Lazy linking - catching up edition

A few things I've come across recently, which I thought might be of interest for others.

Paul Krugman explains how the legacy of Milton Friedman is getting eroded in today's GOP: Milton Friedman, Unperson

If you're on facebook, you've probably come across posts which claims that court rulings have shown that there is a link between autism and MMR vaccinations. As anyone with a minimum of science literacy knows, that's not the right venue for such things to be decided. Even so, Emily Willingham explains at greather length, why the claim is nonsense in Court Rulings Don't Confirm Autism-Vaccine Link

A chart telling the difference between extroverts and introverts, but with input from an extrovert.

I've always been a bit in awe over Randall Munroe's work ethics when it comes to his fantastic online comic xkcd, and my awe certainly didn't become lesser when I read this Wired article about his epic 3,099 panel comic.

Researcher David Kriesel has found problems with numbers being substituted when scanning on certain Xerox scanners. Xerox has looked into it, and have confirmed that there seems to be a problem - they are working on a software patch.

I expect that everybody, and their dog, have already seen this, but anyway: An Open Letter to David Cameron and the IOC

Via Jill - The Ghost Rapes of Bolivia (trigger warning: rape)

And finally: the most important map of Europe you'll see today!

Reducing the risk

Measles warning, a photo by Kristjan Wager on Flickr.

The Danish National Board of Health has started a new campaign, trying to make people get vaccinated against measles, offering free vaccinations to anyone born after 1973 (people born in 1973 and earlier will have to pay a fee).

The angle of the campaign is to make clear to people that measels isn't a harmless childrens' disease, but is quite dangerous.

The headline of the sign is "Over 100,000 Danes can be hit by an epidemic - are you one of them?"

A bad time for anti-vaxxers

My, my - this is definitely a bad start of the year for the anti-vaxxers.

First Brian Deer's articles in the British Medical Journal (How the vaccine crisis was meant to make money and How the case against the MMR vaccine was fixed, with more on the way), and the BMJ editorial, where they put themselves on the line by making clear accusations of fraud against Wakefield (Wakefield’s article linking MMR vaccine and autism was fraudulent).

Most of the media picked up on this, and for once didn't try to "balance" the story, but instead actually made clear that Wakefield had no credibility.

Now, Salon.com has decided to removed a 2005 article by Robert F. Kennedy Jr. This article was one of the main reasons for me getting into the fight against anti-vaxxers (and more importantly, for Orac getting into the fight). It was co-published by Rolling Stones, which unfortunately hasn't removed the article.

Salon explains why they removed the article here

Measles outbreak in German caused by anti-vaccinationists

In the first months of 2010 there has been a measles outbreak in Berlin, Germany.

According to this Eurosurveillance preliminary report there has been 62 cases as of the end of March. This is more than the entire number of cases in 2006 (57) which until now had been the year with the highest number of cases in recent years.

So, what caused this drastic increase? You guessed it - anti-vaxxers. Yes, the outbreak is among unvaccinated children.

The first case was diagnosed January 5th, and was in an unvaccinated child returning from a trip to India, where measles are endemic (what the hell were the parents thinking?). The first case is a pupil at a private school - a Waldorf-Schule, which is a Rudolf Steiner school, and thus unsurprisingly have many parents who are against sensible things such as vaccinations. According the preliminary report, the proportion of students vaccinated against measles is "significantly below 70%".

One of the talking points among anti-vaxxers is that more children with vaccinations get sick from measles than children without vaccinations (which of course is pure nonsense, given the fact that a much larger proportion of non-vaccinated children get sick). Well, in this outbreak "[n]one of the reported cases had been vaccinated against measles before being exposed during this outbreak". In other words, every single case was an unvaccinated child.

In order to stop the spread of the disease, the District Health Offices took some drastic steps:

* Temporary exclusion of students and teachers without measles vaccination or naturally acquired immunity from schools with confirmed measles cases;
* Offering measles vaccination for unvaccinated students and teachers in affected schools (vaccinations in collaboration with private practitioners);
* Equivalent measures in kindergartens with measles cases;
* Active detection of contacts and exposed persons;
* Sampling of clinical material from measles patients to confirm diagnosis and perform genotyping at the National Reference Centre for Measles, Mumps and Rubella;
* Recommendation of temporary restrictions of private contacts with unprotected persons and of any public activities in groups for patients and their unvaccinated family members;
* Public health information to increase regional clinicians' alertness regarding measles in their area;
* Enhanced communication with educational institutions and parents with critical attitudes towards vaccination of the children.

