The Independent on Sunday apparently thought it would be a good idea to publish a front page story scaremongering about the HPV vaccine. Some elements remind me of previous unfounded vaccine scares promoted by the press and the anti-vaccine movement.
Here’s the article. The bases for the article appear to be: adverse reaction reports taken out of context; the anecdote of a patient; and a review of case series and anecdotal reports.
Adverse events reports – misusing these figures is the kind of thing anti-vaccine campaigners do. As the IoS eventually point out (in paragraphs 22-24 right at the bottom of the article – this is a known problem), the MHRA make the point that:
The reporting rate of suspected side effects, which are not necessarily proven to be caused by the vaccine, is influenced by many factors and expected to differ across vaccines. The greater number of reports for HPV vaccine does not necessarily mean that it is any less safe than other vaccines.
The Americans have the VAERS database, and like the MHRA emphasise that reports do not prove a causal connection. They have to do this, because people who are anti-vaccine keep wrongly suggesting otherwise. There is some discussion of HPV notifications in this CDC report. There is no mention (in a review of 25,000 reports following 67 million doses of the vaccine) of the postural orthostatic tachycardia syndrome that the IoS refers to.
Case series – do Paul Gallagher and his editor Lisa Markwell understand what a case series is and where it would be placed in a hierarchy of evidence? How about case reports, or anecdotal reports published on anti-vaccine websites?
Gallagher seems to write mostly on crime with a few articles on the food and drink industry and the odd piece on health. Markwell’s biography describes her as a foodie and refers to restaurant review which suggests her specialist subject is food and drink.
Would either of them remember that the whooping cough vaccine and MMR vaccine scares began with case series reports from mavericks and were stoked by the mainstream media? Do the pair fully understand the damage that these stories can do? I wondered before whether “don’t get too excited about case series” was a lesson that should have been taken from the Wakefield and Wilson cases. I also identified “don’t take anything newspapers publish on health too seriously” as a possible lesson for us to learn from media coverage of vaccine scares.
Would either of them spot the warning signs in this review? The author, Manuel Martinez-Lavin, links to the Sanevax website and cites the Geiers. They speculate. They refer to a decision not to recommend the vaccine as a “moratorium on HPV vaccination”. A poster on the Bad Science forum managed to spot some issues with the paper that might perhaps have passed the IoS journalists by. This is from his summary of the paper: “it’s a shite paper, based on assumptions not supported by any evidence base, poor choices of references, and the ignoring of pretty much the entire evidence base of safety surrounding HPV…”
If Gallagher and Markwell are ignorant of the place of case series and case reports, ignorant of the misuse of adverse events reports, and ignorant of the history of vaccine scares I’d suggest they have been careless and foolish to publish this front page scaremongering. If they’re not so ignorant, then they’ve been quite cynically irresponsible. Either way, they should be embarrassed.
[Edit, 01/06/2015: Dr Jen Gunter has now written a post on this, which is worth reading.]