Daily Mail, Jerome Burne Want to Scare or Mis-inform Readers About the Chickenpox Vaccine

Distressed child receives a vaccination

Distressed child receives a vaccination

Every day there are important and essential discussions about the UK vaccination schedule. These discussions take place in Well-Baby Clinics, with doctors and nurses, with family members and friends, queuing in the supermarket, on message boards and blogs and the pages of newspapers. The common thread to all of them is the need for good quality, appropriate information.

So, what were the Daily Mail and Jerome Burne thinking when they put together this latest compilation of innuendo framed by the emotive photograph of a distressed child who seems trapped between two uncaring, faceless white coats?

One of the last times we mentioned Jerome Burne, co-author of Food Is Better Medicine Than Drugs with Former Visiting Professor Patrick Holford, he had failed to meet the usual high standards of The Economist (Part 1, 2, 3), presenting a distortion of evidence that was at odds with the authors of the papers he cited in support of his writing. We also mentioned that for one who is associated with those who style themselves after the Salem Witches in their ability to detect a conflict of interest in others, he was more than a little blithe concerning the perception of his own. So, here we are again, only this time it is the Daily Mail that is the venue for these distorted interpretations of research findings and a vaguely menacing, anti-vaccination message.

Jerome Burne is almost certainly not responsible for the sensationalist headline for the story but it is a nice set-up for the mis-information he is about to disseminate: Why giving children the chicken pox jab could give YOU shingles. Now, for anyone who knows anything about shingles, that’s an unpleasant prospect. First impressions for some readers might be that somehow, it is possible to catch chickenpox from a freshly-vaccinated child and that this exposure triggers shingles in adults – the rather more sophisticated and nuanced clarification does not occur until considerably later in the piece.[a]

Children might soon be vaccinated against chicken pox, according to recent reports. But some experts question the need for a vaccine against an infection that’s so mild – especially when it could put thousands of elderly people at greater risk of shingles.

Well, that depends on who you style as experts with a valid opinion and the questions and answers that you report from actual experts. Plus, how many readers are slightly startled to move from the soothing claim that chicken pox is “mild” to the following dramatic report?

Chicken pox causes up to 50 deaths a year, 40 of them children, and it seems the Government’s Joint Committee on Vaccination and Immunisation is considering adding a vaccine against it to the MMR jab.

50 deaths? In the UK? It seems not (see below) but this is difficult to interpret without some indication of whether this figure is for the UK, Europe, USA or the world.

Burne moves on to alarm the reader.

But there is widespread concern about [discussion of a universal chickenpox vaccination programme]. First because a similar MMR super jab now used in America has been found to double the risk of fits in some children.

The source of this claim, oddly enough, is a report on the Merck ProQuad vaccine by the CDC.

Now, watching any child have a fit is distressing. Watching your own child have a fit can make it seem like your heart has stopped for the duration. So, ‘doubling the risk of fits’, isn’t that really rather alarming and, on the face of it, completely unacceptable?

As so often happens when journalists resort to quoting relative risk rather than absolute numbers, that rather depends on a number of factors and your interpretation of them.[b]

One in 33 children experiences at least one fit (febrile seizure) before the 6th birthday. The majority of these fits occur within the first few hours of a child’s fever. Patient UK details the three classes of fit, which range from momentary (commonest) to a duration of more than 30 minutes (rare). Patient UK also offers some good advice on an appropriate response to the fit and how to care for the affected child.

Although alarming, a febrile seizure is not usually dangerous. Full recovery is usual. Most illnesses which cause fever and febrile convulsions are the common coughs, colds, and virus infections which are not usually serious. However, the illness that causes the fever is sometimes serious, for example, pneumonia. [Emphasis added.]

For further information there is a good NHS Clinical Knowledge Summary on children’s febrile seizures. However, it is clear that common infections such as colds as well as preventable childhood diseases can trigger a febrile convulsion.

Returning to the troubling issue of ‘doubling the risk of fits’, Dr Iksander of the CDC’s Advisory Committee on Immunization Practices told Web MD that:

The highest incidence [of fits] is between 14 and 18 months of age. That’s right at the time we give [children] MMR and varicella vaccinations.

