So you are comparing a preference and something about fat causing X (not sure about the evidence), to an evidence-less based claim that Y causes Z?
No. I'm depicting a person who is in a discussion and perceives that they are being attacked, to the extent of completely mis-perceiving the other person's intent and meaning. ("You look great!" "Look, I didn't have TIME to iron, all right? I don't need your passive-aggressive remarks!" "Uh...what?") And who perceives every attempt to clarify as a further attack. Who enters a conversation with a focus on debate, rather than discussion, and who therefore seems to begin processing a counterattack as they hear each phrase the other person is saying, skipping the step of interpreting what they actually meant.
This is a thread about evidence based medical knowledge re vaccines. A number of unsupportable claims were made after I used a vaccine belief example in another thread. The posts addressing my example were off-topic so following standard forum protocol, instead of hijacking the thread, I started a new thread. Moving on to the current thread. The topic is vaccine myths and misconceptions. The thread is not about echoing or promoting the myths. It's not about excusing the myths in order to prevent social discord. That people don't appreciate their beliefs being challenged is not my problem given the thread is about false beliefs. If they or anyone else believes said vaccine claims are valid, defend those beliefs, with evidence. If people don't have an interest in discussing the scientific evidence about vaccines, why are they here in the thread?
For the sake of completeness of information relevant to public health, an excerpt from CDC website http://www.cdc.gov/flu/about/qa/flushot.htm Exact immune mechanisms for this variable response vary, and this general information site doesn't go into any useful detail (vast majority of relevant and recent scientific papers aren't freely available on the internet, and to post excerpts would be breaching copyright), but it mustn't be forgotten that most of these vaccine-effect studies that are used in creating guidelines and pamphlets are done on a population of fit and healthy adults, and therefore may not equally apply to immunocompromised patients. Considering that certain patients get sick whether or not they receive the flu vaccine, from the same or a different strain, this preventative measure is advised in clinical practice, but not insisted upon. Here is an article (http://iai.asm.org/content/13/2/464.short for full article click PDF link on the righthand side) that investigated this phenomenon as early as 1975. At that time, it was shown that there is a temporary effect of reducing cell-mediated immunity following, in this case an infection with attenuated rubella virus (rubella vaccine) but the effect was observed with many others, including measles, mumps, polio, smallpox and indeed influenza vaccines. Science has moved on since then, and this may or may not explain what we are currently seeing, but that's the nature of this game, which evolves and is never constant. Also, recently published study by Harvard School of Public Health, conducted on 600 children, showed that certain chemicals (PCBs and PFCs) which can be easily obtained from the environment, even at non-toxic levels, can show up to 50% reduced immune response to the vaccines they are given, and may account for why certain people seem to get the very diseases they are vaccinated against. This effect hasn't been directly linked to any serious diseases or outcomes, but it just goes to show that various papers mustn't be viewed in isolation and that issues surrounding immunity are complex and far from comprehensively known at this stage. The most important thing in any public health issue is to be open to all forms of evidence, continually question our attitudes and be open to changing our mind, and advise best we can, balancing the risk to the individual with the risk to general public. If you are interested in comprehensive analysis of vaccine science, have a look at this excellent article. Whilst firmly pro-vaccination (a sentiment I throrughly support) it opens with a following statement:
Why are we discussing the OP’s person in addition to the issue in this thread? That said, this is an interesting topic. I’d imagine, though, that the moms and dads on CW know better than trust an internet forum when making a decision over their children’s vaccinations. First I was like... What? But on the other hand; let us google what swine flu vaccines did in Europe. Still, just look at the history of vaccinations, all the research that’s been done, the ratio between positive impact and negative impact, and the diseases that have been eradicated--and leaving your kid unvaccinated seems like A Very Bad Idea. Can we not read other people’s post with enough critical an eye to see if there is an agenda without a doctor undermining and possibly even discrediting a nurse publicly by underlining the fact (or “fact”) that she has an agenda? I’ve seen many of us participate in several interesting debates with a clear agenda, whether it is to ban all porn or, I don’t know, make all italics go away for all eternity, so I find it redundant to throw it about as a mean to… shut someone up. Well said. Not sure why people latch so easily on absolutes. Does it make life simpler? It is true, though, that sometimes we trust doctors/researchers too blindly, as was the case with the swine flu vaccinations. So many young lives irrevocably ruined by narcolepsy. I suppose that’s why we should learn to look at research with a critical eye (easier said than done). Just because Ginger didn’t go to med school (I’m not sure how nurses are trained in the US, but here they don’t go to med school, but to a vocational school), read a load of research there, pass the exams, and do some research and practical training on certain topics herself doesn’t mean we have to attack her. We should debate the research she provides, and the research/evidence alone, not her person. Besides, a degree alone doesn’t make a doctor good and reliable (like @jazzabel actually alluded, people make mistakes), gee, your run-of-the-mill health center docs just google your symptoms, then prescribe some pills (and sometimes put their finger up your bum). What seriously worries me is the money factor. There have been enough instances were greed has led to cutting corners, and in turn, human health and lives have been endangered.
