Finally it's loaded for me! Abbie, have you seen Salty [Current - ed.]'s accusation that you've been lying to us, "*I feel it necessary to mention one more time that her recent claims that the HPV vaccine is 100% effective against cervical cancer are FALSE"
Please stop irresponsibly spreading dangerous falsehoods about the HPV vaccine. You and your commenters continue to misunderstand basic facts, and you are misleading people. My sources include the same as yours. Read the CDC information you quoted. Notice the phrase “caused by the four vaccine types.” The two covered strains of HPV that can lead to cervical cancer cause about 70% of cervical cancers.* So even if the vaccine is taken by people prior to any exposure (efficacy declines with age due to greater probability of having been exposed, such that the FDA recently declined GSKMerck’s request to extend approval to women 27-45) and provides lifetime protection (which has not yet been established, of course), it is still not 100% effective against cervical cancer. Under the best conditions and assumptions, it will still only protect against 70% of cervical cancers.
The vaccines do not protect against all HPV types— so they will not prevent all cases of cervical cancer. About 30% of cervical cancers will not be prevented by the vaccines, so it will be important for women to continue getting screened for cervical cancer (regular Pap tests).
GARDASIL is the only human papillomavirus (HPV) vaccine that helps protect against 4 types of HPV. In girls and young women ages 9 to 26, GARDASIL helps protect against 2 types of HPV that cause about 75% of cervical cancer cases [other sources say about 70%],…
…GARDASIL may not fully protect everyone, nor will it protect against diseases caused by other HPV types or against diseases not caused by HPV. GARDASIL does not prevent all types of cervical cancer, so it’s important for women to continue routine cervical cancer screenings.
When you tell people the vaccine is 100% effective against cervical cancer, you give people a false sense of safety that might lead some later to forego regular Pap tests, which are demonstrably effective in preventing all cervical cancers in all women. Please correct this error.
My doctorate is from a highly respected university. I assume you’ll get your own real PhD in the future, but you fail the entrance exams for Google U.
SC
*Note that this does not mean that all infections with these four strains will lead to cervical cancer.
So I recently learned of a grant competition for projects on "The Uses and Abuses of Biology":
The aim of the interdisciplinary Programme is to investigate contemporary non-scientific uses and abuses of biological thought (beneficial, benign or negative) in the domains of philosophy, the social sciences, the media, religion and politics. Collaborative projects between those engaged in the biological sciences and investigators from other disciplines are particularly welcomed.
Sounds good, I thought. So I went to the web site...
The Grants Committee, in classic Templeton style, is comprised entirely (or almost) of members of the Templeton "family" who work on the the so-called intersection of science and religion (John Hedley Clarke, Nidhal Guessoum, Elaine Ecklund, David Livingstone, Ard Louis, Alister McGrath,...). I could have guessed the nature of the suggestions for sample projects without even looking, but it was fun to look. Here's a selection*:
•Does the teaching of biology convey implicit philosophies?
•Have the publications of the ‘new atheists’ in biology stimulated a rise in creationism and Intelligent Design?
•What is the sociological impact of notions of biological altruism on the interpretation of altruism within human societies?
•How does the field of biological complexity impact on ideas of human value and purpose?
•Are the biological sciences communicated in ways that are implicitly materialistic or teleological?
•Biology and the Imago Dei – an investigation into the ways in which the biological sciences have influenced interpretation of this theological concept.
•The impact of biology on the interpretation of Jewish food regulations. •Biology and natural theology - contemporary attempts to utilise biology in the justification of theological ideas.
•How does contemporary eugenics impact on notions of human freedom and spirituality?
*What's excluded is also interesting:
Topics excluded from the Programme include: bioethics, history (unless with strong contemporary relevance and application), ethical issues in the application of science, questions of sexual identity and policy, and race.
This last is especially strange as some of the reading suggestions are about race.
One of the more shocking aspects of the report I talked about in my previous post were the cigarette-sponsored concerts in Indonesia headlined by artists from North America, the UK, and Australia. (Well, not all that shocking, unfortunately.) I was disappointed to see that a public campaign and petition to get artists to pull out of the tobacco-sponsored Java Rockin' Land festival appear to have failed, and the concerts went off this summer as planned. (Other artists, like Alicia Keys and Kelly Clarkson, had previously heeded the message and changed course.)
