I wrote yesterday about Katie Couric’s disastrous segment on the HPV vaccine on her daytime TV show, and I included a list of several articles that also discussed the many ways Couric was irresponsible, inaccurate and damaging to public health. I also wrote a lengthier piece analyzing her show over at Knight Science Journalism Tracker that was published today and that I hope you’ll check out.
Since that post, the number of scathing articles about Couric has exploded. Searching “Katie Couric HPV vaccine” on Google pulls up pretty much nothing but well-deserved criticism. (I’ve included a lengthy list at bottom.) And yet, Couric, whose ratings were already nosediving (a potential motivating factor for Wednesday’s sensationalistic piece of crap episode), has decided to double down on her false balance. As Skeptical Raptor describes at his blog today, Couric issued a statement this afternoon which purports to address the criticism with a defense that the show “presented the facts supporting the potential of the vaccine.”
Of course, the show didn’t present the facts; today’s statement even references one of the most egregious inaccuracies in the show: Diane Harper’s statement about “the clinical trial results that the vaccine only provides protection for a finite amount of time.” In fact, the vaccine lasts longer than the five years claimed by Harper, just as other HPV vaccines have been shown to do. The statement also references Harper’s misleading discussion of Pap smears: “She also questioned, given the overall success of Pap testing to screen for cervical cancer, whether the vaccine is necessary or just optional.” As Tara C. Smith wrote at Aetiology, detecting pre-cancerous cells through abnormal Pap results – hopefully before it’s too late – is not the same as preventing the infection that can cause the cancer in the first place, not to mention the fact that Paps can have false negatives and that too many women do not get regular Pap testing as they should.
So Couric’s producers seem to think that the way to address their grievous treatment of an important public health issue is “to continue the conversation and invite a number of medical experts, journalists and scientists to weigh in here” — because CLEARLY letting experts, journalists and scientists comment on a webpage is just as good as devoting a major portion of a daytime TV show to inaccurate, misleading scare-mongering. It’s greatly disappointing that a once-respected journalist is allowing concerns over ratings to trump accurate and responsible journalism – especially one who had already built a reputation for drawing attention to public health issues such as colon cancer.
I am also going to “continue the conversation” about HPV, but I will do so with a responsible discussion of other recent discouraging news related to the vaccine which reveals how important it is that the public receive accurate information about it. Expect to see a post soon about another recent study on HPV vaccine uptake obstacles along with personal stories of acquaintances of mine who had the HPV strains that can cause cancer.
Meanwhile, here’s a more comprehensive list of the many articles criticizing Couric’s HPV vaccine segment. (The ones I already listed yesterday are toward the bottom.)
Tara Haelle, KSJ Tracker, “Guest post: Anti-vaccine fear-mongering back in the mainstream: Katie Couric trades fact for emotion”
Skeptical Raptor: “Katie Couric doubles down on the Gardasil false balance”
Harpocrates Speaks: “Katie Couric chooses ratings over ethics”
Alexandra Sifferlin, Time: “Is Katie Couric The Next Jenny McCarthy?”
Jen Gunter, Dr. Jen Gunter: “Impact of Katie Couric’s misinformation on HPV vaccine in one image”
Jen Gunter, Dr. Jen Gunter:: “The real HPV controversy from Katie Couric’s show, her expert”
Christine Vara, Shot of Prevention: “Victims Katie Couric Neglected To Mention In Her Discussion of HPV”
Skewed Distribution: “Katie Couric tries and fails to undo the damage”
Hunter, Daily Kos: “Couric’s anti-vaccination segment a symptom of wider scientific illiteracy”
David Kroll, Forbes: “Katie Couric And Cervical Cancer Prevention With The HPV Vaccines, Gardasil And Cervarix”
Liz Klimas, The Blaze, “Katie Couric Slammed for HPV Vaccine ‘Alarmism‘”
Robin Marty, Care2: “Katie Couric Ditches Journalism for Drama in Manipulative HPV Vaccine Story”
Katie McDonough, Salon: “Katie Couric gets called out for promoting bogus science on HPV vaccine”
Ryan Jaslow, CBS News: “Katie Couric show on HPV vaccine sparks backlash”
Phil Plait, Slate: “Katie Couric Gives Anti-Vaccine Ideas a Shot”
Alyssa Rosenberg, ThinkProgress: “Why Did Katie Couric Invite Vaccine Deniers On Her Talk Show?”