That’s one potential confounder but even so, what does this ‘doubling of risk’ mean for a child? Helpfully, a CDC Safety Study on ProQuad gives the absolute numbers:

Four out of every 10,000 kids who got separate MMR and varicella shots on the same day had a febrile seizure seven to 10 days later. Nearly twice as many kids who got ProQuad — nine in 10,000 — had febrile seizures seven to 10 days after vaccination.

Looking at those figures and bearing in mind the natural incidence of fits in children, perhaps that ‘doubling of risk’ isn’t quite as shocking or sensational as it might otherwise seem. It is even at some variance with an earlier US study of 3298 children that reported no increase in fits (the numbers may have been too small to show a small effect). Similarly, a NZ study did not report an increase in adverse events.

What about studies in Europe and other versions of the combined MMRV vaccine? HolfordWatch located a recent publication about the GSK combination vaccine for MMR and varicella from Germany but Burne oddly excludes that report despite the encouraging finding that:

the clinical profile of this combination vaccine, in terms of injection-site and general tolerability, is similar to that of the component vaccines. A higher incidence of low-grade fever has been noted following the first dose of MMRV vaccine, although it is no different from component vaccines following the second dose.

So far, we are barely into the story and we’ve had to point out that Jerome Burne cherry-picked a particular study and headline figure without attempting to place it in context.

What of the rest of the story? It is only now that he explains the mechanism by which a chickenpox vaccination programme for children might raise the incidence of shingles for adults.

[T]he jab has raised the rate of shingles among the old – according to one U.S. study, cases have risen by 90 per cent. Here even the Government health watchdog, the Health Protection Agency, has predicted that a vaccine could cause a 20 per cent rise in shingles cases.

But how could a vaccine for children make old people ill? Chicken pox and shingles are caused by the varicella virus – after a childhood attack of chicken pox, the virus lies dormant in the nerves until triggered in later life when it flares up as shingles.

The belated explanation is welcome but, again, note the lack of detail for the striking 90% statistic that makes it difficult to identify even for readers who are familiar with the clinical literature. The HPA does place its forecast of a 20% increase in cases in the context of a medium-term trade-off that should be accounted for in any decision-making process.

Burne fails to report that the 90% increase in shingles, following a vaccine-associated decline in chickenpox was reported from preliminary data and is in conflict with another large US study that did not report an increase. The authors who reported the 90% increase were considerably more tentative about their findings and were careful to include appropriate nuance.

Our study is subject to several limitations…

As varicella vaccine coverage in children increased, the incidence of varicella decreased and the occurrence of herpes zoster increased. If the observed increase is real, widespread vaccination of children is only one of several possible explanations. [Emphasis added.]

However, there is a considerable disparity between 20% and 90% and a reader’s alarm might be, understandably, exacerbated on reading:

[S]hingles is often a nasty condition in the elderly. By the age of 85, 65 per cent of us will have suffered this often extremely painful disease.

It begins as a burning sensation along the nerves down which the virus is moving, followed by the rash and fever, usually lasting three to five days. But in some cases – as many as 20 per cent of those over 50 – severe pain will be there six months later.

40 per cent of sufferers will have long-lasting pain due to permanent nerve damage, according to the Shingles Support Society.

If the virus reaches your eyes, it can cause blindness. If you have to go to hospital for chicken pox, your average stay will be three days, but for shingles it is 11 days and you are six times more likely to die.

Although the inflammation doesn’t kill you, it can lead to fatal conditions such as pneumonia, inflammation of the brain or severe bacterial infections in the eruptions in the skin leading to toxic shock. Some experts put the death rate from shingles at five times that from chicken pox

In a paper published in the International Journal Of Toxicology, Dr Goldman claimed that since shingles results in three times as many hospitalisations and five times as many deaths as chicken pox, this increase meant the vaccination made no sense. [Emphasis added.]

65% by the age of 85 is an extraordinary statistic that, paradoxically, makes a nonsense of the 90% increase figure. If you were to put those figures together, you would need to be counting recurrences of shingles in the same person because you would have 123.5 cases per 100. This smacks, more than a little, of cherry-picking the most alarming figures.

