AVN Failure: The gift that just keeps on giving

Short attention span? Skip to the bottom for a version of this post designed specifically for you!

Meryl needs to choose her sources more carefully

Look, it's like this. I'm worried that this blog is turning into a single-issue publication, I really am. But demolishing the continued utter fail of the AVN is just too easy. It's like shooting fish in a barrel. No, scrub that. It's like dropping a grenade into a barrel of fish and running away very fast.

Above is a screenshot, courtesy of my good friend Peter, from the AVN's Facebook page. This is Meryl Dorey posting a story she's found that she thinks supports her point of view.


Does it support Meryl's point of view?

Sure, if you skim-read it and go no further. However there are a few little problems with it.

Firstly, you'll notice it comes from a site called sify.com, which you may not be familiar with. I certainly wasn't familiar with it, so I checked it out. It turns out to be a news portal based in India, run by an IT/ISP company, SifyCorp. Here's the thing, though.

  1. Have you seen the size of their astrology section?
  2. India is a country in which Homeopaths are legally allowed to call themselves "doctor", and practice their witchcraft with the luxury of heavy government funding and the backing of a large, credulous establishment.

OK, so the source isn't exactly unimpeachable, so let's look at the text of the article:

New Delhi: The pentavalent or the five-in-one vaccine that has been recommended in India by the National Technical Advisory Group on Immunization actually killed children in Sri Lanka and Bhutan, warns an article in the latest issue of the British Medical Journal (BMJ).

Really? The BMJ says that the vaccine actually killed children? That dosn't sound like the BMJ. I'm sure they'd couch it in more considered terms.

Let's continue

The report by a group, including paediatricians, professors, health activists and a former Indian health secretary, cautions against the introduction of the five-in-one vaccine that combines antigens against five diseases - diphtheria, pertussis, tetanus (DPT), hepatitis B and Haemophilus Influenzae type B (HIB) - in a single shot.

Hmmm. A "report" by a group including "health activists"? Isn't Meryl Dorey calling herself a "health activist" these days? And a former health secretary of the country that allows homeopaths to call themselves doctors? Alarm bells are ringing everywhere. I need to see this article.

'Our article describes how the World Health Organisation (WHO), in an elaborate cover-up, changed its own criteria for classifying adverse effects to say the vaccine was not responsible for the deaths in Sri Lanka,' Jacob Puliyel, head of paediatrics at St Stephen's Hospital in Delhi and key author, told IANS.

Former union health secretary K.B. Saxena, professors of community health in Jawaharlal Nehru University in Delhi Debabar Banerji, Imrana Qadeer and Ritu Priya, co-conveners of All India Drug Action Network Mira Shiva and Gopal Dabade and former adviser in finance ministry N.J. Kurian are the other authors of the report.

Whoah! Now there's a cover up? Reported in a BMJ article? How come I didn't know about this? Whe did the BMJ become conspiracy whistle-blowers? I NEED TO SEE THIS!

So I googled up the BMJ "article".

And guess what I found?


No, seriously, that's the "UK Report" that the Sify.com article cites. Check the author list. Check the text. It's the one.

And it's not a "report". It's not an "article". It's a "rapid response", basically a Letter To The Editor written in response to an article, in this case, an article entitled "Antivaccine lobby resists introduction of Hib vaccine in India", found here.

I don't have full journal access, but I can easily glean this from the rapid response:

It seems the article explained, in part, how a group of  doctors are up in arms over the Hib rollout. They've highlighted the way three out of five deaths in a vaccine study were reported, and have taken the issue to court in India to block the vaccine rollout. The reason cited in the response is as much economic as it is epidemiological, but does contain some unfortunate phraseology which does give the impression of antivax leanings ("the useless vaccines the rich may be taking"), though the letter writers aren't happy about the label. 

Three of the deaths in the study population were reported, it seems, as "unlikely" to be related to the vaccine. But the doctors and activists are up in arms over a devation from "normal" WHO reporting standards, and they think those three deaths should be upgraded from "unlikely". Here's a passage from the rapid response:

The standard WHO classification of AEFI is best understood in the form of an algorithm. The first question is whether the adverse events have a plausible time relationship to vaccine administration. All such reactions are classified in one of three categories: ‘Very likely/Certain’, ‘Probable’ or ‘Possible’.