Seriously, bands? You want to advertise for tobacco companies? You want to be part of getting kids hooked on smoking? You're OK with that suffering on your conscience? A while back I posted about the Sun City campaign by Artists United Against Apartheid,* in which musicians joined together to refuse to play a resort area in apartheid South Africa and produced an album sold to raise funds for the anti-apartheid cause. If the Cranberries and others are so shameless as to participate in this exercise in irresponsibility, other artists should come together to criticize these concerts and state publicly that they themselves would and will not participate.
I've been recommending Allan Brandt's The Cigarette Century since it came out. It's a superb history of science on a hugely important topic. Although the bulk concerns the history of science - and industry interference with it - in the US, the later segments dealing with the successful push to market cigarettes in other countries are some of the most disturbing. While smoking rates fortunately continue to plummet in the US, the number of smokers, especially children, is exploding in poor countries. Many of these people don't know the risks, and hundreds of millions of them will die terrible, preventable deaths. The costs to health care systems are staggering.
I was happy to see that Current TV's Vanguard has done an episode, "Sex, Lies, and Cigarettes," on the marketing of cigarettes in Indonesia and the work of anti-tobacco activists to educate and protect children there.
For those who get Current TV, they seem to be showing the episode fairly regularly. It and the other Vanguard reports are very good.
So I have a new camera [!!!] and have spent the past several days tormenting cats and kittens (for, generally, a good cause), amongst other activities. And they're unspeakably cute.
But I also went down by the river yesterday and found many an odd thing. I've done nothing to it and this is one of the best pictures I've ever taken. I love it, in every way. Don't? I don't care.
As Monnett attempted to explain in the interview, his influential paper included observations made flying over transects of a region of the polar ocean, as such:
Before a storm, 4 swimming polar bears observed / 11 percent of total region surveyed = about 36 expected swimming polar bears over entire region
After the storm, 3 dead floating polar bears observed / 11 percent of total region surveyed = about 27 expected dead floating polar bears over entire region
Thus, over the entire region, the rough estimate for the survival rate of swimming polar bears assuming they were caught in the storm is 9/36 = 25 percent.
The interview descends into farce as May reveals that he was incapable of understanding the very basic math behind the study:
ERIC MAY: Did they comment at all about any of the stats?
CHARLES MONNETT: Uh, there’s no stats in there.
ERIC MAY: Well, calculations, for, for example, the 25 percent survival rate.
CHARLES MONNETT: Oh, well, that’s just a mindless thing. That’s in the discussion. Um, that is not a statistic. Um, that’s a ratio estimator. It’s a, it’s a fifth grade procedure. Do you have kids?
ERIC MAY: No.
CHARLES MONNETT: Okay, well, if you had kids, you would know that in about fifth grade, they start doing a thing called cross multiplication. “X” is to “Y” as, you know, “N” is to “M.” And you can – there’s, there’s a little procedure you use to compare the proportions. And so that’s a, um, simply a calculation. It’s not a statistic.
May then tried to argue that there were actually 63 polar bears, because 4 live polar bears + 3 dead polar bears / 11% = 63. Dr. Monnett quickly grew frustrated at the innumeracy and illogic of this calculation:
CHARLES MONNETT: And so I, I don’t even still follow what they did to get the 60 percent. That, that’s –
ERIC MAY: The 63 percent.
CHARLES MONNETT: Yeah, that’s just goofy. [...]
ERIC MAY: Okay, and we’ll – let me, let – “of bears before the storm, then the total number of bears after the storm is 63,” and that’s where I came up with the sixty –
CHARLES MONNETT: That’s just stupid. I – did you do that?
ERIC MAY: No.
CHARLES MONNETT: That is stupid. …
CHARLES MONNETT: Somebody is deficient in fifth grade math.
ERIC MAY: (Laughing)
CHARLES MONNETT: Seriously. I mean, give me a break.
The head and founder of France's Servier laboratories was placed under investigation on Wednesday in a probe of the drug Mediator, which officials say has caused at least 500 deaths in France, and has sparked a public furore over drug regulation.
Jacques Servier, the company's president, is being investigated in Paris on suspicion of dishonest practices, deception over the drug's quality, and of falsely obtaining authorisation to sell it, said his lawyer, Herve Temime.