This has helped stop the spread of the disease, but strikingly enough, few parents have taken the offer of getting their children vaccinated. What's more, some parents did something much more incredible - they filed an action against the District Health Offices at the Berlin Administration Court for not allowing their children to go to school so they could get infected.

In early February, parents whose children were affected by the temporary school exclusion filed an action against the respective District Health Office at the Berlin Administration Court. The claim argued that the health authority’s decision impeded the unvaccinated children’s rights to visit school and to acquire immunity against measles through natural infection. Measles was claimed to be a harmless infection in children without severe complications and possible long-term disabilities. The specific vaccination against measles was perceived to be inefficient and dangerous.

They wanted their children to get sick with a potentially deadly disease! What the hell is wrong with these people? How can anyone be so ignorant?

Luckily the claims were dismissed by the Berlin Administration Court, but cases are pending at the Berlin High Administrative Court. Hopefully they will be dismissed there as well.

Measles are a serious disease, which causes hundreds of deaths every day. For people to want to expose their children to it, shows how dangerous the anti-vaccination movement is.

A bridge too far

This is a, somewhat belated, reaction to Chris Mooney's article in science progress Will the Vaccine-Autism Saga Finally End? in which Mooney writes about the latest developments regarding Wakefield and his infamous study on the possibility of a MMR-autism link (a study which was retracted by The Lancet recently).

Most of the article is quite fine, but at the end, Mooney writes the following:

Instead, I believe we need some real attempts at bridge-building between medical institutions—which, let’s admit it, can often seem remote and haughty—and the leaders of the anti-vaccination movement. We need to get people in a room and try to get them to agree about something—anything. We need to encourage moderation, and break down a polarized situation in which the anti-vaccine crowd essentially rejects modern medical research based on the equivalent of conspiracy theory thinking, even as mainstream doctors just shake their heads at these advocates’ scientific cluelessness. Vaccine skepticism is turning into one of the largest and most threatening anti-science movements of modern times. Watching it grow, we should be very, very worried—and should not assume for a moment that the voice of scientific reason, in the form of new studies or the debunking of old, misleading ones, will make it go away.

This paragraph is problematic for several reasons. First of all, as Orac reports, this has been attempted before, without success. Not because of lack of trying from the scientists, but because of the behavior by the anti-vaccination crowd.

Second of all, it's problematic because it lends credibility to the anti-vaccination crowd. If the scientists are willing to debate them, then there must be something to it, or so it would seem to many.

Let me go into this a little deeper. When I talked to a friend about this yesterday, he said something which actually sums up the problem really well, while staying in the bridge building metaphor: "One cannot build bridges to alternative universes".

When we are dealing with the anti-vaccination crowd, we are dealing with a crowd that believe that there is a world-wide conspiracy among Governments, pharmaceutical companies, doctors, nurses, scientists, and many other, to suppress knowledge about behavior which is harmful to children.

This might not be what they say, but it's the consequences of their claims.

Think about it for a moment.

Childhood vaccinations are given all over the world, from Communist China, over theocratic Iran and feudal Saudi-Arabia to capitalist USA, yet the anti-vaccinationists want us to believe that all these governments willfully ignore data that shows that these vaccinations cause autism?

Big Pharma, as medical companies are often called, is a billion dollar industry, with heavy lobbying in the US, yet in countries like Denmark, vaccinations are made by state-run institutions (in Denmark, Statens Serum Institut).
Somehow, the anti-vaccination crowd wants us to believe that the Danish state continues to give childhood vaccinations, causing autism, even when the same state is the one who has to cover the cost of the special needs of the autistic children, due to the Danish welfare state?

Doctors and nurses all over the world are involved in giving out the vaccinations. They would also need to be part of the conspiracy.

Scientists all over the world do studies into the side effects of vaccinations, into the root causes of autism, and many other related subjects which would uncover a vaccination-autism link, yet only discredited people like Andrew Wakefield makes claims about such a link.

That is one big conspiracy theory.

Yet, Mooney wants us to build bridges to this crowd. Agreeing on something, anything, in order to... what exactly? How does one convince someone who not only believes in such a conspiracy, but actively promotes the conspiracy theory, that it doesn't exist?

And then there is the problem of giving credibility to the anti-vaccination crowd.