Orac, Respectful Insolence: “Katie Couric on the HPV vaccine: Antivaccine or irresponsible journalist? You be the judge!”
Amanda Marcotte, Slate: “Katie Couric Hands Her Show Over to Anti-Vaccination Alarmists”
Seth Mnookin, The Panic Virus PLOS Blogs: “Katie Couric promotes dangerous fear mongering with show on the HPV vaccine”
Emily Willingham, Forbes: “Katie Couric Promotes Anticancer Vaccine Alarmism”
Matthew Herper, Forbes: “Four Ways Katie Couric Stacked The Deck Against Gardasil”
Karen Ernst, Moms Who Vax: “In the Media, A Bad Day for Vaccines”
Dorit Reiss: “The Costs of the Fight Against the HPV Vaccine”
Tara C. Smith, Aetiology, “The Pap smear is no panacea, Katie Couric”
Michael Hiltzik, LA Times, “Katie Couric puts the anti-vaccination movement into the mainstream“
I blogged about Katie Couric’s shoddy and shameful segment about the HPV vaccine over at the Knight Science Journalism Tracker so you can read my assessment there, focusing primarily on the segment’s false balance and media coverage of it.
I did not spend any time at that piece correcting the misinformation in the show and about the HPV vaccine in general, but University of California law professor Dorit Reiss at Moms Who Vax and Skeptical Raptor both do a fantastic job of this. Definitely check out their work, which includes plenty of links to peer-reviewed research.
I also wanted to gather some of the best links I found about the show to post here. Ironically, I have been gathering research for an extensive myth-busting post about the HPV vaccine, but that’s a ways off still. I have my work cut out for me with formerly credible journalists like Couric helping to tear down any progress that’s been made in getting accurate information out about the HPV vaccine.
At Moms Who Vax, Karen Ernst, founder of Voices For Vaccines, called yesterday as a “bad day for vaccines” in the media: she discusses the cringe-inducing missteps in the Couric show while lamenting the media’s neglect of a court case finding the HPV vaccine was not responsible for one girl’s death.
At Forbes, Emily Willlingham described the false equivalence that Couric was setting up for the show on Twitter even before the show had aired.
Also at Forbes, Matthew Herper sums up Couric’s four biggest mistakes on the show: “downplaying the effectiveness of the vaccine, “overplaying the power of Pap smears,” “underplaying the risk of cancer” and “pulling viewers’ heartstrings.”
Over at Respectful Insolence in a lengthy but thoroughly worthwhile post, Orac provides some background and context on Couric’s past reporting – including past tolerance of anti-vaccine crusaders – and summarizes in great depth how horribly the episode went.
Tara C. Smith at Aetiology explains why Dr. Harper’s enthusiastic trumpeting of Pap smears misses the point when it comes to preventing cervical cancer.
At the LA Times, Michael Hiltzik also addresses the way Couric’s handling of the segment puts emotion ahead of fact, leaving science to flail helplessly while viewers are frightened and swayed by heartbreaking stories.
At PLOS Blogs The Panic Virus, Seth Mnookin warned the day before of what was coming and concludes with a succinct list of links that make it clear what part of the story Couric is neglecting.
At Slate, Amanda Marcotte describes how audience guest Dr. Diane Harper (who might as well have been on stage) misconstrues the evidence and misleads the viewers. Harper is already well-known as the subject of an inaccurate zombie article online that just won’t die, though Skeptical Raptor does a fantastic job of debunking it.
Heck, even Yahoo News! has a reprinted story about Couric’s feeding the “controversy” beast.
Honestly, about the only heartening thing about this whole disaster of a show was that when I googled “Katie Couric HPV vaccine” to see if there were any good articles I missed, every single results on the first two pages was a critical take on just how many ways Couric screwed over science yesterday.