The UK HPA reports a rather less alarming figure of 1 in 5 as a lifetime occurrence of shingles. Just to make sure, HolfordWatch contacted the HPA and they confirmed that they stand by that estimate and explain that the incidence varies from one year to another from around 1 in 5 to 1 in 7. We may add more detail from the HPA later.

HolfordWatch is not in a good position to judge how easy it would be for a general reader who is unfamiliar with the clinical literature to disentangle Jerome Burne’s gaullimaufry of conflicting numbers that seems strangely slanted towards frightening rather than informing. Careful readers might wonder why it is so difficult to identify any reputable sources for these figures and why the only comparatively-identifiable one is not reported as contentious (Scopie’s Law might hint at the repository where you will find this: Goldman paper (pdf).) It might also be difficult to recall that Burne described chickenpox as “mild” with a ‘low mortality rate’, so again, although these percentages look alarming, the absolute numbers may be comparatively small and Goldman does not give a clear source for his figures.

As for Burne’s alarming reference to shingles-related “blindness”, the Shingles Support Society reports that shingles in the eyes is a ‘rare’ complication that left “untreated” may damage the eyes.

Unabashed, the article continues, paying lip-service to the chickenpox vaccination’s reduction of childhood illness and death but then questioning it.

[C]oncerns are being raised about the benefits of the chicken pox vaccine for children. The U.S. vaccination programme cut the number of infections by 79 per cent, with a corresponding drop in the number of hospital visits and deaths; down from 100 to 20.

But critics say reporting the disease is no longer mandatory in the U.S. – making it appear less common – and that those who died before vaccination were very often already ill.

Now, that seems to be an easily-verifiable claim. Jerome Burne does not, however, turn to any of the authors of the 2007 UK surveillance report for chickenpox who compiled the mortality and morbidity statistics for a comparable UK perspective. No, Jerome Burne’s expert of choice is Dr Richard Halvorsen, author of a book that refers to vaccination as an experiment in which ‘children are guinea-pigs’, and (unmentioned by Burne) the director of the BabyJabs clinic that sells single-jabs and offers parents an a la carte vaccination schedule. Dr Halvorsen is also featured on the website of Burne’s co-author, Patrick Holford.

A recent UK study used to support the idea that we should start vaccinating found that in just over a year, 112 children had chicken pox badly enough that they had to go to hospital and eight died,’ [Halvorsen] says. ‘But one of those eight was still in the womb and five also already had serious medical conditions.

‘In fact, out of a population of 10 million children in the UK, only one previously healthy child died from chicken pox. It’s tragic of course, but is it really worth all the other risks, not to mention the millions it will cost, to reduce those figures?’

‘We don’t know why the UK child died, but American research suggests some of the drugs used to treat serious cases, such as antibiotics and steroids, may make it worse, he adds.

Somehow we have gone from eight deaths to one, but, undeterred, we located the surveillance study. Perhaps predictably, Halvorsen’s account does not match up with that of the study’s authors.[c]

The study authors stressed that their figures show a “minimum estimate of severe complications and death resulting from varicella in children in the UK and Ireland”. They carefully described their criteria for including children in their figures and they were considerably more complex than Halvorsen’s “children had chicken pox badly enough that they had to go to hospital”.

The case definition was any child <16 years of age hospitalised with complicated varicella, as defined by list of clinical conditions (table 1), or admitted to ICU/HDU with varicella or one of its complications. The list of clinical conditions was determined by literature review and reference group consultations involving infectious disease paediatricians, virologists and public health specialists…

This study could not have included data on all varicella hospitalisations, as this would have been unmanageable with the methodology used…It was therefore necessary to restrict ascertainment to severe cases….We therefore decided to specify which clinical presentations would be considered as severe complications. This gave clear inclusion criteria but may have excluded other presentations considered just as severe. Indeed, 28 of the initial reports (15%), while reporting true varicella complications, did not meet the case definition. These included presentations of cellulitis, abscess or osteomyelitis in the absence of bacteraemia, cerebral infarct, acute renal failure, orchitis, idiopathic thrombocytopenic purpura, stroke and ataxia not requiring hospitalisation. It is worth emphasising that most children admitted to hospital in the UK and Ireland as a result of varicella will not have met our case definition. Such children often appear to have secondary bacterial infection of skin lesions, manifest by fever and cellulitis, yet infrequently have positive blood cultures or meet criteria for toxic shock syndrome or necrotising fasciitis. [Emphasis added.]