When one builds a bridge, the idea is to cross from one side to the other, not to meet halfway. There is the continent of reality, and then there is the islands of anti-science - meeting somewhere between, will move you from reality towards anti-science. Even more so, when you move towards the anti-science crowd, yet the anti-science crowd stands firm - you won't reach each other, but it will move the halfway point closer to their position. A sort of negative Overton Window, if you want.

No, the scientific community should most certainly not try to build a bridge to the anti-vaccination leadership. Instead, the scientific community should try to inform the public, especially journalists, about what the science says, given them the information needed to form informed opinions, when studying the subject.

People like Paul Offit is doing yeoman's work in this regard, with books like Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure, yet we could use many more.

So, if one wants to build bridges, one should build bridges to the general public, probably through journalists, and ignore the lunatic fridge like Jenny McCarthy.

A side note: Chris Mooney is interviewing Paul Offit in Point Of Inquiry - I haven't heard the episode yet, so I can't comment on it.

The Wakefield saga continues

As my readers might be aware, Andrew Wakefield, the British doctor who almost single-handed started the MMR-scare, has been under a great deal of fire recently, with the UK General Medical Council finding that he "failed to act in interests of children" last week.

Now, the Lancet, which published Wakefield's original study, has retracted it.

Lancet accepts MMR study 'false'

The Lancet has been slow in retracting the study, but the GMC ruling against Wakefield appears to be the last straw.

The comment by the Lancet on the retraction states the following:

Following the judgment of the UK General Medical Council's Fitness to Practise Panel on Jan 28, 2010, it has become clear that several elements of the 1998 paper by Wakefield et al are incorrect, contrary to the findings of an earlier investigation. In particular, the claims in the original paper that children were "consecutively referred" and that investigations were "approved" by the local ethics committee have been proven to be false. Therefore we fully retract this paper from the published record.

Short, and too the point.

Wakefield's ordeal is not over yet. If one reads the GMC's report on their findings, it's clear that they are not done with Wakefield yet (emphasis added).

Having made the above findings of fact, the Panel went on to consider whether those facts found proved or admitted, were insufficient to amount to a finding of serious professional misconduct. The Panel concluded that these findings, which include those of dishonesty and misleading conduct, would not be insufficient to support a finding of serious professional misconduct.
In the next session, commencing 7 April 2010, the Panel, under Rule 28, will hear evidence to be adduced and submissions from prosecution counsel then Dr Wakefield’s own counsel as to whether the facts as found proved do amount to serious professional misconduct, and if so, what sanction, if any, should be imposed on his registration.

Page 55 of the GMC findings.

Personally, I am looking forward to the result of the 7 April 2010 panel, but I doubt Wakefield is.

Ben Goldacre explains the situation

Ben Goldacre, of Bad Science fame, explains how dangerous irresponsible media coverage can be.

That must be the worst kept secret in the world

One of my readers was unhappy about my pro-vaccination post and sent me a couple of emails about vaccinations. Included in these emails was a link to a site Think Twice, which has some "information" about vaccinations.

I started to take a look at the site, but I only got as far as the first page on it, called "Secret Government Database of Vaccine-Damaged Children", and the stupidity started to burn so much that I had to write a post about it.

Let's start with the very title, shall we? The title refers to the Vaccine Adverse Event Reporting System (VAERS) database, which runs in the US. Hardly a secret database, as anyone can report to it, and certain people are required to do so (I'll get into this later). What's more, it's hardly just a database about children with adverse effects from vaccination, but again, this is something I'll get more into.

The page begins

The general public is essentially unaware of the true number of people -- mostly children -- who have been permanently damaged or killed by vaccines.

This is something I actually agree with. A number of people think that huge numbers of people, mostly children, have had serious adverse effects to vaccinations, while in truth the numbers have been very small.

In fact, most parents would be surprised to learn that the government has a secret computer database filled with several thousand names of disabled and dead babies, children who were healthy and alive just prior to receiving the vaccines.

VAERS is a database of possible adverse effects, to which anyone can report any possible adverse effects of vaccinations they have observed. On top of that, doctors and other medical people are required to do so by law. This allows the CDC and FDA to see if there are any patterns emerging, which requires attention. If such patterns were to show up, they would result in a scientific study of the possibility that the adverse effect was caused by the vaccination, unless such a connection was already shown to not exist.