Jacques Servier, chairman of France’s second-largest drugmaker, must post bail of 4 million euros ($5.51 million) and his freedom may be restricted as he faces charges that he helped hide the risks of a drug suspected of causing the deaths of as many as 2,000 people.
Servier, 89, was charged with involuntary manslaughter, aggravated deception and fraud, the newspaper Le Monde reported, citing his lawyer.
If he has actually been charged with involuntary manslaughter, it seems a strange detail for Reuters to leave out.
While there's been some attention to the ongoing trial of Italian scientists, developments in the case of Charles Monnett - author of a 2006 paper about drowned polar bear sightings - are receiving little. I haven't followed the case and wouldn't make any strong assertions about this being politically motivated (though Inhofe's involvement sets off alarm bells), but some of the recent developments - including that the IG's investigation is itself now being investigated, as well as revelations in PEER's rebuttal - leave me deeply suspicious.
In a letter recently sent to U.S. Senator James Inhofe (R-OK) on the case, Acting IG Mary Kendall claimed her agency would not “opine on the substance of the underlying science.” Yet during an August 9th interview, IG agents continued to press Dr. Monnett on details of the 2006 peer-reviewed article in the journal Polar Biology, including how the paper’s abstract was edited, how comments made by anonymous peer reviewers were resolved and whether a conservative estimate was within the bounds of good science.
Naomi Rose of the Humane Society International has prepared a report about the deleterious effects of captivity on orcas. The Orca Coalition reports that it's been submitted to the judge in Morgan's case. It's not a peer-reviewed article, but it does review the scientific literature. I haven't checked all of the references, but I don't know how many are needed to convince. This has been a disastrous experiment, and needs to be put in the past.
We maintain that the only logical conclusion, after considering the preceding evidence, is that orcas do not belong in captivity. They do not thrive: they are physically harmed, living shorter lives, and they are psychologically harmed, injuring each other and humans in a way rarely or never observed in the wild.
...It is not justified to continue their display for entertainment or even for education, especially when that education is biased toward information that supports a corporate narrative rather than good science.
As long as the public buys tickets to see orcas perform, oceanaria are unlikely to voluntarily close orca exhibits. Therefore it is up to the public, as well as the media, the regulatory agencies, and the scientific community, to consider and weigh the evidence and make the only logical deduction. Orcas are too large, too intelligent, and too behaviorally and socially complex to adequately provide for in concrete enclosures. No more orcas should have to die prematurely; no more trainers should be put at risk. It is time to accept that we have been wrong in our assumptions. The orcas deserve no less (pp. 8-11).
CRIN has announced the debut of a children's rights wiki, providing information on laws and conditions around the world (including in the US). From the Q&A:
Organisations and individuals working to advance children's rights can contribute to the Wiki. This includes international and national NGOs, Children's Ombudspersons, legal organisations, governmental organisations and academics, among others.
I had to stop in the middle of Green Is the New Red when I read about a certain report. ALEC has been in the news over the past several months, and its corporate agenda is of course well known. But I was still taken aback to read of their 2003 report about animal rights and environmental activism:
In 2003, ALEC issued a report titled “Animal & Ecological Terrorism in America.” The Private Enterprise Board Chairman at the time was Kurt L. Malmgren, a senior vice president of the Pharmaceutical Research and Manufacturers of America. The editor of the report, Sandy Liddy Bourne, would later become vice president for policy and strategy at the Heartland Institute, which calls climate change “scare-mongering.” In a section titled “From Books to Bombs,” the report outlines the history of animal rights and environmental extremism, beginning with Darwin’s publication of The Descent of Man. According to ALEC, the voyage of the Beagle charted a course that led to the Animal Welfare Act and then to the ALF. The next step, the report warns, is physical violence. The authors make this warning repeatedly and dishonestly… (p. 127).
They are hell-bent on revolutionizing a system of perceived abuse into one that abides by deeply rooted philosophies of fundamental animal equity and environmental preservation. Change has been slow to take root, both politically and within the psyche of the American public. Yet the movement has brought the nation from an understanding of the ethics of animal/ecological welfare to a presumption of fundamentally protected rights. Outlined below is a timeline of this historic and sustained struggle for animal rights organizations:
1859 – Philosophical roots bud as a result of Darwin’s publication of The Descent of Man where he claims, “There is no fundamental difference between man and the higher mammals in their mental faculties.”