We hope that it is plain that the version of this that Jerome Burne has attributed to Halvorsen does not match the facts.

Either Burne or Halvorsen mis-states the number of deaths. Using the authors’ careful criteria, there were 6 deaths:

UK varicella deaths have been reported previously, from routine statistics, to be an average of 4 (1991–2000), [3] 4.7 (1995–97), [6] or 8.5 (1967–1985) [8] deaths per year for children aged 0–14 years. Our figure of six deaths, including one intrauterine death, is within this range. The lower figures are for more recent years, which may reflect the wider use of prophylaxis in high-risk contacts and/or earlier treatment of high-risk cases.

Halvorsen’s summary of the dead children seems a little off-hand. Although 4 of them had underlying health problems, it is not clear that they would, necessarily, be such that the child might not have been expected to have a reasonable life-span. The health problems included:

HIV, cerebral palsy (n = 2) and cardiac skeletal myopathy…

One of the deaths reported in our study was in a child with HIV. High varicella mortality rates for HIV patients are not typical, with other studies reporting few deaths. [28 29] However, fulminant varicella with concomitant cytomegalovirus presented with HIV in this individual.

Our finding of a high proportion of cases having infectious complications is similar to other studies. [9–13, 16, 18–23] In particular, there has been recent concern over the relatively high number of invasive Group A Streptococcus infections, [30] as found in our study.

From all of the above, it may be seen that Burne’s account and his report of Halvorsen’s account is difficult to rely upon for a fully-rounded picture. There are many important factors that must be taken into account before there can be a full justification for accepting or rejecting a universal vaccination programme for chickenpox for UK children. The issue of whether there will be a combined MMRV or two separate jabs delivered at the same visit is another consideration. However, such a discussion is hindered, not helped, by spreading as much mis-information as the Daily Mail, Jerome Burne and Richard Halvorsen have in this article. This isn’t facilitating the public understanding of difficult issues, it is preventing discussion of them.

All told, putting together this has probably taken about 8-9 hours of work from different contributors and we didn’t have suffient time or resources to rebut all of the canards. Casual readers who only see the Daily Mail version of events will be left with a very skewed impression of varicella and shingles and it would take a mass of detail to disentangle those impressions. Detail such as the ones we have provided: details that could not possibly be addressed in a normal conversation with a GP or Health Visitor. Details that could not be presented in the course of normal conversation without overwhelming the parents or other concerned individuals.

Here at HolfordWatch, we don’t know what the answer is – but we are certain that the Daily Mail has failed its readers. If they had wanted to provide an informed and balance article, then they would have asked a credible expert to write it.

Notes

[a] Chickenpox (varicella) is caused by the varicella zoster virus (VZV). VZV also causes shingles. A first infection with VZV will result in chickenpox after which the virus lies dormant. However, if the virus is then reactivated (and this may happen for a number of reasons), it may result in shingles. Effectively, at the risk of sounding like a immunological version of A Tale of Two Cities, when somebody has had chickenpox, VZV remains in the nerve cells and can be recalled to life to wreak havoc at any time in that person’s life.
[b] Burne gives an absolute number but it is near the foot of the piece and easily missed after the alarm call of the opening story: we thought we might illustrate the diminished impact of that by placing this information in a footnote.

The number of extra cases was small, about one more in 2,000, but there is another difference between the two regimes. Proquad contains five times the amount of chicken pox virus as the single dose. Whether that caused the additional convulsions is disputed.

It is not said by whom that causation is made or their evidence for it nor why they believe that the number of antigens from an attenuated strain of virus should be causally related to the “additional convulsions”.
[c] The distortion may lie in Jerome Burne’s version of what Dr Halvorsen said rather than Halvorsen’s own error but it does not seem much at variance with Halvorsen’s typical stance on matters that relate to vaccination.