Since reporting can be done by anyone, and not just medical trained people, the inclusion of an adverse reaction in the VAERS database, does not mean that the reaction was as a matter of fact caused by the vaccination, something clearly stated in at the VAERS website (yes, the secret database has its own website).

Of course, the medical establishment and federal government don't readily disclose this information because they know it's likely to frighten parents into seeking other ways to protect their children. In other words, parents just might think this issue through on their own and decide to reject the shots.

The data in the VAERS database is not meant for the public, but rather to serve as an warning for the relevant governmental agencies (CDC, FDA) allowing them to take action, if such is required. The reason why the data from VAERS is not meant for the public is very simple, the data is not verified, and a cause and effect relationship between the vaccination and the effect has not be established. For more on the problems on VAERS data, see this page on the VAERS website.

One thing that the VAERS website doesn't say, is that some people might try to stuff the database with data for political or monetary ends.

Federal Admission of Vaccine Risks:

In 1986, Congress officially acknowledged the reality of vaccine-caused injuries and death by creating and passing The National Childhood Vaccine Injury Act (Public Law 99-660). The safety reform portion of this law requires doctors to provide parents with information about the benefits and risks of childhood vaccines prior to vaccination, and to report vaccine reactions to federal health officials. Doctors are required by law to report suspected cases of vaccine damage. To simplify and centralize this legal requisite, federal health officials established the Vaccine Adverse Event Reporting System (VAERS) -- operated by the Centers for Disease Control and Prevention (CDC), and the Food and Drug Administration (FDA).

Actually, among the things The National Childhood Vaccine Injury Act did was to create the National Vaccine Injury Compensation Program (VICP), which "is a no-fault alternative to the tort system designed to compensate individuals injured by childhood vaccines, whether administered in the private or public sector." (source). The reason for that was to protect the manufacturers of vaccinations from being sued out of business, ensuring a reliable source of vaccinations for the US. Vaccination manufactures had been sued by a number of people for possible adverse effects, and while those suits held little merit, the simple fact that they happened might be enough for the vaccination manufacturers to decide to stop making vaccinations, instead sticking to more profitable sorts of medicine.

Note that even if there is no merit to a lawsuit, it still takes resources from the company, and if there is enough such lawsuits, it might cause the company to go bankrupt, from the sheer expenses of defending themselves in court.

Ideally, doctors would abide by this federal law and report adverse events following the administration of a vaccine. However, the FDA recently acknowledged that 90 percent of doctors do not report vaccine reactions.

I've tried to find the source for this claim, and while I have found many anti-science sites report it, none have linked to the source where the FDA actually said it.

It's well known that there are a number of problems with passive reporting systems like the VAERS, such as under-reporting, which actual adverse effects don't get reported, over-reporting, where the same incident is reported several times, and bad reporting, where the effects are obviously non-related or the data is too sparse to be useful in any way.

They are choosing to subvert this law by claiming the adverse event was, in their opinion, not related to the shot.

If they actually believe that it's not related to the shot, it's not subverting the law to not report it. Since we cannot read the mind of the people involved, we have to take their words for it. If the site have any evidence of anyone subverting the law by not reporting any adverse effect they believe is cause by vaccinations, they should report it to the proper authorities.

In fact, every year between 12,000 and 14,000 reports of adverse reactions to vaccines are made to the FDA (data initially accessible only through the Freedom of Information Act). These figures include hospitalizations, irreversible brain damage, and hundreds of deaths. Considering that these numbers may represent just 10 percent, the true figures could be as high as 140,000 adverse events annually.

The more serious types of adverse effects are the more likely to be reported, as more medical people are involved in the process. The less adverse effects, which includes fever, is probably the stuff that will get under-reported the most.

And, as I said, there is no source for the 10% claim.

However, even this figure could be conservative. According to Dr. David Kessler, former head of the Food and Drug Administration, "Only about 1 percent of serious events [adverse drug reactions] are reported to the FDA." Thus, it is entirely possible that millions of people are adversely affected by mandatory vaccines every year.

David Kessler wrote that in 1993 ("Introducing MEDWatch," JAMA, vol. 269, no. 21, 6/2/93, pp. 2765-2768), so his remarks should not be taken as any kind of evidence for the current situation. Also, he was talking about all drugs, and not just vaccinations.

