Hypothesis: To be a good parent, you must be a critical thinker...

I read this a few days a go and have had time to digest it, and it occurred to me how important it is that, when making medical decisions for children, it is so so very important to be a critical thinker. Parents confront a barrage of misinformation, half-truths, purest bunk and useful knowledge every single day. When you are going to make a decision for a child, you must be willing to work hard to extract the best information you can from the din or you don't deserve the privilege of being a parent.

Janice Shaw Crouse, who appeared at Townhall.com, should never make decisions for anyone but herself. Her article is called, "HPV Vaccine: What Parents Need to Know," and this rings me to my first observation:

One should not make health care decisions (or any important decision) on the basis of information acquired through politically partisan media. You should make health care decisions on the basis of consultation with your doctor. If you don't like their conclusion, you are welcome to get a second opinion and a third. Eventually you will have to get used to not liking it.

What I'm saying is that if you have read Janice Shaw Crouse, you have already lost a major battle.

I sat at a picnic table listening to various mothers discussing their hectic schedules trying to keep up with teenage daughters, all on the same sports team. When one mother told of squeezing in an appointment that morning to get her daughter the HPV shot that her doctor recommended, the conversation turned to the necessity to "protect" their girls in such troubling times. I stayed quiet, hoping to learn the values guiding these parents' decisions. Predictably, they had not thought through the issues, nor did they know the facts.

Those mothers were merely following doctors' recommendations and that of all the experts.

Only listening to the recommendations of "all the experts"? Eh? This brings me to my second principle: Experts are experts for a reason: they have expertise.

It is a befuddling feature of modern life that so many Americans are willing to reject the notion of legitimate expertise out of hand. Yesterday, I had a discussion about the future of our profession with a number of other PhDs. We were talking about the "copyleft" movement and the notion of "owning" intellectual property, and a few colleagues floated the idea that our publishing and credentialing process was designed in such a way that it excluded large numbers of people from seeing our research: we publish in journals that have fairly small circulation among an audience of primarily specialists. The problems of peer-review notwithstanding, I made the point that we had the responsibility to vet our ideas before other knowledgeable experts before we presumed to take them to the public. Knee-jerk dismissal of the value of expertise gives dullards, misfits and cranks more esteem than they deserve.

Gardasil, the HPV vaccine, was approved in 2006 by the U.S. Food and Drug Administration for females as young as nine and up to age 26. It has been marketed as a protection against four types of the human papillomavirus (HPV). Merck, the company that makes Gardasil, claims that the drug will protect against two types of HPV that cause 70 percent of cervical cancers and two types that cause 90 percent of genital warts. Every federal health authority recommends the shots and, according to the Centers for Disease Control and Prevention (CDC), about a quarter of the nation's 13-17 year olds have received the immunizations. The vaccine is on the CDC's vaccine schedule for 11- and 12-year-old girls, and the American Academy of Pediatrics recommends it.

Third principle: Do not second-guess the CDC and the American Academy of Pediatrics when it comes to matters of public health and childhood vaccination. Not even if God tells you to.

The CDC is not perfect, but the value of vaccination and the utility of evidence-based medicine has more than proven itself in the doubling of the expected lifespan in the West over the last 125-150 years.

(As an aside, Do you know what the Church's reaction was to the Black Death? A decree that anyone, "even women," can hear last confessions. I'm listening to the CDC.)

Even so, some physicians remain wary of the trend to give young children a new, largely untried drug. A study in a journal of the American Association for Cancer Research revealed that about half of the doctors in a survey of over a thousand physicians in Texas did not routinely recommend Gardasil for their pre-teen patients.

Fourth principle: Beware of the phrase "some physicians," as well as anything that comes from Texas. Who? Who said this? Physicians with Alzheimer's? Seriously, be wary of unnamed sources, especially when you can't possibly see how someone suffer by having their name attached to a statement. Also, I challenge Crouse to make the argument that a vaccine that, in her words, "a quarter of the nation's 13-17 year olds have received" qualifies as "untried."

What those Texas doctors suspected, we now know for sure - that serious concerns are legitimate regarding the use of Gardasil.

Principle five: It is the parent's responsibility to check sources to make sure that the conclusions derived from the study are in fact the same as the conclusions reported in the media.

I'm not a doctor (not a real one, anyway), but I can do a little research, and this article was very easy to find. And it's true that according to this article:

The [...] results of a recent survey showed that more than half of Texas physicians do not follow these recommendations.

But Crouse's conclusions are precisely the opposite those of the researchers, who say:

"Two years after the FDA approved the vaccine, the study suggests that additional efforts are needed to encourage physicians to follow these national recommendations," said Jessica Kahn, M.D., M.P.H., associate professor of pediatrics at Cincinnati Children's Hospital Medical Center.