...
From Darwin’s initial theories on the nature of animals and other scholarly works concerning environmental sustainability, these groups have progressed to the modern day firebombing of those institutions that have caused a breach in their vision of good society.
So the philosophical ancestor of today’s “radical” animal rights movement is Charles Darwin? On the surface, Darwin’s an odd choice. If his scientific ideas were so conducive to today’s radicalism, we’d expect him to have been a radical in his own time. But in fact the ideas quoted in the report were shared by many people over the centuries. His observations are accurate but not really original. The Animal Rights Library includes this selection from Darwin (and, incidentally, one from Richard Dawkins), but it also includes works from Tolstoy, Gandhi, Paley, and Schweitzer. Religious and secular arguments (and believers and atheists) have long been and still are found on both sides of animal rights questions around the world.* Anti-vivisectionist movements existed in Darwin’s time, but he was no anti-vivisectionist radical: see this excellent piece by Eric Michael Johnson.
But I think the theory of evolution, what it suggests about the inseparability of humans from other animals, and its rejection by the Religious Right are at the heart of why Darwin’s writing was selected in the report as the intellectual ancestor of the animal rights movement. It’s an interesting question to what extent evolutionary knowledge affects people’s thinking about our ethical-political relationships with other species. As I’ve said before, I think scientific knowledge can play a role in developing our ethical sensibilities concerning other animals. No ethical position, much less any set of tactics, automatically or inevitably follows from this knowledge, though. People with a deep appreciation of evolution can still be unmoved ethically to protect nonhuman animals.
The link made in the ALEC report, though, isn’t an intellectual or empirical one. It’s politically motivated – an attempt on behalf of corporations to appeal to the Religious Right, whose ideology we saw in action in the hilarious “Religiosity and Global Warming Advocacy” panel at the Big Footprint conference. By insinuating a nebulous link between the ToE and (a caricature of) the animal rights and environmental movement, they can smear both. By opposing to them a vision of religion that doesn’t recognize the mass exploitation and destruction of nonhuman animals by humans as a fundamental moral issue – or even celebrates it - and a minimalist animal “welfare” program in the interest of corporations, they can promote both.
*This is discussed in Paul Waldau’s Animal Rights:
So this morning's Today Show featured Dr. Roshini Raj talking about “Four Vaccinations That Every Woman Should Get.” These turn out to be the flu shot, DTAP, HPV, and Hepatitis B.
Guthrie: The next one is the vaccine for Human Papillomavirus, better known as HPV. Now, I was under the impression that you, a woman only needs to get this when, you either get it when you’re young or it’s not worth getting at all.
Raj: Well, right now it’s FDA approved for age, for women aged 12 [sic] until 26. And we think that after the age of 26 that most sexually active women have probably been exposed to most strains of HPV, so it won’t be as effective. However, it still could probably protect some women over the age of 26. But certainly if you’re under 26, sexually active, you should be getting this vaccine. This is a truly remarkable vaccine that could help prevent most cases of cervical cancer, so it’s really important. And by the way, men under the age of 26 should also think about getting it. It protects against genital warts, and would protect against passing this virus to other women.
Doesn’t the Today show have fact checkers to verify these claims before they’re aired? Raj’s remarks give the impression that FDA approval for older women is likely, so they should seriously consider it. In fact, in April the FDA denied Merck’s request to extend approval for the vaccine to women 27-45. It is not approved for women over 26. Why on earth is a health expert presenting it as a vaccine “all women” should get?
Merck would like to expand vaccination with Gardasil to much older women, but even if the FDA approved it, there are serious cost-benefit questions. Merck has suffered a regulatory setback of its owh this year, when the FDA rejected its application to legally extend the ages for which Gardasil can be marketed. Currently, it is approved for girls and women between the ages of 9 to 26. Merck wanted to extend that to age 45, and initial reports said Merck had data to support the extension that they would submit to the FDA by the end of this summer.