Maybe it doesn't matter that doctors won't report vaccine reactions, because the federal government won't investigate them. Government officials claim VAERS was designed to "document" suspected cases of vaccine damage. No attempt is being made to confirm or deny the reports. Parents are not being interviewed, and the vaccines that preceded the severe reactions are not being recalled. Instead, new waves of unsuspecting parents and innocent children are being subjected to the damaging shots.

Again, this demonstrates a serious misunderstanding of the nature of VAERS. It's supposed to give the CDC and FDA information on which it can base further studies - proper scientific studies. The incidents reported in the VAERS database, cannot be used as a basis to make decisions on, since the miss the fundamental safe-guards required in proper studies (double-blind testing, control groups etc.).

In other words, there is work going on the confirm or deny the reports, but not on an individual level. That would be a waste of everybody's time.

The page continues to talk about who pays compensations for adverse effects, and how vaccinations are made - all as wrong as the stuff I've quoted above. I think, however, that I'll stop now, where the focus has been primarily on the VAERS. As I've tried to show, the database is neither secret, nor reliable, but can be instead be considered a warning system, which can indicate that there are problems with a given vaccination. It's not a tool for research, but rather a tool to indicate where research should be done.

Why vaccinations matter

It's barely a week since Barack Obama was elected in the historical 2008 Presidential election, and there has been some rumors going around about which people he would pick for his administration. One of the names that has been mentioned, was Robert F. Kennedy, Jr. (RFK) as head of the U.S. Environmental Protection Agency (EPA).

RFK has a solid record on defending the environment, and some progressives where quite happy about this possibility. There was one group of people who were vehemently against this choice, however, the science bloggers (who are largely progressive). This might surprise people, but with a little background knowledge, it makes perfect sense.

Scientists, and science in general, have been among those most negatively affected by the Bush administrations, which were actively anti-science and anti-scientist. It would take too long to go into all of the ways this happened, but for more on this subject I recommend Chris Mooney's excellent book The Republican War on Science.

While not all scientists and science bloggers where overwhelmed by Obama, there was a clear sense that if Obama won, this would change. Politics would stop interfering in sound science, and scientists would not face political pressure to confirm with political stances. In other words, an Obama administration, would result in a, if not pro-science, then at least neutral attitude towards science from the politicians.

This is why the suggestion of RFK as head of the EPA dismayed many scientists and science bloggers. RFK as it happens, is not the sort of person that gives confidence of an pro-science atmosphere. As a matter of fact, RFK is considered not only ignorant of science, but actively against sound science by many of us.

Why do we feel this way? It all goes back to June 2005, where RFK wrote an article that appeared in both Rolling Stones and Salon.com. The article was titled "Deadly immunity" and was the shocking tale about how the scientific and medical community were covering up on how vaccinations causes autism. Or rather, how the component thimerosal, which degrades to ethylmercury, were the culprit of the rising number of autistic children.

This was indeed a shocking article, but not for the reasons RFK claimed. The shocking part of the article was the fact that anyone would publish it. Anyone spending more than five minutes on fact checking it, would have found numerous problems with it. The primary one being that there is absolutely no evidence of there being any kind of connection between vaccinations and autism. And it's not like there hadn't been any research into it at the time where RFK wrote the article. There had been large epistemological studies in several countries, including my own native country, Denmark, that couldn't find any causation between vaccinations and autism. While scientists and people in medicine, are cautionary in nature, there were an overwhelming consensus of rejecting any autism-vaccination link.

Another major problem with the article, is that RFK demonstrated rather impressively the difference between how scientists and lawyers debate. In science, it is regarded as a cardinal sin to leave out contrary evidence, to quote out of context (often referred to as "quote-mining"), and to pick just the data that suits your (called "cherry picking"). Among lawyers, this is not only acceptable, but actually good practice - they are trying to win a case after all. One of the things RFK did in the article, was to quote parts of the transcript from the Simpsonwood conference, where a possible autism-vaccination link was debated. The quotes RFK presented gave a clear indication of a conspiracy to hush up a autism-vaccination link, demonstrating to the readers that the scientists had something to hide. The problem was of course, that the quotes were taken out of context, as a skeptic blogger, Skeptico, demonstrated by finding the quotes in the transcript, and including the context (Robert F. Kennedy Junior’s completely dishonest thimerosal article). So, not only were the transcript of the conspiracy easily available on the internet, but a quick browse through it, would demonstrate that there were actually no conspiracy at all.