In the absence of personal expertise, Crouse needs to justify her conclusions, and at the very least needs to NOT OMIT INFORMATION THAT CONTRADICTS HER. Omitting potential objections is sign of a very weak position.

The highly-promoted, so-called breakthrough vaccine that was recommended for all girls and given to numerous children and teens to prevent possible future cases of cervical cancer, is related to "adverse events" experienced by thousands of girls after taking the vaccine.

Principle six: Beware the phrase "is related to." What is the nature of this relationship? Is it a correlation or a causative relationship? In the absence of more complete information, the phrase "related to" is absolutely worthless. The anti-vaccination movement is grounded in mistaking a correlation between autism and the MMR vaccine (the first signs of autism appear around the time the MMR series is completed) for a causative link (over a dozen double-blind studies have shown conclusively that there is no causative link between vaccines and autism).

The reason why the HPV vaccine is a so-called breakthrough is because it so-is. IT PREVENTS A CANCER!!! WHEN PEOPLE TALK HOPEFULLY ABOUT ONE DAY SEEING "CURES FOR CANCER," THIS IS WHAT THEY ARE TALKING ABOUT!

In a just-released article in the Journal of the American Medical Association, federal researchers report that after analyzing 12,424 "adverse events" [out of the 13,758 reports of problems as of May 1] voluntarily reported by girls vaccinated with Gardasil that two problems are common. One - fainting - is not inherently serious, but can be if the girl falls and hits her head. The other side effect - "dangerous blood clots" - is quite troubling. Most of the problems with Gardasil (93 percent) are minor: headache, nausea, and fever. But a disturbing seven percent included hospitalization, permanent disability, life-threatening illness, or death. [...]

Few parents would want their child to be among the 39 deaths to girls who had just taken the Gardasil shot.

Wait. 39 deaths? Out of how many? According to the article that you are citing, "more than 23 million qHPV doses [have been] distributed in the United States as of December 31, 2008." That is .00017% of cases. Is this even statistically significant? I mean, you expect such a tiny percentage of people to die after, say, watching American Idol, or after any routine, everyday event. Be careful not to fall into the "post hoc" trap, the logical fallacy that because B follows A, A caused B. That's simply not true. Were the studies able to prove a causative link between the shot and death? Indeed, the article you are now citing concludes, NO!

"The postlicensure safety profile presented here is broadly consistent with safety data from prelicensure trials. Because VAERS data must be interpreted cautiously and cannot generally be used to infer causal associations between vaccines and AEFIs, postlicensure monitoring will continue, and identified signals may be evaluated using epidemiologic observational studies," the authors conclude.

How dare you leave that information out? Or for that matter, the abstract which was in big print at the top of the page?

An analysis of the adverse events reported following distribution of quadrivalent human papillomavirus recombinant vaccine since 2006 indicates that adverse event rates were consistent with pre-licensing data and expected background rates of other vaccines, with the exception of a higher proportion of reports of fainting and blood clots, according to a study in the August 19 issue of JAMA.

Notice that "higher rates" of fainting and blood clots does not mean "high rates." The HPV vaccine is as safe as any other vaccine, Janice.

Nor would most parents want their child to take the risk of hospitalization, disability, or a life-threatening illness. [...]

Actually, when they realize how staggeringly remote the chances are, they in fact do, at least according to the study of Texan doctors:

"Physicians are the gatekeepers for this vaccine and the studies have shown that one of the most important predictors of health behavior is what your physician recommends," said Vernon, who is also an editorial board member of Cancer Epidemiology, Biomarkers & Prevention.

So, you are a complete failure all around, Janice. I'm not going to read on. I have pulled out the very heart of your argument. Having completely pissed away any possible credibility by misrepresenting your sources, how can I expect to benefit from anything that you have to say?

Honestly, I don't know who this person is. I know her bio is at the bottom of the Townhall page, but all authors' bios are. I have not made it that far down the page, so I am going to do a search and make a prediction. There are only two reasons that I can think of that someone would so heinously misrepresent science in such a way that would endanger the lives of our girls. Either they had a lot of money to make from it or they have a religious bias. So hear's my search...

Janice is at Concerned Women for America, a religious think-tank, and is senior Fellow at the Beverly LaHaye Institute (yes, that LaHaye). If this had been a vaccine for anything but a cervix, you would not have objected. There are 4,000 deaths from cervical cancer every year (and far more reported cases!), and you would let these women die because you want sex to have dire consequences? God damn you, Janice. You are perhaps the worst person I have covered in a long time. You have no conscience.

HJ