@KaTrian: I won't repeat any of my previous comments, I just wanted to end my contribution to this topic with couple more relevant facts. I agree with you, many health professionals are influenced by a variety of more or less altruistic factors, but on the other hand, most laypeople don't have the foundation required to critically appraise a medical paper. Just like I couldn't make heads or tails from a paper discussing new developments in bridge engineering, someone else might get a headache trying to get through a medical research paper. There are many ways in which specifically drug companies, but other parties as well, manipulate research, one of the main ones is cherry-picking publishing, where it's been known to happen that out of a hundred studies carried out to investigate a certain drug, less than 10% showed data that suited the researchers, but only those were actually published, misleading the professionals as well as general public that they constitute 'overwhelming evidence'. This continues to be a problem, especially because a lot of busy doctors get courted by drug company reps who sweet talk them into accepting such papers without question, but most younger generation is wary and careful of this. One simple guidance is to be sceptical about drug-company sponsored research, and all reputable medical journals now demand that any sponsorship is truthfully declared. Like anything can be supported by a statistic, anything can be supported by a research paper, which is why even when they are good, still aren't 'be all, end all'. For what it's worth, medical consensus is usually a result of many different forms of evidence, and can be trusted to be the best possible advice in the here and now. What will be in 10 years time, none of us can know. The quality of medical advice still varies, and it's up to each individual patient to decide who or what they are going to trust. Second and third opinion are the best way to get a good idea of what are the best available options. With any medical advice, there are many factors to consider and personal experience is a very strong influence. Medical community has moved away from the old-style paternalistic medicine and forcing patients to accept our recommendations at all cost, and these days we encourage autonomy. I strongly feel that is the best way to rebuild the trust between medical profession and the general public. That's all
@jazzabel: Thank you for answering, much appreciated, though I should've probably mentioned that I won't be offended or use it against you in the future if you didn't cos you mentioned you will unwatch this thread Depends where the school teacher was educated j/k! I wouldn't compare bridge engineering to medicine though. A layman is bound to know more about health, diseases, healthcare, etc. "simpler" aspects of medicine, than of bridge engineering. But I get what you mean. However, perhaps I misunderstood something, 'cause I find it an outrageous idea that it's somehow beyond me (you, him, her, them) to interpret/understand/evaluate research data that isn't of their field of expertise. I can be no authority on the subject, but I can still study it. I can be a hobbyist. Not a hobbyist doctor, though Yeah, and I think that's why people often offer data to support their claims -- and keep opinions as opinions. If the data they present has problems, there's always someone ready and eager to jump in and point out whatever flaws there are. I didn't notice anybody badgering anyone here strictly in this sense (sure, Ginger's fairly vocal, but she probably doesn't come hunt you guys down if you leave your kids unvaccinated). This isn't a health center or a hospital. We don't come here to look for an opinion on that weird rash that appeared after a totally innocent weekend in Tijuana. I thought we're here to discuss a topic, mull over several viewpoints, roll our eyes and laugh at others (preferably behind our computers, though nothing stops us from typing these reactions for all to see), and then exercise our autonomy if we so wish. For one, threads like these can be thought-provoking, but they are rarely life-changing.
@KaTrian: I had to run off to lunch, and was just tidying up my answer before I saw your reply. I decided to make it more generalised, but the essence is still there . I was referring purely to paternalistic style of medicine that was typically practiced 30+ years ago, which has resulted in deep distrust of medical professionals, and we are still feeling the backlash of that. As opposed to patient autonomy that is now our main concern. With research, it takes doctors two year study in epidemiology to learn how to spot more covert statistical flaws in papers. It is actually quite difficult to do even for us sometimes, especially since tiny tweaks can dramatically change conclusions (and their quality). In my comment I am not referring to anyone apart from yourself, please don't try to apply my comments to issues I am not referring to or discussing. On a side note, the fact you keep reading certain things into what I said only testifies to the fact that anything can be misinterpreted, if it's taken out of context. Anyhow, I am always happy to discuss medical stuff ad nauseum, but I'm desperately trying to get away from this thread. Can't you tell?