Still, RFK's articles did their job, making the readers believe that there were something dangerous about giving their kids vaccinations, thus increasing the number of people who didn't give their kids any.

That's unforgivable.

It's without any type of hyperbole that I would claim that vaccinations are among the most important contributors to the increased standard of living in the last 100 years. It's practically impossible to overstate the impact the availability of cheap, easily obtainable vaccinations have had on our societies today.

20 years ago, when I had English in my primary school, I had a teacher who could not use one of her arms, due to the polio she had as a child. Polio used to cripple, and even kill, children every year until the vaccinations made by Stalk in 1952 and Sabin in 1962 made it possible to vaccinate against it. Now polio is extremely rare in the Western World.

Smallpox used to be a major thread all over the world. According to the WHO fact sheet on smallpox: "As late as the 18th century, smallpox killed every 10th child born in Sweden and France. During the same century, every 7th child born in Russia died from smallpox." Now Smallpox is considered eradicated, due to a worldwide vaccination campaign.

Less serious diseases like Rubella, Mumps and Measles, are covered by the MMR vaccinations given in childhood. Rubella can cause brain damage to the child, if caught by a pregnant woman. Rubella and Mumps can cause hospitalization, but are rarely fatal. Measles, on the other hand, causes deaths. According to the WHO fact sheet on Measles:

# Measles remains a leading cause of death among young children, despite the availability of a safe and effective vaccine for the past 40 years.
# In 2006, it was estimated that there were 242 000 measles deaths globally: this translates to about 663 deaths every day or 27 deaths every hour.

In other words, Measles are not just a minor issue, and people who allow their children to get effected with Measles, are risking their lives. Even if the child survives, there is a real risk of brain damage from complications due to Measles.

And then there is the problem of herd immunity.

Some people who are vaccinated, are not actually immunized. This means that if there is an outbreak of the disease, they are at risk catching it. Others are not able to get the vaccination for medical reasons (problems with their immune system could be one reason). Again they are at risk during an outbreak. These people are dependent on "herd immunity", where enough people are immunized to keep the diseases from spreading. Due to the increased number of children not getting vaccinated, these people are at increased risk of getting the diseases. So, it's not just the health of their children the parents are risking, it's also the health of other peoples' children.

As it stands right now, it doesn't look like Robert F. Kennedy, Jr. is going to be appointed as head of the EPA, but the dark legacy of his fear mongering lives on. He has never retracted any of his statements in the article, and he is actively supporting the "Green Our Vaccines" campaign lead by Jenny McCarthy - another campaign aimed at getting people scared of vaccines. The war against science lives on, in another legacy. Let's hope it never gets officially sanctioned by the Obama administration.

The future of AIDS treatment

MSNBC has an article, Finding the way again after failed AIDS vaccine, about the future of HIV/AIDS treatment, after the recent failure of a new vaccine by Merck (not only didn't it help people, it seemed like the vaccination might make it easier for people to get infected by HIV).

The MSNBC article raises some good point, especially at the end, where Robert Bazell writes

But meanwhile we do know that treatment works well for those who are infected, and old-fashioned prevention efforts keep people from getting infected in the first place. Perhaps it is time to re-think the priorities.

I think Bazell is both right and wrong. Yes, we should up-prioritize research into treatments, and focus on proper sex-ed (which is most assuredly not abstinence-only sex-ed). On the other hand, it is also necessary to find a cure for HIV, and we shouldn't cut back on that. Instead, we could cut back on many other less urgent, or directly wasteful, things (think what kind of resources an end to the Iraq war would free).

Another thing we need to educate people on, is what causes HIV/AIDS, so AIDS-denialists are rejected as the idiots they are. Now, too much credence is made to their dangerous ideas by far too many people, including people in positions of power.

HPV vaccines in New England Journal of Medicine

As Nick Anthis, over at The Scientific Activists points out, the New England Journal of Medicine (NEJM) has a lot of articles about HPV vaccines.

Instead of linking all the articles, I'll refer you to either the frontpage of New England Journal of Medicine or Anthis' post.

Anthis sums up the content of the articles thus:

In short, the vaccine is safe, and it is effective. It's no surprise that it's not 100% effective at preventing cervical cancer, given its limited scope. The fact that it prevents at least 17% of cases of cervical cancer should make its distribution a major public health priority. Given that its effectiveness decreases dramatically if there has been prior exposure to HPV, mandating it for sixth grade females is entirely justified. Also, given that HPV is so strongly linked to throat cancer, and given that males transmit HPV to females, vaccination in males as well should be a priority in the near future.