A new field report from the CDC last week left me feeling disheartened, disturbed and frustrated. The short version: a new trend appears to be occurring in which parents decline administration of an essential vitamin for their babies after birth – with potentially fatal consequences. And the reasons, unfortunately, appear based on the same kind of fear and misinformation that leads some parents to decline other important preventive care for their children.
I’m talking about vitamin K, which the American Academy of Pediatrics has recommended since 1961 to prevent the possibility of severe bleeding in babies who develop a vitamin K deficiency in their first few weeks or months of life. The field report from the CDC appeared in last week’s Morbidity and Mortality Weekly Report with data on Nashville-area parents who declined vitamin K. The investigation was triggered by four cases of babies who experienced life-threatening bleeding because of not receiving the essential vitamin, initially reported last August.
Turning down vitamin K appears to be a relatively new thing, judging from the dearth of peer-reviewed research on it, despite other countries’ recommendations for it as well. I found very few studies that looked at how common it is for parents to decline vitamin K administration at birth, typically 0.5 to 1 mg (depending on birth weight) given as an intramuscular injection. (It can also be administered orally at parents’ request, but it requires three carefully timed administrations and is discouraged because of lower effectiveness, particularly for the type of deficiency bleeding these four infants had.) I’ll get to what those reasons for parental refusal might be in a moment. Meanwhile, the findings of this field report imply that the trend could be growing — or about to start growing.
The four babies whose cases precipitated the report were all diagnosed with late vitamin K deficiency bleeding between February and September at the same Nashville children’s hospital. Late vitamin K deficiency bleeding – the form less likely to be prevented by oral administration – occurs when a baby is between 2 and 24 weeks old. These four infants were all between 6 and 15 weeks when symptoms began. The other two forms are early (within 24 hours of birth) and classic (within the first week of birth), though the former typically occurs only in women who were taking medications that inhibit vitamin K (such as anti-epileptic drugs, some antibiotics, tuberculosis drugs such as isoniazid, or blood thinners such as coumarin or warfarin).
One of the babies experienced gastrointestinal bleeding and the other three had intracranial hemorrhaging – severe bleeding in the brain. Although all four survived, at least one with the brain bleeding is already showing problems with gross motor skills and all three with intracranial hemorrhaging are being tracked by neurologists.
Despite these four cases in one city in less than a year, the researchers found no others in Nashville between 2007 and 2012 — which, along with their survey findings, is what leads me to worry this is an increasing trend. The CDC researchers randomly sampled the birth records of all babies born in the first ten months of 2013 in three Nashville area hospital and four birthing centers. In the hospital with the highest rate of refusal, 3.4% of 3,080 babies never received vitamin K injections — but among the birthing centers, a whopping 28% of 218 babies were never given vitamin K.
Wow. More than one in four babies at the birthing centers in one city (and not necessarily a city known for its mama “crunchiness”) did not receive a standard treatment to prevent a potentially fatal condition. Read the rest of this entry »
One of the amazing things about the Internet age and Google is that access to information is almost limitless.
One of the frustrating and most damaging aspects of the Internet age and Google is that access to information is almost limitless.
Oh, that double-edged sword.
Seriously, it’s wonderful to live in an age where information is so readily available. It allows us to research pretty much anything we can dream of digging into — as long as we can distinguish the cream from the crap and we have enough of a base knowledge to understand what we’re reading. And that’s where the danger seeps in for those of us who want to research health, medical and other science issues.
One of the unfortunate observations I’ve made in reading what others have to say online — whether in their own blogs, on comments to articles, on Facebook or Twitter, in website forums or anywhere else — is that a lack of base knowledge or understanding in various scientific concepts often interferes with a person’s ability to get the (accurate) information they actually seek. Or, the person falls prey to logical fallacies or cognitive traps that prevent them from reading what something really says or means, rather than what they think it says or means or want it to say or mean.
These two problems converge in the “Dunning Kruger effect,” in which an individual tends to increasingly overestimate his or her ability and/or knowledge in a field with the less skill/ability/knowledge he or she actually has. The combination of a weaker base knowledge in scientific disciplines or concepts, the influence of logical fallacies and cognitive traps, and Dunning Kruger (which is, itself, a type of cognitive trap), contribute to the poor levels of scientific literacy I and many others have also seen and written about online. This combo also contributes to poor medical and health decisions that people may make, such as choosing not to vaccinate their children.
