccine (aka FluMist) include warnings related to “metabolic disorders”, which I would take to include mitochondrial disorder. (See http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5808a1.htm, section title “Contraindications and Precautions for Use of LAIV”.) The greater problem here is that mitochondrial disorder apparently doesn’t have an effective screening test, so it will be hard to know what your child’s risk is.

So, the final tally – out of 8 deaths mentioned by Dr. Mercola, there’s only one that we can really entertain the idea of linking to a flu vaccine. Compare that to the 36 deaths directly, lab-confirmed, linked to H1N1 and I think you see why I feel Dr. Mercola is pushing the wrong message with the tone of his article.

Do we need better science? Always! To quote Sir Humphry Davy (from 1810!) “Nothing is so fatal to the progress of the human mind as to suppose our views of science are ultimate; that there are no new mysteries in nature; that our triumphs are complete; and that there are no new worlds to conquer.”

But the media has completely abandoned their ethical duty to present useful information instead of focusing on unsubstantiated rumors, opinions, and uncorrelated facts. Don’t feel too smug though, because it’s all of us, the consumers of the media, who are letting them get away with it. What’s the best course of action? Learn some basic critical thinking skills and practice them often!

Shooting Again!

This last Sunday I got a chance to pull out the cameras and do some real shooting for the first time in a long time. My friend CLT organized a “meet & greet” style photo shoot with some relatively local photographers and models. We hung out on the Old Town Mall for a while, then we went back to CLT’s studio and shot some more. It was a blast to get to do some modeling shots, check out some other folks portfolios, play with some new equipment and just generally have a good time with some other shutterbugs. I’m slowly working through the images from that shoot now (when I’m not studying for my certification test). The shot above is the latest to be posted. You can check out the others on my Flickr photostream!

Parkinson’s Law

Work expands so as to fill the time available for its completion.

A simple observation published by Cyril Parkinson in 1955. The implications are as simple as they are far reaching. Psychologically, we need deadlines and commitments to keep us sharp. So don’t be afraid of setting goals, the more aggressive the better. You may not hit your goals, but the pressure from the deadline will keep you focused and guarantee that you will achieve far more than you would have otherwise.

I’ve observed and experienced this first-hand on numerous occasions. Most recently, my stalled attempts to update my certifications is largely due to the fact that it’s too easy to put off the studying an extra day or two when I don’t have a deadline. On the opposite side of the spectrum, I’m setting aggressive goals and deadlines for a wireless project. And now I have a meeting with the Director of Economic Development next Monday to talk about how to make that project happen.

So the personal lesson here, is that I need to set a goal for my certifications. But the broader lesson is that we all need goals and deadlines to focus us on what needs done. Life is too short to procrastinate on things that are important. If it’s important enough to do, set a deadline for it. If it’s not important enough for a deadline, why are you even spending time on it?