If the time of the adverse event and the time of vaccine administration make a causal connection improbable, it is classified as ‘Unlikely to be related’. If the time of the event and the time of vaccine administration make a causal connection incompatible, it is to be classified as ‘Unrelated’

For adverse events that have a plausible time relationship to vaccine administration, the next level of the algorithm is used to distinguish Probable from Possible. If the death cannot conclusively be attributable to another cause, it is classified as ‘Probable related’. If the death can be attributable to another cause then the association with vaccine is said to be ‘Possible’

What these docs, and a lot of them are actually real doctors*, are whining about is that the assessment in this study was changed from their preferred AEFI classification and that:

Using this new classification, they declared that 3 of the Sri Lanka reactions were ‘unlikely’ to be related to vaccine ‘although it could not be conclusively attributable to another cause’

Of course, the doctors reporting to the WHO made the choice to use this methodology, not the WHO. The reason for this I can't yet figure out, but hey, that's the report they produced.

So, let's recap. A group of doctors and sundry tag-alongs have written a letter to the BMJ complaining that they were mentioned in an article as "antivax", and whining about a methodological difference from what they expected in the said BMJ article. They got an "unlikely" and they wanted a "possible" or "probable". They actually include the cause-of-death assessments of the three subjects in question. These causes are not "unknown", so the best they'll get is a "possible".

It's possible that I'll convert to Islam tomorrow.

Just not very likely.

Frankly, it's a non-story about some methodological arcana that is probably more boring than useful, unless you're into medico-legal detail. It has some socio-economic insight into the way Indian medicine works, but overall it's not very useful as proof of vaccine dangers.

And it's been elevated to the status of "UK Report in the BMJ says five children killed by vaccine" by a numpty news agency, then regurgitated wholesale by Meryl Dorey, who claims to be an "expert" on vaccination.


I mean, seriously.

Meryl. Check your sources.


And now, the version for the attention-span challenged:


The pentavalent or the five-in-one vaccine that has been recommended in India by the National Technical Advisory Group on Immunization actually killed children in Sri Lanka and Bhutan, warns an article in the latest issue of the British Medical Journal (BMJ).





* Yes, real doctors, so they're legit. Although a couple of them seem to have a bee in their bonnet about globalisation and the WHO, which might colour some of their statements somewhat.

posted @ Friday, July 30, 2010 6:16 PM


Comments on this entry:

# re: AVN Failure: The gift that just keeps on giving

Left by Sean the Blogonaut at 7/31/2010 9:38 AM
Do you think Ms Dorey and the AVN actually bother to look into the detail themselves or is it just an attempt to bombard the reading public with sensationalist quotes?

# re: AVN Failure: The gift that just keeps on giving

Left by Coran at 7/31/2010 11:27 AM
Yeah, I followed it up directly on the BMJ website, looked at the back and forth between the letter-writers and others. It annoys me that people claim "an article in the BMJ said ..." when it's just a letter, it's a wilful misrepresentation, imo.

Although some of the language in the correspondence set my skepti-senses tingling, if I were to give them the benefit of the especially charitable doubt I could say it looks like there is some small dissent within a community of experts on whether this represents an increase in the rate and severity of the adverse reactions we know are possible. The truth is most likely to be determined by those experts (as opposed to journalists or conspiracy nuts), so I'll leave it up to them to determine.

# re: AVN Failure: The gift that just keeps on giving

Left by Jason at 7/31/2010 3:25 PM
@Sean I don't think, a lot of the time, that it's a deliberate attempt to decieve (at least in specific terms). I think they're just not smart enough to tell the difference between a letter to the editor and a study. They're blinkered to their own incompetence.

Sify.com should be pilloried for this, and Meryl Dorey, of course, is already on the ropes, but trying to fight back. It's futile, of course. Inevitably she's going to lose and lose badly, but I suspect it might get worse before it gets better

@Coran - I started this post with a bit of venom for the letter writers, but after covering over their stuff I'm willing to give them the benefit of the doubt too. No doubt they *are* getting support from antivax lunatics, though.
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