So, although I’m just one blog in a sea of voices, I’m going to start a couple of occasional series in which I try to help fill a little of this deficit. I know that simply educating people will not magically lead them to make good decisions — that’s what the problems of cognitive bias are largely about — but it can certainly help, especially to those open to learning.
The goal is to help readers become aware of logical fallacies or cognitive traps that may trip them up in “Logical Fallacies 101″ and to provide some basic lessons in epidemiology in “Epidemiology 101.” The latter may also include a bit of “Immunology 101″ sometimes. Some of these posts will be written by me, and others will have guest authors If there are any requests for particular issues, “lessons,” etc. you would like to see, please let me know in the comments!
Although I’m usually the person writing about vaccines as a journalist, I periodically critique the way others cover vaccination issues as well, particularly when I feel the issue is not covered responsibly. The last time I critiqued such a journalist, it was because of his false balance. This time, I feel obligated to point out the significant flaws in a story whose message, on its face, most would expect me to support. But even if the intentions are good and there are kernels of truth to a story, I cannot support an misleading message that is so oversimplified that it borders on being inaccurate — even if it’s an opinion piece (and especially if it’s then buttressed by a hubristic follow-up “defense”).
I’m referring to the recent piece by Julie Ioffe in The New Republic, “I’ve Got Whooping Cough. Thanks a lot, Jenny McCarthy.” Ioffe describes her awful experience with pertussis, now on day 72 of the “100-day cough.” Her description is of the disease is spot on, and she does an effective job of conveying how this illness is pretty bad for adults too, even if it’s not as likely to be fatal as it is for babies under 3 months old. I understand what she’s trying to do: she wants to use her experience with a vaccine-preventable disease to convey the irresponsibility of not vaccinating. And with almost any other vaccine-preventable disease covered by immunizations on the CDC recommended schedule, she would have a pretty good case.
But not with pertussis. Using whooping cough, her case is weak, she is uninformed, and her article could actually backfire. You see, Ioffe blames non-vaccinating parents and anti-vaccine advocates such as Jenny McCarthy for her plight, but, for once, this is misplaced blame. Ioffe is correct that whooping cough has come “roaring back,” but it’s because of problems with the current vaccine. Anti-vaccine sentiment has helped the resurgence along, but it’s not the primary culprit. And frankly, if Ioffe were following current recommendations, she would have had her booster and would have been less likely to catch the disease.
Now, Ioffe is a talented and accomplished journalist. She knows how to report and has an impressive resume. But she has not done her homework here, and it shows. It could actually be damaging to the very issue she is trying to help – that of the resurgence of vaccine-preventable diseases due to low vaccination rates fueled by anti-vaccination beliefs and fears. She writes, “The illness has, since the introduction of a pertussis vaccine in 1940, has been conquered in the developed world. For two or three generations, we’ve come to think of it as an ailment suffered in sub-Saharan Africa or in Brontë novels. And for two or three generations, it was. Until, that is, the anti-vaccination movement really got going in the last few years.”
Except she’s wrong. Pertussis, unlike most of the diseases for which we have vaccines, never went away. It has remained endemic since the 1940s. As the CDC’s tracking of annual rates of pertussis shows, the introduction of the pertussis vaccine in the 1940s did dramatically reduce the incidence of whooping cough. And for several decades, cases remained fairly low, almost never exceeding 5,000 cases a year. But the US still saw several thousand cases a year, and there were cyclical outbreaks every three to five years. And if you study that chart closely, you’ll notice the uptick in cases started in the mid-1990s. Read the rest of this entry »
It’s that time again — that time when dozens of spurious articles pop up all over the web touting all the dangers of the flu vaccine. Articles on unreliable, alarmist, misinformative sites like Natural News, Mercola, chiropractic blogs and other such sites rail against the “toxins” in the vaccine, or claim the flu vaccine doesn’t work, or that it causes this or that horrible disease, or that the flu itself just really isn’t all that bad. (I’m not going to link to any of them. They get too much attention as it is.)