BPSDB

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25 Comments

Filed under Jerome Burne, patrick holford

25 responses to “Daily Mail, Jerome Burne Want to Scare or Mis-inform Readers About the Chickenpox Vaccine

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  3. Wulfstan

    Even by Jerome Burne’s standards that article is a disgrace.

    It’s easy to see why you couldn’t cover every error that you identified. The problem is that most readers (myself included) would never be able to spot those errors and he does write in an authoritative style and seemed to use plenty of experts.

    This isn’t a comment on your efficiency but do I take it that you have approached the HPA with an enquiry and they are taking hours to get back to you? If so, it’s good that they want to be exact but isn’t that sort of delay at the heart of some of the mishandling of the MMR business?

  4. To be fair, the HPA offered a quick initial response – and need to check some details with the person who did the modelling. It would be good if there were an agency with remit and resources to quickly challenge this type of nonsense in the press – but that would require funding for a reasonable number of staff etc…

  5. Mojo

    “What does the Daily Mail get out of this?”

    Well, after a while they can run another story with a headline along the lines of “How the middle-class MMR refuseniks are putting every child at risk“.

  6. UK RD

    another excellent review, Holfordwatchers

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  8. When our daughter got chicken-pox, as she has leukaemia she and mum had to go into isolation at hospital for over a week … not pleasant for either of them. This sounds like MMR all over again. The no. of nasty drugs she has taken in the last 2.5 years had a much higher risk of life-threatening effects but would I deny her the chance to recover from leukaemia? Of course not!

    • It is particularly annoying that articles such as Burne’s tend to ignore the entire issue of shared social responsibility for herd immunity for those members who need it more than others. There isn’t always a straightforward answer but I would like to see Jerome Burne or Richard Halvorsen acknowledge it as an issue.

      • Yes, when there are many immuno-compromised children I find it immensely frustrating when people like Richard Halvorsen dismiss the deaths of such children as almost inevitable and just a question of time.

        Not always, but the prognosis of so many serious childhood illnesses has changed beyond recognition. If children can be protected and supported during critical stages of their lives and illness then more and more they are surviving beyond 5 years. I think that the Childhood Cancer Survivor Study estimates that in 2000, around 1 in 900 US adults was a childhood cancer survivor.

        I think that people like Jeni Barnett, various health journalists and Richard Halvorsen have got to lose the idea that serious childhood illness will always end in death so exposure to illnesses such as measles etc. is just bringing that forward a little bit.

        The above sounds horribly blunt. But I remember coming across the notion of a Survivors’ Bill of Rights that explained the difficulties that some survivors were having because so many young people now survive but various systems etc. have yet to adapt to this reality.

        Cross-posted comment made on Angus’ blog about Childhood ALL.

  9. jdc

    Terrible article from Burne and the Daily Fail. I was a little surprised to learn that the wh*l* website was used as a source of information, but perhaps I shouldn’t be.

    PS – nice comment from Mojo pointing out the lack of joined-up thinking at the Fail.

    • To be fair, I had to use the Scopie repository because it was an obscure paper and I couldn’t track it otherwise or link to it…However, as Jerome Burne shows no sign of having read the other papers on which he relies I have to wonder if he managed to track this one down in a National Library or resorted to wh*l*.

      Perhaps we should give up any fantasy that the Daily Fail has an editorial line or policy that they feel demands any semblance of consistency.

      • RE Scopie’s Law: sorry, I had automatically assumed that it was the case that Burne had relied on info garnered from wh*l* (rather than you linking to whl because it was the only place on the internet that hosted a copy of the PDF and it only being a possibility that Burne had used whl as a research tool). My bad.
        Still, I suppose my assumption may not be an unfair one: “as Jerome Burne shows no sign of having read the other papers on which he relies I have to wonder if he managed to track this one down in a National Library or resorted to wh*l*.”
        One cannot be certain, but… it strikes me that if I were looking for information on vaccination it would be easier to click on wh*l* than schlepp to the nearest National Library (I don’t need to make the obvious point that “easy isn’t always better”, but will do so anyway).