In which case I apologize; sometimes it's difficult tell, but good thing we can always clarify what we meant! Over & out it is for you then
For the record, PubMed is open access and about 80% of the papers have a publicly available abstract. In addition a fair number of scientific papers on vaccines are entirely open access because they were funded with public dollars. Questions about influenza vaccine effectiveness have been on the forefront for the last couple years. I mentioned Ben Goldacre's work exposing research bias. The Cochrane Reviews have published several meta-analyses and in some they had trouble showing evidence of vaccine effectiveness in clinical trials. Yet we know the vaccine prevents infection and the infection is dangerous killing tens of thousands every year. Influenza vaccine effectiveness a very complex subject with a lot of fuzzy edges. There are thousands of research papers on influenza vaccine and every kind of population, all ages, healthy and unhealthy, immunocompromised and immunocompetent. It's always important to look at the preponderance of evidence. There are no single research papers being cited as gospel in this thread. Live attenuated vaccines are not the same as killed vaccines and enlist all aspects of the immune system. Killed vaccines trigger antigen antibody responses and resulting T-cell memory. All kinds of non-vaccine foreign proteins do the same thing. I'm not one that dismisses anecdotal evidence. In science those anecdotal reports are valuable. Sometimes we collect anecdotal reports systematically and using controls the anecdotes provide the bulk of the data for some kinds of research. Sometimes we take anecdotal observations and develop hypotheses which then need to be tested. It's not that the evidence is being dismissed. It's the conclusion that is at issue. There's no question the human immune system is extremely complex. It's also quite capable of multitasking. A killed vaccine just introduces a foreign protein into the body triggering an antigen antibody response. If that taxed the immune system, why are we not constantly immunosuppressed by all the foreign antigens that we are exposed to on a daily basis?
What's so outrageous about it? Expertise is the reason we're all here able to be typing away on our keyboards. Some things, plain and simple, are not easy to understand. And by I understand, I don't mean the superficial kind, I mean the kind that will actually lead to something fruitful , or what Ginger terms "success." That does take years of study.
The narcolepsy occurred as a specific response to a single vaccine brand. It's not clear yet what happened but the vaccine was pulled from the market (or they stopped using it in a specific age group, I'd have to review what happened). The system worked effectively, the vaccine problem was identified fairly early on and addressed. You have to consider risk and benefit when making a vaccine decision. Risk of narcolepsy in children and young people receiving AS03 adjuvanted pandemic A/H1N1 2009 influenza vaccine: retrospective analysis It is unfortunate but the vaccine was produced during a serious pandemic that had a disproportionately high fatality rate in young people. You don't have advanced practice nurses in your country? I'm surprised. Do you have midwives? That's an advanced nursing practice. Registered nurses in the US have several backgrounds from 2 year community college degrees to PhDs in nursing science. I have a master's degree in nursing science. I'm a licensed advance practice nurse. I have the same independent prescriptive authority as every physician in this state and my scope of practice includes the ability to make independent medical diagnoses as well as prescribing drugs. I'm also certified as a nurse practitioner in family practice, infection control and occupational health. I've had a private practice for more than 20 years in the specialty of occupational infectious disease. I see people who've been exposed to blood or other infectious diseases, give a lot of vaccinations and TB skin tests, teach infection control, and write related policies. Because it's a specialty, some of my clients include physicians that contract for my services. Just because one is an MD doesn't mean one knows every field of medicine. You wouldn't expect a psychiatrist, for example, to know how to treat a complicated drug resistant infection any more than you'd expect every family practice doc to have special expertise in psych meds. There are several outpatient surgery centers that I go to when someone, including the surgeons, are exposed to blood in the OR. I also see a lot of dental workers, police, fire and a few other patients/clients. There are many nursing and medical practitioners who are very aware of problems with research bias. I give about 1,000 flu vaccinations a year but I don't ignore the research on problems with flu vaccine. That would be foolish. On the contrary, it's really important to follow the science and use a critical eye doing so. I'm not alone.
What the mapmaker said. There are times when the abstract is not enough, but sometimes it is. Like the BMJ article I cited above, the whole paper is open access, but the abstract had what I was looking for, the incidence of the narcolepsy per vaccine dose. Thank you.