August, however, saw a flurry of news stories and medical journal articles that cast serious doubt on the efficacy and cost-effectiveness of vaccinating women later in life. The August 21, 2008 issue of the New England Journal of Medicine (NEJM) carried both an editorial and a lengthy study on HPV vaccines. The editorial was written by Dr. Charlotte J. Haug, editor of The Journal of the Norwegian Medical Association. She directly challenged the claim that HPV vaccination is effective at preventing cervical cancer. "Despite great expectations and promising results of clinical trials, we still lack sufficient evidence of an effective vaccine against cervical cancer," she wrote. "With so many essential questions still unanswered, there is good reason to be cautious."
The accompanying NEJM study, "Health and Economic Implications of HPV Vaccination in the United States," looks specifically at the cost-effectiveness of the HPV vaccine. Anytime someone raises the question of cost-effectiveness, of course, someone is bound to object that we can't put a price tag on human life. In reality, however, cost-benefit considerations always play a role in health decisions. With respect to cervical cancer in particular, the high cost of Gardasil compares poorly against simple Pap smears, which provide a time-tested, reliable and inexpensive diagnostic tool that can detect premalignant processes early and thereby prevent cervical cancer. It seems, therefore, that financial and public health sense should favor programs to ensure that all women, but especially those most at risk from cervical cancer, receive consistent and appropriate screening.
As for Gardasil, the NEJM study concluded that while the cost benefit of vaccinating twelve-year old girls falls within accepted guidelines for wealthy countries, the cost benefit declines rapidly as age increases. This finding is a major blow to Merck's efforts to promote intensive "catch up" vaccinations of girls and women who are over the age targeted by schools and proposed mandates. The benefit drops dramatically by the time women reach the maximum approved vaccination age of 26. In the even higher age range of 27 to 45 for which Merck is seeking additional approval, the calculated cost benefit is far outside the accepted range.
This information might seem to suggest that it is all the more important to vaccinate girls at the youngest age possible. Merck's Dr. Richard Haupt told the New York Times that the NEJM study "underscores the value of vaccinating pre-adolescent girls." But there is a big hitch. The NEJM study states clearly that its cost-benefit ratios are based on an assumption that the vaccine provides lifetime immunity to HPV. There is no evidence that this is actually the case. In fact, a number of indicators suggest one or more boosters will be needed during the recipients' lifetimes.
Even in the best-case scenario, HPV vaccines would only prevent 70% of cervical cancer cases, which means that regular and consistent screening, such as tried and true Pap smears, will remain critical for women's protection against cervical cancer. This means that the significant costs of the three shot initial Gardasil vaccination series (with a price tag of $450-$1,000, not including a possible booster) will be in addition to the existing costs of screening.
The NEJM article spelled out the bottom line: "If vaccine-induced immunity lasted only ten years, the vaccination of preadolescent girls provide only 2% marginal improvement in the reduction of the risk of cervical cancer as compared with screening alone."
It is irresponsible for those who are supposed to be educating the public about vaccines to make scientifically unsupported claims about them. It is also irresponsible to present HPV vaccines as a means of cancer prevention without noting declining effectiveness with age, the unknown duration of protection, the unknown long-term risks, and especially the fact that even the people who’ve received the vaccine prior to any exposure to HPV (and even if it turned out that the vaccine provided lifetime protection) still need to have regular Pap smears, as the vaccine only prevents the strains that cause 70% and not 100% of cervical cancers. There is a very real risk that people who’ve received the vaccine will believe themselves fully protected and forego regular cancer screenings. There’s also a risk that attention and resources will be diverted from screening, which is an extremely effective method of prevention (for all women and for all cervical cancers), educating about and reducing disparities in which could prevent the relatively few cases of cervical cancer that still occur in the US.
I have no medical expertise, so if anyone who does notices any errors in what I've prevented here I would appreciate the corrections.]
The other day, the Today show featured a health segment with Dr. Nancy Snyderman talking to Natalie Morales about the importance of early detection of various conditions, including depression.
Snyderman: But the hallmark for depression versus just having a lousy day is hopelessness. People say it's like being in a steel can where you just can't claw yourself up the sides. If you're irritable, you no longer like to do the things you like to do, and I mean reduced sex drive, like nothing brings you satisfaction anymore, sometimes fatigue, you'll hear women say I just don't want to get out of bed in the morning. Or difficulty concentrating. Any of those alone may not be enough, but put them together and it's important. And for you and I who have children, you have to really look at transitional times in a child's life. Pre-adolescents can really become depressed and when you see it as a parent you may not notice it. But changing grades, friends at school.