        RE the Daily Fail: I am still shocked sometimes by what seems to be the blatant hypocrisy of this organ. To play such a vigorous part in the MMR scare and then print an article that calls the people who fell for the Fail’s hoax “refuseniks”, “morons”, and “middle-class twits” (including, presumably, a number of their own readers) is something I find breathtakingly hypocritical – not to mention arrogant.

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  11. Lilo

    Nine in ten thousand is nearly twice as many as four in ten thousand? What new and interesting definition of the word “twice” is that?

  12. another take on the chickenpox vaccine:

    http://insidevaccines.com/wordpress/2008/03/20/eradicate-chickenpox-sure-why-not/

    The assumption that we’ve got it all figured out–we can vaccinate against chickenpox, eliminate the illness, save lives, and not have a significant increase in shingles…hubris comes to mind. All vaccines have side-effects, so there is also an assumption that the side-effects will be rare and not as serious as the occasional complications of the illness.

    Vaccine programs = insane optimism IMO.

    • If people are questioning the wisdom of a vaccination policy (that doesn’t even exist as yet) then it is helpful if they pose correct questions and cite research appropriately – Burne didn’t within that article.

      There are legitimate questions, as we have indicated previously.

      Have you no compunction that one of your supportive commenters on that post is homeopathy4health who recently banned logic from her blog?

      Andrew’s comments are no longer allowed on this blog. This is because he has a tendency to write opinions based on logic and not from experience or facts. He is a programmer by profession.

  13. Jerome Burne

    I’ve only just come across this disinterested and objective critique of my article on the wisdom or otherwise of a chickenpox vaccine, so I’d like to respond to a few points. First though, many thanks for reading it so carefully, even my mum doesn’t pay that much attention to my articles.

    1) You dispute my claim that some experts question whether we need a vaccine against something so mild especially when it raises the risk of shingles, saying “it depends on whom you style as experts.” The ones I quote include an infectious diseases expert who has just retired from Western General Hospital, Edinburgh and the UK Health Protection Agency (HPA). Pretty reliable I’d say.
    2) You rightly query whether the 50 deaths from chickenpox per year 1 quote is for UK, Europe etc. It is actually world wide (Seward, J. F., and W. A. Orenstein. 2006. Commentary: The case for universal varicella immunization. Pediatr. Infect. Dis. J. 25:45–46.). You’d make a good sub; the fact simply reinforces one of my key points that this is a very mild condition, a major reason why a vaccine is unnecessary
    3) You attempt to dilute my comments about the multiple American vaccine containing chickenpox – Proquad – which doubled the number of fits, by going into a very informed discussion of fits and how they are not that uncommon and usually harmless and that the doubling was from a very low base.
    All true but again you shoot yourself in the foot. That doesn’t alter the fact that ProQuad did double the rate and others beside me thought this important. An AP report on Feb 28 2008 stated that as a result of this finding the federal advisory panel on vaccines had watered down its “preference for the combo vaccine.” Previously the panel had said that giving ProQuad was preferable to giving single shots. In other words it now considers the combination vaccine no better than individual shots – a highly contentious issue as far as MMR is concerned and very relevant since if a chicken pox vaccine was introduced it would most likely be added to the MMR.

    4) Then we come onto the cloudy issue of how many extra cases of shingles there might be if a vaccination was introduced; figures vary a lot as I think I made clear. You ask for source for the 90% incidence – it’s Yih,W. K., D. R. Brooks, S. M. Lett, A. O. Jumaan, Z. Zhang, K. M. Clements, and J. F. Seward. 2005. The incidence of varicella and herpes zoster in Massachusetts as measured by the Behavioral Risk Factor Surveillance System (BRFSS) during a period of increasing varicella vaccine coverage, 1998–2003. BMC Public Health 5:68.
    I’m happy with giving sources but this was a newspaper article not a Cochrane review which is why I didn’t review the literature as you seem to require. However I did also quote both the infectious diseases expert and the HAD who both predicted an increase. It does seem to me on all these points you have a bit of a “wood for the trees” problem. Once again my main point stands – if you vaccinate against a pretty mild disease you will very likely increase the incidence of a nastier condition in the elderly. Is that worth it?

