The Agency for Healthcare Research and Quality (AHRQ) is an up-and-coming agency within the US Department of Health and Human Services tasked with the totally impossible job of leading us all towards cheaper, faster, better health care. They give grants, release guidelines, and rally the troops to focus on the patient, not the disease.
Once in a while, they take up a topic with the unique contours of the political hot potato, a mess of panic and voter bloc interest. A topic like vaccines.
A recent issue of the esteemed medical journal Pediatrics featured an article by a group of experts, pulled together by AHRQ to answer a clinical question (never mind that it was long ago settled). The topic? The safety of vaccines routinely given to kids in the US. This is a well-turned subject most recently addressed by the equally venerable experts at the Institute of Medicine who arrived at the same conclusions.
Their method was the increasingly familiar “systematic review,” wherein the entire world’s literature on a topic is painstakingly scrutinized. Using sophisticated statistical techniques, those reports of sufficient quality are tossed together and re-analyzed—using the muscle-power of larger numbers to make a stronger case in one direction or another.
The AHRQ study played out like this: 20,478 articles or meeting abstracts were identified by an electronic dragnet, of which 3,208 had enough about vaccine safety to warrant a closer look. These were really clawed through and mostly discarded for faulty (or absent) study design, missing information, or else use of non-US approved vaccines. Once whittled down, they were left with 67 studies—typical fallout in the world of the systematic review, though one that sometimes raises questions from those first hearing of the approach.
They then worked through a rating system that quantified just how good the evidence, pro or con, was for each vaccine of interest: measles-mumps-rubella (often called MMR) which uses weakened though still-live viruses; the chicken pox vaccine (ditto); and killed or genetically engineered vaccines against influenza, hepatitis, meningitis, and several other conditions.
After all the rigmarole, they found what any pediatrician already knew: the MMR causes fever. Fever, in a child, can provoke seizures. They found zero evidence to support a connection between MMR and autism or other neurologic problems. For chicken pox, they found, as long has been known, that children with abnormal immune systems may develop serious complications from the vaccine. For rotavirus, which kills at least a million kids worldwide a year, the decades-old vaccine can cause an unusual, painful condition called “intussusception,” where a length of bowel actual telescopes over the downstream bowel. This risk too had been known.
Indeed, there is nothing surprising about the AHRQ article or the IOM’s review. Rather, the surprise is that groups as important and as busy continue to re-re-re-review the same data to reach the same conclusions, all because of the relentless countervailing force of the anti-vaccine crowd. The scientists at AHRQ and IOM (and everywhere in between) are making the same basic mistake: thinking that with just a little more evidence, they will be able to convince the doubters of the soundness of their view. One more study, one more statistical calculation, one more authoritative pronouncement, and our side will win!
But nothing the scientific, evidenced-based, reality-based, rational world can do will change the minds of those who are not working from the same basic premise where science trumps belief. For them and millions of others, belief trumps science. To try to win them over on the merits of the argument is doomed to failure and even derision: the accusations that the latest study is rigged, that the scientists involved actually are only “scientists,” that the real evidence, long suppressed by the orthodox view, shows clear and incontrovertible evidence that vaccines are killing and maiming people left and right.
In other words, the evidence is in—and it shows that evidence doesn’t matter to the large swathe of resist-niks who simply cannot see the centrality to the public’s health of vaccination.