I agree, and I only meant the idea that research should be left for the experts to interpret is an outrageous (or perhaps more like, unsettling) idea. I do a lot of research for writing, on subjects that I’m no expert in (say, nutrition, athletics, military/combat, etc.), yet I should be able to tell (to a degree anyway) how legit, valid, factual etc. whatever research is without always turning to someone with a degree, especially when that degree doesn’t always guarantee expertise, seriously, the scholars one meets… However, just ‘cause I can tell pretty well which nutritional “facts” are pretty much bs, it doesn’t make me an authority in the subject. I’d imagine a nurse/practical nurse/a licensed advance practice nurse is better-equipped than me to interpret certain medical papers, but probably not as well-equipped as a doctor specialized in the subject matter, whatever it is.
Given the continuum is going to include nurses that are dedicated to evidence based medicine and doctors that believe in every bit of medical nonsense out there, your imagination based on titles includes a false assumption. And that's not even addressing the fact one can be a doctor of nursing and some advanced practice nurses function on the same level as an MD within their specialty.
When I was teaching practical nurses, I had to read on our system a little bit, and it seems to be different from what the US or the UK have, for example, but perhaps closer to Germany. We have practical nurses who study 3 years in a vocational school, the same school where hair dressers and car mechanics are educated. That's interesting. Seems the latter is rarer over here. Afaik, we don't have "nursing science" either that you can get a university degree on. There is "an advanced nurse" type of an occupation in the Finnish system as well, but while doctors study 10 years in the university, they study in polytechnic 3-4 years.A good friend of mine is an advanced nurse, another friend of mine is studying to become a doctor, and there's a clear difference between the level of their education as well as the demands. Her degree isn't comparable to a master's degree. However, recently they've made it easier for someone with a nursing degree to apply to university if they want to become a doctor, which is good, because nurses often have more practical experience than doctors. Midwives have a similar degree from polytechnic as the "advanced nurses," except they have to usually study around a year longer and their pay is better -- but still no Master's Degree (and this is not to say completing MA automatically makes one a more knowledgeable person). Perhaps, but especially within our system, the differences between nurses and doctors may be starker when it comes to academic research in comparison to your system. That's why I said " probably not as well-equipped as a doctor specialized in the subject matter. "
Jumping in a little late, but what the hell: Some hobbyists/amateurs have practiced their object of interest, whatever it may be, so long and so diligently, that their level of knowhow may reach (or even surpass) that of some professionals since not all pros are created equal. Note that I'm not saying this sort of thing makes anyone an authority on a subject, just that saying essentially that no hobbyist/amateur could compare to a pro when it comes to understanding/interpreting research data, is a blanket statement, imho (if that was even argued, but I wanted to point this out just in case). In the context of just medicine... maybe it's true, maybe it's the exception, I wouldn't know.
Ok, anything is possible. Some things to consider. 1. Regular people don't have free access to journals. Academics do. They can look at virtually any paper whenever they want to do. 2. Regular people don't get the insight of professionals. An academic might have a professor tell them a paper is bogus, even if its been published and they will tell you why. 3. Regular people haven't gone through the process of collecting their own data. Academics have. This provides context. 4 Regular people aren't put to rigorous expectations, in terms of research methods, understanding and conveying scientific knowledge. Academics are. Philosophically speaking, I used to believe the hobbyist could excel just like anyone else, however, in many cases, that's pure vanity, when things like research are based on many centuries of hard work and premises. It doesn't apply to everything, hopefully not writing, but it does apply to science just as it does to martial arts. Maybe there's one or two exceptions out there, that's it. This response is purely for T. Trian, and in no way against the op here. She's responded very well and I accept her responses for the case of this thread. This reply is merely in regards to protecting my blanket statement, which I still hold to be true.