    5) You say “65% by the age of 85 is an extraordinary statistic”. It comes from the Herpes Viruses Association, ( http://www.herpes.org.uk/shingles/#shingles.) who have an impressive list of patrons and should know. Around here you comment – “Jerome Burne’s gaullimaufry of conflicting numbers … seems strangely slanted towards frightening rather than informing.” Actually, if you are worried about frightening people, what do you suppose will happen when the case for introducing the vaccine is being made? That is where the scaring comes in.

    6) Thank you for telling me about “Scopie’s law” and the Whale site, which I have never seen. Trouble is that all your rather laboured point about the Goldman paper being so obscure and so hard to find that you had to go to this loony site to find it doesn’t do you any favours. It was published in a perfectly respectable journal – the International Journal of Toxicology – and is available on PubMed. Have a look – Int J Toxicol. 2006 Sep-Oct;25(5):313-7. The paper give high figures for possible shingles incidence which you dismiss with: “Goldman does not give a clear source for his figures.” Again not true. He quotes figures from the Varicella Active Surveillance Project (VASP) and has a number of references.

    7) You have another quibble about my “alarming reference to shingles-related “blindness”; supposedly another example of scary unreliable data. Wrong again. See just one example: FDA Consumer magazine May-June 2001 which talks about shingles can affect the ophthalmic nerve “possibly causing temporary or permanent blindness.”

    8) On the issue of number of deaths in the UK from chickenpox I do admit to an error – the figure given in the 2007 UK surveillance report which you refer to and which Dr Richard Halvorsen quotes from is six. The figure I gave was eight – no idea how it crept in. But while again I acknowledge your sub-editing skills, it makes absolutely no difference to the argument. The bulk of the cases, sad as they are, were suffered by children with chronic disorders. Vaccinate them by all means but is that a sound basis for a national program?

    9) I’m delighted for you to continue to sub my articles – you must be my most assiduous reader. But it would be grown up and in the spirit of scientific enquiry if in future you laid off the gratuitous insults, they just make you look a little silly.

    • I strongly suggest that you read the critique more thoroughly. It is rather a shame that you don’t catch these errors for yourself and that you have failed to read the references we give correctly or to accept the nuance. Do you really have that little concern for your readers? We have considerable respect for the readers of various newspapers and believe that they deserve accurate reporting. Might we point you towards Health News Review for an idea as to how to obtain viewpoints from various experts and to present a spectrum of ideas that reflects the scientific landscape, relative costs, relative and absolute risks etc..

      Perhaps you might ask Daily Mail to carry links to relevant research and sources: it is profoundly irritating to read assertions in so many health or science pieces and it would make it easier to check if there were links, maybe in the style of New York Times.

      You might notice how much a recent post by Patrick Holford has improved since he included some references to support some assertions that he had made in the original version. There are still some problems with it but it is improving. Sometimes, this is what accepting well-informed critique can do.

      While you are here it would be interesting if you respond to the errors in your co-authored book, Food is better medicine, because we have long been curious just which of you is responsible for various errors – and why they weren’t caught by the ‘team of expert reviewers’.

      However, having read your attempt at self-justification that seems to rely upon not understanding the criticism or the references, I have a greater understanding of why some of the errors in the book have persisted.

      • jerome burne

        I agree with your about references and I have no problem with that. I have in the past done stories for the Mail which have, at their request, been supported by quite a scaffolding of references, all of which has been removed in the final version. Whether the paper will want to post them on line I have no idea – I will suggest it. You must be familiar with the constraints of newspapers – assuming that “dynutrix” is aka Ben Goldacre.

        I’m very unimpressed by your response. When you strip out shoolmasterly phrases about read the critique more thoroughly and how it’s a shame I’m not catching errors, there is nothing there. I’ve got a limited amounts of time to spend raking through the entrails of my old articles but I thought it worth it because you made a number of serious points about my piece and I felt the least I could do was to respond seriously.

        If I am to expect the same kind of lazy point scoring in reply if I respond to your critiques of “Food is Better Medicine than Drugs” then I will have to decline.

        • See, no, dvnutrix is not Ben Goldacre. This is one of the reasons that we can not take your assertions on trust as there is evidence of little thought on some matters (you wouldn’t believe the number of bloggers that commenters repeatedly and erroneously assume to be Ben Goldacre – who is actually busy being a doctor, writing a column, running his own blog and publishing a well-received book on Bad Science).