One of the articles in the NEJM is a perspective piece by R. Alta Charo. It's very interesting even for those of us with no medical training, and it makes some good points.

HPV-vaccination mandates, which are aimed more at protecting the vaccinee than at achieving herd immunity, have been attacked as an unwarranted intrusion on individual and parental rights. The constitutionality of vaccination mandates is premised on the reasonableness of the risk–benefit balance, the degree of intrusion on personal autonomy, and, most crucial, the presence of a public health necessity. On the one hand, to the extent that required HPV vaccination is an example of state paternalism rather than community protection, mandatory programs lose some of their justification. On the other hand, the parental option to refuse vaccination without interfering in the child's right to attend school alters this balance. Here the mandates act less as state imperatives and more as subtle tools to encourage vaccination. Whereas an opt-in program requires an affirmative effort by a parent, and thus misses many children whose parents forget to opt in, an opt-out approach increases vaccination rates among children whose parents have no real objection to the program while perfectly preserving parental autonomy.

Opposition to HPV vaccination represents another chapter in the history of resistance to vaccination and, on some levels, reflects a growing trend toward parental refusal of a variety of vaccines based on the (erroneous) perception that many vaccines are more risky than the diseases they prevent. In most cases, pediatricians have largely restricted themselves to educating and counseling objecting families, since it is rare that the risks posed by going unvaccinated are so substantial that refusal is tantamount to medical neglect. In the case of HPV vaccine, parents' beliefs that their children will remain abstinent (and therefore uninfected) until marriage render it even more difficult to make the case for mandating a medical form of prevention. Even with an opt-out program, critics may argue that the availability of a simple and safe alternative — that is, abstinence — undermines the argument for a state initiative that encourages vaccination through mandates coupled with an option for parental refusal.

But experience shows that abstinence-only approaches to sex education do not delay the age of sexual initiation, nor do they decrease the number of sexual encounters.3 According to the CDC, though only 13% of American girls are sexually experienced by 15 years of age, by 17 the proportion grows to 43%, and by 19 to 70%.4 School-based programs are crucial for reaching those at highest risk of contracting sexually transmitted diseases, and despite the relatively low rate of sexual activity before age 15, the programs need to begin with children as young as 12 years: the rates at which adolescents drop out of school begin to increase at 13 years of age,1 and younger dropouts have been shown to be especially likely to engage in earlier or riskier sexual activity.

I hope that these, now demonstrately safe, vaccinations will soon be widely available.

Dr. Charles has more, as does Shelley Batts and Carl Zimmer.

Chickenpox vaccinations less effective over time

There are a significant number of people who believe that vaccinations are harmful to their children, and even that they might cause autism. These people have a tendency to believe that getting the immunity to the diseases in the old fashioned way (getting sick) is less bad than getting vaccinated against them. This approach has already caused small children to die for childhood diseases that are easily avoidable through vaccinations.

Today, Ny Times bring an article giving another example of why such thinking is dangerous.

Chickenpox Vaccine Loses Effectiveness in Study

The chickenpox vaccine Varivax has changed the profile of the disease in the population, researchers are reporting.

In a study appearing Thursday in The New England Journal of Medicine, the researchers confirm what doctors have already known — that the vaccine has sharply reduced the number of cases in children but that its protection does not last long.

With fewer natural cases of the disease, the study says, unvaccinated children or those whose first dose of the vaccine fails to work are getting chickenpox later in life, when the risk of complications is higher.

“If you’re unvaccinated and you get it later in life, there’s a 20-times greater risk of dying compared to a child, and a 10- to 15-times greater chance of getting hospitalized,” said Dr. Jane Seward of the Centers for Disease Control and Prevention in Atlanta, who worked on the study.

To the people who are against vaccinations, the logical solution would be to stop vaccinating children, so the get it as children. This is not the right way of solving this. The 20-times greater risk of dying as an adult happens to a significantly smaller group of people - remvoing the vaccination for all, would increase the number of deaths. And even if the disease doesn't result in death, there are other bad results.

The chickenpox virus remains in the body for life and can be reactivated as shingles, a painful rash.

No, the correct way of dealing with this, is to vaccinate more people, and boost the vaccinations later in life as necessary.

The study can be found here for people who has access to The New England Journal of Medicine (which I don't have)