I could be wrong, but I’d venture to guess there is more nonsense and misinformation about the flu vaccine than any other vaccine out there. Perhaps it’s because it’s a once-a-year vaccine, so that cyclical nature brings out new myths each year. Or maybe it’s because it’s for an illness that many people have had, even more than once, and survived, so they mistakenly assume a vaccine is unnecessary.
Whatever the reasons, I’ve decided a comprehensive post addressing every myth I’ve been able to find is long overdue. I plan to update this post as necessary, and I’ll likely republish it each year as a reference. Note all the links where I provide my sources — more than half of these go directly to peer-reviewed medical research.
To make it easier to navigate, I’ve listed all 25 myths here at the top with links to that myth’s debunking explanation.
First, an important note: I am a science journalist but not a medical doctor. I’ve compiled research here to debunk common myths about the flu vaccine. You should always consult a reliable, trusted medical professional with questions that pertain specifically to you. For the CDC recommendations on the 2013-2014 flu vaccines (including information on which vaccines pregnant women, the elderly and children under 2 should *not* get), please consult the CDC site directly.
Myth #1: The flu vaccine gives you the flu or makes you sick. (No, it doesn’t.)
Myth #2: Flu vaccines contains dangerous ingredients, such as mercury, formaldehyde and antifreeze. (Not exactly, and the ingredients aren’t dangerous.)
Myth #3: Pregnant women should not get the flu shot. (They should.) / The flu shot can cause miscarriages. (It doesn’t.) / Pregnant should only get the preservative-free flu shot. (Nope.)
Myth #4: Flu vaccines can cause Alzheimer’s disease. (They can’t.)
Myth #5: Flu vaccines provide billions of dollars in profits for pharmaceutical companies. (Maybe, maybe not, but so what?)
Myth #6: Flu vaccines don’t work. (Um, they do work.)
Myth #7: Flu vaccines don’t work for children. (Again, they work.)
Myth #8: Flu vaccines make it easier for people to catch pneumonia or other infectious diseases. (No, they make it harder.)
Myth #9: Flu vaccines cause vascular or cardiovascular disorders. (No, they don’t.)
Myth #10: Flu vaccines can break the “blood brain barrier” of young children and hurt their development. (No, they can’t.)
Myth #11: Flu vaccines cause narcolepsy. (Not the seasonal flu vaccine, and not most others.)
Myth #12: The flu vaccine weakens your body’s immune response. (It actually strengthens it.)
Myth #13: The flu vaccine causes nerve disorders such as Guillain Barre syndrome. (Extremely rarely – and more commonly with flu infections.)
Myth #14: The flu vaccine can cause neurological disorders. (No, it can’t.)
Myth #15: Influenza isn’t that bad. Or, people recover quickly from it. (Uh, it’s pretty bad.)
Myth #16: People don’t die from the flu unless they have another underlying condition already. (Actually, healthy people DO die from the flu.)
Myth #17: People with egg allergies cannot get the flu shot. It will kill them! (No, it won’t, and there’s an egg-free vaccine.)
Myth #18: If I get the flu, antibiotics will take care of me. (No, they can’t.)
Myth #19: The flu shot doesn’t work for me, personally, because last time I got it, I got the flu anyway. (It still reduces your risk.)
Myth #20: I never get the flu, so I don’t need the shot. (You can see the future?)
Myth #21: I can protect myself from the flu by eating right and washing my hands regularly. (No, you can’t.)
Myth #22: It’s okay if I get the flu because it will make my immune system stronger. (Selfish, much? And no, it doesn’t.)
Myth #23: Making a new vaccine each year only makes influenza strains stronger. (No, it doesn’t.)
Myth #24: The side effects of the flu shot are worse than the flu. (No, they aren’t.)
Myth #25: The flu vaccine causes Bell’s palsy. (No, it doesn’t.)
Myth #1: The flu vaccine gives you the flu or makes you sick. (No, it doesn’t.)
This is by far the most common myth I hear – even though it’s scientifically impossible from the inactivated vaccine. Are there people who become sick right after having gotten the flu shot? Of course, and it’s an illness they had likely caught before the shot and it took a a few days for symptoms to appear, or it’s just coincidence (and it may or may not be the flu). The flu shot takes two weeks to confer protection, and it takes 2-5 days to incubate a flu virus. A person who does come down with the flu within a week of getting the shot was already infected when they got the vaccine.