          On the topic of Ben Goldacre – you might take a leaf from his book and start a blog – that way you would be able to provide the references that are missing from any newspaper items even if the newspaper in question won’t take them as yet. However, we are hoping for movement on that front as we seem to be persuading even Science: So What? to re-think their policy on this issue.

          You do seem to rely on sub-editors to catch your factual errors – that is not really their job or their responsibility.

          You did not make any substantive points in your response however, since you are returning to the matter, we shall, of course, dedicate a post to your response at our leisure and not over the Bank Holiday w/end. We’re sorry that you misconstrued our desire to respond to you as a gesture of respect with intellectual sloppiness, however, one considers the source and doubts the sincerity of that affectation of your critiquing our response in this manner. We invite you to respond to our fuller response. As for the point scoring, let us demur on that and refer you to your earlier comment and the alleged foot shooting: we also advise you to consult a good definition of the psychological phenomenon of projection.

    • Thanks for the link to the Herpes Virus Association. You might like to suggest that the Mail corrects the claim that “By the age of 85, 65 per cent of us will have suffered this often extremely painful disease”: if your figures come from HVA, they give a figure of 60% by age 85.

      • Jerome Burne

        Help! You have sucked me into a dreadful pool of pedantry, a place I swore not to go when I started this. But I can’t resist since several of your points seem confused.

        You claim that because I wrote “assuming dvnutrix is aka Ben Goldacre” that you cannot take my “assertions” on trust and that this provides evidence of “little thought” on my part. But you have confused “assumptions” with “assertions”. Telling someone you are making an assumption, as I did, is a way of asking a question. It was a perfectly reasonable assumption but I was leaving it open for you to confirm or deny. The lack of thought here doesn’t seem to be my problem. Further I’m not sure why I, who use my own name, should be considered less trustworthy than someone with a pseudonym.

        My original point about sub-editors was a bit of a joke. It referred to your excessive concentration on minor details. It is important to get your facts right of course but in the nine points that I responded to there was just one incorrect figure – 8 rather than 6 deaths. What is crucial is to distinguish between facts that affect the main thrust of the argument – and those that don’t. I will certainly correct the figure if I return to this topic (thanks) but it makes no difference to the case that this is not a condition that has a high mortality rate.

        I don’t quite know how to respond to your claim: “You did not make any substantive points in your response.” For instance you said originally that the rise in fits following the ProQuad was inconsequential; I showed that an FDA panel had considered it serious enough to water down its “preference for the combo vaccine”. That seems pretty substantial. Or do you not understand the significance?
        Otherwise my response demonstrated that the points you raised to justify your original liberal smattering of insults – “distorted interpretations”, “gaullimaufry” (absurd medley) “spreading misinformation” – were not grounded in the facts – there were perfectly legitimate references for my claims, papers supposedly obscure were not, sources were authoritative etc.

        You suggest that my aside about you “shooting yourself in the foot” was just the sort of point scoring I had accused you of. The difference is that it was tied to a specific example – the FDA and ProQuad. You however didn’t deal with a single point of mine and simply again scattered broad spectrum slights: “little concern for your readers”, “attempt at self-justification”, “not understanding the criticism or the references”.

        I know your style depends on portraying yourself as informed and evidence based and scientific and everyone else is idiotic, confused and probably with a self-serving agenda but you must know that is not only just wrong but that it does nothing to create a sensible debate. Also you should be aware that allegations of projection are a two-edged sword.

  14. I don’t think its pedantry to argue for a balanced presentation of the risks attached to a particular intervention. For example, would it not have been helpful for you to – as well as using the Shingles Support Society’s figure – have noted that there are considerably lower credible figures for lifetime occurrence of shingles?

    I’m glad you see it as important to assess the risks and benefits of particular interventions. With that in mind, perhaps you might share the evidence which convinced you to argue (in Food is Better Medicine than Drugs) that IgG home allergy tests are useful for diagnosing “food sensitivities”. We would also be fascinated to know how you determined that the various supplement regimes suggested in the book are safe and effective.

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