Holford Watch: Patrick Holford, nutritionism and bad science

Dr. Val, the Voice of Reason of Revolution Health, is a gifted writer and we agree with her on many issues. However, we disagree with her response to some of the blogosphere criticism of Medscape for the lamentable Alison Gandey article: HPV Vaccine Adverse Events Worrisome Says Key Investigator?

[A] splashy apology isn’t in their best interests given Nick G’s point about drawing more attention to anti-vaccinationist woo.

In this case Medscape did the right thing, and next time we find an error, we should flag it directly to the Editor-In-Chief for the most rapid and civilized resolution. Readers like us can help make Medscape better - but tearing them down when they’re responsive to correction doesn’t seem productive.

We will overlook the issue of whether or not Medscape were sent emails expressing disagreement with Gandey’s piece but took some time to act until prodded by Orac’s high-profile criticism. According to Google, the original article is widely reproduced in various antivax places on the internet. So, unfortunate though it may be, it is desirable that there are posts that criticise the flaws in the piece and the Medscape withdrawal does not achieve that. Plus, the new pushpoll on the front page does the topic no service. That poll doesn’t look as if Medscape has genuinely been responsive to correction and the poll, like the article, still fails to provide a context for the assertions.

Serious neurologic, thromboembolic, and autoimmune complications have been reported in a small number of patients who received Merck’s HPV vaccine, prompting a recent joint advisory by the FDA and CDC. But the agencies emphasize that the vaccine is safe. How will this news change your use of the HPV vaccine?

The opening statement closely shadows the opening of the Gandey piece that has been removed.^[a] But, beyond that, because Medscape has not issued a correction, it also perpetuates a disorted view of the opinion of leading specialists such as Dr Diane Harper who has been involved in researching the safety of HPV vaccines. Judging by the title, Dr. Harper and Professor Abby Lippman should have been the core of the article: we contacted Dr Harper in July to ask her to clarify some points in the Medscape article that had been attributed to her.

Following Medscape’s recent action, we contacted Dr Harper again and she has given permission for us to discuss her perspective (all following excerpts are from an August 7 email). Harper emphasises that, as for all injected vaccinations, there are known potential local adverse events for HPV vaccines such as arm pain or swelling: there are no severe adverse events that are directly associated but science accepts the possibility that a vaccination may be part of a complex set of factors that underlies such an event.

I sincerely hope that the public does not get the impression that the HPV vaccine could not possibly have any adverse events associated with it– other than pain, redness and swelling, there are no known DIRECT outcomes from Gardasil; but there are less common health conditions where the administration of Gardasil may be the final inciting factor to a serious outcome. For instance, eating salt does not cause one to die; but if you have congestive heart failure, and you eat a high salt diet, you will go into florid pulmonary edema with the risk of death. Salt did not cause the death, the underlying heart disease caused the death.

Jane Moore’s Channel 4 Dispatches programme featured several UK public health experts who strongly emphasised the message that even when a young woman has been vaccinated, it is essential that she should avail herself of a regular screening programme. Several commentators argued that HPV vaccines would not have their desired impact on women’s health unless they were used in conjunction with an appropriate screening programme. Harper makes a similarly strong recommendation and emphasises the importance of education on this matter so that people can make an informed choice.

Similarly, we do have Pap screens available that have been wonderfully effective. Every girl/woman/parent needs to know that there are potential risks involved with vaccination and if those risks are not personally tolerable, the girl/woman can still be protected from cervical cancer by participating in the screening programs, without taking the vaccine!

Harper regrets that her nuanced, pro-education message that emphasises the importance of making an appropriate individual decision, was overshadowed by Dr. Christiane Northrup’s statements concerning germ theory.

Ultimately, that is one of the integral problems with this faux notion of journalistic balance that incorporates nonsense such as germ theory dissent as if it is a respectable argument that deserves serious attention in the arena of public discussion. There are complex factors to be considered and the risk profile may vary from one individual to another, and across different countries with different health programmes and facilities. Bizarre ideas that have been outdated for 200 years should have no part in framing a 21st century discussion about public health policy - nor should they displace discussion about education and screening programmes, and whether HPV vaccines are an appropriate public health investment.

Unfortunately, Northrup is one of Oprah favourites and she propagates her message in many popular venues. In 2000 Pareek and Pattison assessed The two-dose measles, mumps, and rubella (MMR) immunisation schedule: factors affecting maternal intention to vaccinate (pdf).^[1] They revealed that:

Mothers consulted a wide variety of sources to obtain general information about the MMR vaccine, including health professionals, friends, family, and the media…In contrast, mothers predominantly acquired their information about the side effects of the MMR vaccine from various sections of the media rather than from health professionals, with television the most commonly cited source of information about side-effects (31.4% in Group 1 and 37.9% in Group 2).