Even with the live vaccine in the nasal spray, the weakened virus cannot cause the flu. However, it is theoretically possible to “shed” the virus after receiving the live vaccine, thereby infecting others, though no serious cases have been reported of this occurring.
Edit: One thing worth noting is that some people may feel “under the weather” or generally crappy for a few days after the shot or a week or two later. A headache, nausea, fever, etc. can be a result of the side effects of the vaccine, usually from the immune system ramping up and producing antibodies against those influenza strains. Some may consider this feeling “sick,” but you are not sick in the sense that the flu vaccine caused you to fall ill from a pathogen, and the vaccine certainly didn’t give you the flu.
Myth #2: The flu shot contains dangerous ingredients, such as mercury, formaldehyde and antifreeze. (Not exactly, and the ingredients aren’t dangerous.)
Single dose-shots of the flu vaccine and the flu vaccine nasal sprays do not contain any mercury compounds. The multi-dose flu shot does contain a preservative called thimerosal, which breaks down into 49% ethylmercury and used to prevent bacterial contamination of the vaccine container. Ethylmercury, as I’ve discussed before, is processed differently by the body than methylmercury, the neurotoxin that can build up in the body and is found in fish. (Keep in mind the difference a letter can make in chemistry: methanol is anti-freeze while ethanol is a Chardonnay.) Ethylmercury is made of larger molecules that cannot enter the brain and exits the body within a week.
There is no danger in receiving a vaccine with thimerosal – they’re given all over the world and it’s been extensively studied, even for cumulative effects on children over several years. And, keep in mind, if you’re just one of those paranoid types, you can easily request and get a flu shot without the preservative.
Formaldehyde is used in safely small amounts in several flu vaccines (Fluarix, FluLaval, Agriflu and Fluzone) to inactivate the virus so it cannot cause disease. It is not in other influenza vaccines (Afluria, FluMist and Fluvirin). Formaldehyde also occurs naturally in fruits and vegetables even is produced by the human body for a variety of functions, including making amino acids. The amounts of formaldehyde in these vaccines vary from 5 µg per dose (Fluarix) to 25 µg per dose (FluLaval) to 100 µg per dose (Fluzone). For reference, a pear contains about 39 to 60 mg/kg of formaldehyde (1000µg = 1mg, so pears contains approximately 39,000 to 60,000 µg/kg.) A typical pear weighs about 220g, or 0.22 kg. That means a single pear would contain 0.22 times the 39 to 60 mg/kg, or 8.6 to 13.2 mg (8600 to 13200 µg). (Meanwhile, a single dried shiitake mushroom contains 100-406 mg/kg of formaldehyde.)
The claim of antifreeze being in vaccines comes from the use of octylphenol ethoxylate (Triton X-100) (in Fluzone) or octoxynol-10 (Triton X-100) (in Fluarix) used to inactivate those viruses or to purify other vaccines. Polyethylene glycol by itself is one component of antifreeze but is not antifreeze itself, just as water is a component of antifreeze. But these are not the same as polyethylene glycol and involve the use of Triton X-100 as a splitting agent, which has been shown to be safe. Learn more about specific components of flu vaccines here, but remember, again that ONE LETTER can make a huge difference in what you’re talking about.
Myth #3A: Pregnant women should not get the flu shot. (They should.)
I’m pregnant, and I got the flu shot last week, as should all pregnant women without medical contraindications, as the CDC recommends. The flu shot is safe for pregnant mothers, and even after their child is born, mothers who got the flu shot while pregnant have provided their babies with a bit of extra protection against acute respiratory infections. They also may reduce children’s risk of other conditions, such as bipolar disorder, associated with prenatal influenza exposure. And, moms who get the flu shot also offer their babies some protection against the flu from birth, even if they plan to breastfeed. Read the rest of this entry »
Although it’s not in the limelight as often as various other hot-button “mommy wars” issues, the use of spanking as a disciplinary method is still a controversial – and common – practice. It is also incredibly difficult to study, so before I get to discussing the study published in Pediatrics this week about the possible effects of spanking on young children, I want to review some of the challenges of studying spanking first.
