I think this uncertainty about harms of vaccine is clearly out there -- we must pay attention to it even when the concern may be theoretical. The concern about spread of communicable diseases because of fear mongering (if truly there are no substantial harms) is equally valid. Only patient-centred research (which should also address their legit fears) can address these opposing uncertainties. 



As an EBM proponent I know what I deal with routinely; and that is, snapshots of data taken over a specific period of time usually from specific angles. Much is left behind, so I am often at a loss in constructing a holistic picture of reality. (unless of course, as some say, that reality only is what is perceived, what is not is unreal. In other words, absence of evidence is evidence of absence) 



Consider drug A vs. drug B for the outcome of pain. Relative risk reduction in severe pain is 30% with tight confidence interval favouring drug A. That’s pretty impressive. But only, 25% of patients experienced the outcome over 6-48 hour duration. Whether those who did not respond to treatment were worse off with A than with B was never measured. So the true picture remains unclear. The analogy wouldn't work for vaccines, but it works in support of the middle paragraph.    



Having said that, it is also important that we do not create paranoia; that paranoia, unfortunately, gets created because those who should listen (researchers and funders) do not listen until the whole world cries out loud and abandons what may not have been abandoned. The nature will sort things out ultimately, this way or that way. It has millions and billions of years of experience.   



I am unpoinionated about harms of vaccines...but I'd like to see research look into that more carefully and sincerely as a priority. 



-----Original Message-----

From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Wouter Havinga

Sent: Wednesday, October 08, 2014 10:23 AM

To: [log in to unmask]

Subject: Re: Risk of bias in vaccine safety research missed by Cochrane



I appreciate you reply Douglas,



Humble pie for me indeed with reference to evidence whether the endemic increase of NCD as seen young people in the developed world is related to vaccines but that is because Public Health or CDC don't check for that. This is the bias that I am addressing.



An other bias, in vaccine VE studies, is whether there is a shift to an other commensal that becomes virulent.

We are awash with viruses, bacteria, fungi etc that keep us healthy. Taking one out of the Human Microbiome might have repercussions? Could it be that the serious cases of Enterovirus D68 is due to antiviral/antibacterial vaccinations? Eterovirus D68 has caused severe respiratory illnesses and 4 deaths in the USA.http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-outbreaks.html

According to wikipedia "First isolated in California in 1962 and considered rare, it has been on a worldwide upswing in the 21st century"



"Dengue incidence has increased in the Americas over the past three decades, from 16.4 cases per  100,000 in the 1980s to 218.3 per 100,000 during the decade 2000-2010." http://www.paho.org/world-health-day-2014/wp-content/uploads/2014/02/Dengue.pdf



Personally I don't think that Public Health or the CDC inform people properly so that the public can make up their own mind about vaccination. Particularly if they start to mask people who made up their own mind.  http://jama.jamanetwork.com/article.aspx?articleID=1746248 "New York State’s Mandate to Vaccinate or Mask"



These important possible harms from vaccines are not discussed because of institutionalized thinking, which becomes the norm in society. You came out with just such sound bite: "we have seen already too many examples of the harm from unsubstantiated theories". Douglas, what harm in Western World specifically do you mean? Is it harm to the CDC and Public Health objectives (vaccine penetration) rather than people?



In the area of vaccines, to me, sound bites and normativity rules in these public health institutions - implicit biases and unconscious stereotypes hampers proper public health infectious diseases research. 



My worry is that, within the vaccine area, due to the "Hidden Curriculum" public health - and CDC researchers are not able (allowed?) to think about, let alone talk about the possibility that vaccines might not be all good. To me, this is a very dangerous situation, on a global humanitarian scale.



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