TV is disproportionately powerful in propagating health scares. When Oprah allows Northrup or similar pundits the air time to offer unfounded criticisms of germ theory or evidence-free criticisms of public health issues, then she and similarly powerful figures are perpetrating a great disservice to their audience. Oprah and other media outlets must share the blame for allowing a particular styles of ‘expert’ to confuse their audience with pseudoscience and inaccurate information. Audiences deserve informed and appropriately nuanced health commentary - they deserve better than the health pundits who are disproportionately publicised in such programmes.

And, just in case we are feeling at all smug in the UK, I would remind you of the uncritical publicity that Dr Richard Halvorsen receives in the UK mainstream media. He has recently partnered with Patrick Holford to disseminate his advice on vaccines. According to the patrickholford.com website, in a Q&A section about vaccinations (paywalled), this was one of the questions.

I am a GP and a nutritional student. Is the human papilloma virus (HPV) vaccine really necessary since cancer only attacks those with poor nutritional status – and is it safe?

So, somewhere in the UK (presumably) is a family doctor who is a germ theory dissenter and may well be advising patients on that basis, to say nothing of the issue of the HPV vaccine. It seems that there are some medically-qualified people who might be in sympathy with Northrup’s views but that doesn’t mean that it is appropriate for Medscape to behave as if these perspectives are as valid as others that should be taken into consideration when deciding on the issue of HPV immunisation.

Medscape readers deserve better which is why Medscape should have amended the article or posted a retraction of parts of it, and invited more commentary from Dr Harper and Professor Abby Lippman. The cybervoid of a 404 meets the information needs of no-one.

Notes

[a] Alison Gandey’s article: HPV Vaccine Adverse Events Worrisome Says Key Investigator opened as follows:

Serious neurologic, thromboembolic, and autoimmune complications have been reported in patients who received human papillomavirus (HPV) vaccines. Although not the norm, experts suggest that the events are grave enough to encourage caution. “The side effects that have been reported are real and they cannot be brushed aside,” Diane Harper, MD, from the Dartmouth Medical School, in Hanover, New Hampshire, told Medscape Oncology. Dr. Harper was a principal investigator of clinical HPV vaccine trials for both Merck and GlaxoSmithKline.

News reports of adverse events, teen paralysis, and death have fueled public concern. Back-to-school immunization clinics are stocking up on Merck’s Gardasil and more than16 million doses have reportedly already been distributed in the United States alone. But many parents are questioning whether their children should be vaccinated. And many women are wondering whether they should be vaccinated too.

References

[1] Pareek M, Pattison HM. The two-dose measles, mumps, and rubella (MMR) immunisation schedule: factors affecting maternal intention to vaccinate. Br J Gen Pract. 2000 Dec;50(461):969-71.

Related Reading

HolfordWatch discussed the alarmism about the aluminium/aluminum content of Gardasil and Gandey’s credulous reporting of Dr Northrup’s germ theory dissent: Is the Aluminium Content of Gardasil a Potential Peril? Unlikely.

The New York Times has a Reporter’s File on Gardasil and cervical cancer with some interesting statistics for the US and useful links.

Jeff Bercovici makes some useful criticisms of this and related HPV vaccine reporting: HPV Vaccine Inspires Yellow Health Journalism. “Edelman’s reporting, while heavy on scare-mongering, is suspiciously light on the critical context a layperson needs to evaluate the evidence.” Bercovici discusses the unhelpful nature of the current VAERS which is a point that is also explored in Dr Dave Gorski’s piece.

Jim Edwards comments on mainstream media clumsiness in presenting the numbers: Could Merck Be About To Stumble Over Gardasil Adverse Event Reports?.

Dr Dave Gorski provides an extensive critique of the toxins canard and the inappropriateness of the Vaccine Adverse Events Reporting System for these purposes: Germ theory denialism and antivaccination myths on Medscape. There is some further discussion of Dr Northrup and her germ theory dissent. He comments on the withdrawal: Medscape quietly pulls a bad news article.

Phil Plait of Bad Astronomy has written on provocative piece on how “antivaxxers are potentially the Number One health hazard in America”: Antivaxxers and the media.

Denialism on Gardasil idiocy and the new Medscape pushpoll.

Update 9 August: What Came First? The Chicken or the Gardasil?

Update 13 August: Medscape is just compounding their original offence: Why, Medscape, why? Or: Gardasil is hunky-dory except when antivaccinationists say it’s not.

Update August 20: NYT writes the article that Medscape should have written from the outset: Drug Makers’ Push Leads to Cancer Vaccines’ Rise.

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