Morales: Hormones.
Snyderman: All of that stuff. We even know that in utero we can start to pick up on depressed babies based on how they respond to music and what their overall environment is like. This is not something to be worried about; it's not something to be chastised. It is really something to understand, because there are phenomenal treatments, including therapy.
Morales: And it's usually lower levels of serotonin that triggers depression?
Snyderman: The whole neurotransmitters. And a lot of times it's medicine. Increasingly we believe it's medicine and some kind of therapy.
Now, there’s so much wrong here I wouldn’t know where to begin (how exciting for pharmaceutical companies to have that vast in-utero market still to exploit!), but this last response struck me. In the past couple of months, I’ve noted Abraham Nussbaum asserting that he “know[s] of no serious psychiatrist who believes that psychotropic drugs ‘fix chemical imbalances in the brains’ of their patients” and NIMH head Thomas Insel conceding that notions of neurotransmitter imbalances as the cause of depression are “beginning to look antiquated.” The subject also arose in the recent exchange about Marcia Angell’s article, in which her interlocutors Friedman and Nierenberg refer to serotonin deficiency as “an outdated and disproven chemical imbalance theory of depression.”*
I just read Bruce Levine’s Surviving America's Depression Epidemic: How to Find Morale, Energy, and Community in a World Gone Crazy,** which is a few years old, and was surprised [?] to discover that Insel’s been saying this since at least 2007 (making his recent “beginning to believe” sound rather odd). Despite the fact that the monoamine hypothesis has long been discredited,
…the general public continues to hear (through antidepressant commercials and from many mental health authorities) about the neurotransmitter deficiency theory of depression, and so it was news to many Americans when Newsweek, in a February 26, 2007, cover story about depression, reported: "For decades, scientists believed the main cause of depression was low levels of the neurotransmitters serotonin and norepinephrine.... [However, a] depressed brain is not necessarily underproducing something, says Dr. Thomas Insel, head of the National Institute of Mental Health - it's doing too much.... Instead of focusing on boosting neurotransmitters (the function of the antidepressants in the popular SSRI category such as Prozac and Zoloft), scientists are developing medications that block the production of excess stress chemicals."
Pharmaceutical companies, however, have been so effective at marketing the neurotransmitter deficiency theory of depression that even though the NIMH has now retreated from this view, the general public and many doctors continue to believe it. The mental health establishment has not yet zealously publicized its newer depression theory - that excess stress chemicals (such as cortisol) can cause nerve cell damage - perhaps because it would confuse millions of patients who continue taking neurotransmitter-enhancing drugs (it would certainly upset the pharmaceutical companies that manufacture them) (p. 23).
Amusingly (OK, darkly amusingly), the newest depression “theory” from Insel is completely different from the 2007 “theory,” but that this absurd situation continues year after year – the repeated acknowledgements that the alleged mechanism for the alleged efficacy of antidepressants is wrong with at the same time no real effort made to correct widespread public misperceptions stemming from doctors and from advertising - is amazing and unacceptable. The public has a right to know what the science has shown about this important question, and it’s well past time for people who obviously know the facts to set them out plainly and honestly.
* As Nussbaum does with Whitaker, Friedman and Nierenberg suggest that Angell is ignorantly or disingenuously setting up a straw man by pointing out the scientific discrediting of the chemical imbalance idea: “Angell uses an outdated and disproven chemical imbalance theory of depression (i.e., serotonin deficiency) as a straw man to deny that depression has any biological basis at all.”
Angell replies: “Contrary to Friedman and Nierenberg, I do not 'deny that depression has any biological basis at all'. I know very well that all thoughts, emotions, and behaviors have their origin in the brain. But it is a great leap from recognizing the obvious fact that mental states arise in the brain to knowing why and how they arise. …As for the chemical imbalance theory of depression being a straw man, I still hear it invoked frequently. Even Oldham seems to entertain it in his letter, saying ‘…there is no consensus on whether these imbalances are causes of mental disorders or symptoms of them’.”
** A mixed bag, ranging from the science-based and truly insightful to the borderline wooish and irritating. I recommend…the good parts. I can’t be too harsh as it was through him that I read about Ignacio Martín-Baró.