1. I don't know if some scientific circles are more secretive, but if you aren't a complete hermit, it's pretty easy to get your hands on journals just by requesting them from someone you know who does have direct access to them. One of my doctors regularly gave me cut outs and copies of journals that had information relating to my back problem and I'm not even studying the subject or anything, point being that the doctor did so proactively, illustrating just how "exclusive" that information is. 2. Some professors won't bother, but quite a few are willing to share their knowledge (within reason, of course, none would probably start teaching their entire curriculum to Joe Average). And then there are plenty of professionals out there, most of them quite helpful, and then there are open universities for "regular people," who might not necessarily get the degree there, but they learn similar skills as their counterparts in universities. 3. I'd imagine it's rarer, but it's possible for regular people to collect their own data provided their methodologies are sound (which is also a skill, i.e. can be learned). How about borrowing a few methodology books from your library? Point being that it is possible and does happen. Like you said, anything is possible. 4. From what I've gathered, there are quite a few paths one can take to battle test their theories, get feedback for their research etc. and test their level of knowledge/skill. And I'm not talking about discussion forums here albeit that's not a bad idea to complement the process esp. if there are professors and the like of that field on the board. So a BJJ black belt's knowledge/skills can't possibly compare to a BJJ black belt of the same rank if the second guy is a pro teacher and the first one just trains and competes? Unless, of course, he's some one in a million exception? Sorry, but esp. in combat sports where people actually put their skills to the test, there are countless examples of where the "hobbyist" (non-pro) could wipe the floor with his teacher, but at least partly because it's significantly more difficult to spot your own mistakes yourself, most competitors/hobbyists rely on the help of coaches. And how about the numerous competitive athletes turned coaches/trainers? Many of them do not have a degree in Biomechanics, Exercise Physiology, Science of Sport Coaching, and Fitness Testing, yet they move on to coaching at some point and quite a few churn out good athletes. How is this possible if those with the degree are so far above these athletes-turned-to-coaches? Btw, I didn't fully understand what you're saying: 1. Only academics of field X can interpret data of field X 2. Only academics of field X can interpret data of field X, Y, and Z
Certainly I agree with the BJJ example. I didn't mean to say he'd have to be a teacher, just that he needed the help of a teacher. Let's clarify our vocabulary first, and I take responsibility for this. By hobbyist, I mean someone who is not serious about something to the extent of professionalism. They don't have to be a pro teacher, or a professor, but they must be under the rigorous hand of a teacher. Now, someone whose living is based on that training will have higher demands than someone who does it as a hobby. Plain and simple. The martial art's analogy might break off from science a little, since there are cases when someone with raw natural talent will beat someone less talented, even if the less talented person has better/ more training. This doesn't really happen in science, where there is no analogy to raw talent or athletic prowess. Even someone incredibly smart, must have the foundation first, which takes years of rigorous discipline. I'm not speaking just about medical field but science in general. I'm sure there are cases of people who can produce brilliant things never leaving their garages, but I promise you it's rarer than your argument warrants.
I want to comment a little more, first on the BJJ thing and then back to your initial points. Totally agree with everything you wrote here regarding combative sports. This is more along the lines of what I meant, in terms of combat: Two amateur boxers are most likely going to slug it out, try to get more punches in than the other guy. Two pro fighters (good ones) are much more technical. To the untrained eye, it might not look like this, but every swing that takes place has a purpose and a point, or it is a well timed response. This is something that develops in professional fighters, who have attained a level of comfort and mastery really only attainable after years of consistent, proper training and many bouts. Someone who does all three of those things is no longer a hobbyist in my book. Now, back to science. There's this general idea out there prevailing in many youth out there, that if you put in the time and effort, you can achieve anything. It's BS. Maybe if you're extremely smart and talented, but if that's the case, you don't even care about this argument. One of the key differences between a hobbyist and a serious student is that the serious student subjects himself to constant criticism and failure, whereas the hobbyist can close his book or leave his gym whenever he feels ready, feeling proud of himself for trying. Developing your own methodologies without having ever done it before under strict guidance is not the same as having done it with strict guidance. It's difficult to realize this if you haven't had that strict guidance, but it's the reality. There's just too many things an untrained eye won't recognize.
Yes they do, I posted a major source. In addition there are libraries, and not every "professional" has access to journals their work doesn't subscribe to. In this state, having an RN license gives nurses access to most medical journals through the State Board of Nursing access. I search through the literature all the time, there's no great magic to it. One does need some expertise to utilize the information, but at least via the Net, lay persons have considerable access to professional journals. This depends. It does take time and effort, but it's also true that a formal education is not the only place one can learn, nor is it a guarantee the person with the formal education is still going to be current in their knowledge, especially in medicine where one needs to keep abreast of a rapidly growing knowledge base. People in many occupations collect data from the NSA to the Bureau of Labor Statistics. I don't disagree with the idea you are conveying, and I'm not trying to say that a professional with a lot of experience isn't going to have more expertise than a lay person. But one should look at more than a credential in deciding to accept expert knowledge. And if in one country a credential means one thing, you can't assume it means the same in another. I know some amateur astronomers that have some incredible expertise in astronomy, for example. Maybe they couldn't hold up against an astrophysicist like Neil DeGras Tyson, but I'd have no problem trusting their expertise on Comet Ison's progress in the sky.