I will offer a spoiler about the study’s conclusions: the researchers found that spanking appears to have a negative effect on children’s behavioral and cognitive development from infancy through age 9. This conclusion is similar to another study on physical punishment I coveredlast year with a MUCH larger population. But before I can discuss the specifics, the context of how challenging these studies are to conduct and interpret is important to discuss first.
First, the most practical and ethical way to study it tends to be the least reliable of study methods, a retrospective epidemiological study. In these studies, researchers ask parents if they spanked their children (or they ask adults or teens if they were spanked as children) and then ask about mental health diagnoses and/or give the children/grown adults various assessments for depression, anxiety, etc. Then the researchers compare spanked kids’ outcomes to unspanked kids’ outcomes.
Retrospective studies are less reliable than other types of studies because they are prone to “recall bias” (responders misremembering) or other forms of bias in which the responders are not entirely truthful or reliable for other reasons. Another problem is that researchers have to take into account all the other factors that might *also* have influenced the outcome (in this case, mental health concerns). The typical factors that are considered in these studies are age, sex, family income, parents’ education, race/ethnicity and other characteristics.
But with spanking, there may be many, many other factors that influence a child’s mental health (as a child or later as an adult), and it can be difficult to separate out what might be affecting someone’s mental health versus what might be happening at the same time as the spankings (or even cause the spankings). For example, what about a parent’s mental health? If a parent has a mental disorder, and that disorder increases the likelihood that the parent spanks their children, then how do we determine whether a child who grows up to have a mental health condition developed it because they were spanked or because they were already genetically prone to have one? (And this is just one of MANY factors that can “confound” the results.)
The better type of study, when possible, is a prospective one, like the one published in Pediatrics this week. In a prospective study, the researchers follow the participants forward in time, which can help reduce the bias of misremembering (“recall bias”). Of course, if the information is gathered by asking questions of parents (which is nearly always the case), there is still the opportunity for recall bias. Further, the same concerns with confounders exist: what factors do you take into account and how many can you account for? The more you try to account for confounding factors, the more convoluted your data analysis gets (and potentially the more theoretical and less reliable it gets). Read the rest of this entry »
I have some exciting news to share that also happens to be directly relevant to an evidence-based parenting topic: flu shots. First, let me warn you that this the first of several flu shot posts I’ll be writing in the week or two. I’m starting out easy by writing about my own recent experience first.
Now, the news: I’m expecting another baby boy who should be arriving in early April! At 16 weeks along, I’ve been to a handful of prenatal appointments already, and it’s been interesting to go through this pregnancy with far more evidence-based knowledge than I had while I was pregnant with my first son. Hence, I found myself on the phone a week or so ago calling my OB/midwife’s office to ask why I had not been offered the flu shot at my last prenatal visit, considering it’s already October. I had assumed that my care provider’s practice, like that of my OB in Austin, carried flu shots and included them as part of their standard prenatal care.
I was wrong. The office did not carry flu shots, or even the Tdap, for that matter, even though the Tdap is now officially recommended during women’s second or third trimester to offer a bit of extra protection against pertussis to newborns. Still, the nurse was surprised that my provider had not recommended I get the flu shot. It’s not that my provider had recommended against it; it just never came up (and I did not think to ask about getting one until after I had left my appointment).
It’s possible that my provider didn’t mention the shot because she knows my line of work and that I would already have decided whether I was getting one or not, but I was still concerned that it hadn’t even come up and, especially, that the practice didn’t even have flu shots available for patients.
After all, pregnant women are far, far more likely to get their flu shot when their provider both recommends the shot and offers it there at the practice. In a CDC report on flu shots among pregnant women for the 2012-2013 season, 70.5% of women whose providers recommended and offered a flu shot got one. Unsurprisingly, only 16% of women whose providers didn’t recommend the shot ended up getting one.
And then there were the women whose providers recommended the flu shot — but didn’t offer one: only 46% of them ended up getting the shot. That makes sense. If you can get it right then during your prenatal visit, it’s easy. If you have to go out of your way to a drug store, grocery pharmacy or another provider to get your shot, you’re less likely to make the effort.
Then there are those who do make the effort but run into other obstacles. A couple of friends told me they have been turned down for flu shots while pregnant when they sought them at the pharmacy of several common drug store chains. This was in the past, and it’s only anecdotal, but it’s disturbing considering that pregnant women are among those considered “at risk for medical complications attributable to severe influenza,” and therefore among the high-risk, targeted groups for flu vaccination. Read the rest of this entry »
UPDATED: I have updated this post from the original. The added section starts at the asterisk (*).
While working at a local coffee shop last week – one of my handful of office-away-from-the-home-office haunts – I overheard a mother at the table next to me talking with her three friends about her son. I mostly tuned her out — until she began talking about the raw milk she gets from a local farm. She said the farm cannot sell her the milk (which contradicts what the Illinois statute about raw milk sales actually says, but I may have misheard her), so she “owns” a share of the cow and retrieves her milk once a week. Then she talked about how much her 3-year-old son loves the milk in his sippie cup. I cringed. I bit my tongue. Hard. I knew better than to interject myself into a conversation with a stranger about the dangers of raw milk (which is responsible for frequent bacterial illness outbreaks), but it still bugged me.
Now, a few days later, I find a certain irony in the fact that a study has just been published by Pediatrics looking at the amount of bacteria in raw milk — but there’s a twist. The new Pediatrics study looks at raw human milk rather than raw cow milk. Specifically, the researchers investigated the safety of human breastmilk ordered online. The findings were concerning, but there are also flaws in the study that are important to consider alongside the findings.
It is a small minority of parents who may want breastmilk for their infant but be unable to provide it. They could be mothers whose milk did not come in or dried up (rare but it happens), parents who have adopted a child or parents of a preemie who cannot latch yet, among other possibilities. Generally, the best source for donated breastmilk is a milk bank, though there are not nearly enough of them.
Enter the Internet, where you can buy pretty much anything. But that doesn’t mean it’s safe.
The study authors ordered 101 human milk samples from a popular US milk-sharing website and compared their bacterial and viral content to 20 (unpasteurized) human milk samples donated to a milk bank. The samples were all analyzed at the same time by technicians who didn’t know where each sample originated from. Read the rest of this entry »
Delaying certain vaccines is one of the more common trends among parents who are uneasy about vaccinations but still recognize their value and effectiveness. If they hold off until their child is older, the parents reason, then perhaps the possible side effects will be less likely, or perhaps the child’s immune system will be “stronger” and better able to cope with the vaccine.
A recent study in JAMA Pediatrics, however, may make some parents think twice about this rationale for at least the MMR vaccine. In fact, kids who get the MMR at the recommended age are about half as likely to have a fever that leads to a seizure (“febrile seizure”) as kids getting the vaccine closer to age 2, the study found.
The first dose of the MMR, which stands for measles-mumps-rubella, is currently recommended by the CDC (pdf) when a child is between 12 and 18 months old. Most pediatricians include it in the 12-month well-child visit. I have at least a handful of friends who have delayed the MMR for one or more of their children well past 18 months, even up to 3 or 4 years old (the second dose is recommended between 4 and 6 years old). These parents often have good reasons: their child may have had a reaction to a previous vaccine which they believe may make a reaction to the MMR more likely. The MMR is already known to be more likely than the vaccines to cause a fever in the week and a half after it’s given: according to the CDC, about one in every six children are likely to experience a mild to moderate fever afterward.
Of course, the downside to delaying the MMR, as in delaying any vaccine, is that the child is left unprotected against those diseases for a longer period of time. For measles, a delay has become particularly riskier lately because of the recent measles outbreaks in the US. (These outbreaks led at least one friend of mine to get her child the MMR, which she had been delaying, sooner than she had wanted to.)
But this new study offers another reason to get the MMR on time: children may actually be LESS likely to develop a high fever reaction. The researchers used data from 840,348 children, aged 12 to 24 months, enrolled in the Vaccine Safety Datalink database. They all received either the MMR or the MMRV (MMR plus varicella, or chickenpox, vaccine) between 2001 and 2011. Read the rest of this entry »