European measles

[John Cunningham]

I thought it'd be a good idea to have this under a separate thread, as the previous one is getting long...

Greg,

Since you love stats so much, here's some for you to ponder on.

Let's call the disease measles. Let call the reference:
Muscat M, Bang H, Wohlfahrt J, Glismann S, Mølbak K, EUVAC.NET Group. Measles in Europe: an epidemiological assessment. Lancet. 2009 Jan. 31;373(9661):383–389.
As you know, I am so fond of my up-to-date data. Less confounders of course. And let's concentrate on a age-matched (5-19 years) cohort, shall we, because you like them so much too:

"The status of measles vaccination was known in 89% (n=7333) and 92% (3582) of all reported measles cases in 2006 and 2007, respectively (table 2). In 2006, 2820 (91%) cases aged 5–19 years had known vaccination status, of whom 2058 (73%) were unvaccinated, 452 (16%) had received a single dose of vaccine, and 39 (1%) had been vaccinated with an unspecified number of doses. The following year, 1796 (95%) cases from the same age-group had known vaccination status, of whom 1567 (87%) were unvaccinated, 156 (9%) had received a single dose, and two (0·1%) had been vaccinated with an unspecified number of doses."

2006: 73%+16%=89% inadequately vaccinated, aged 5–19 years.
2007: 87%+9%=96% inadequately vaccinated, aged 5–19 years.
Overall, therefore, the percentage of cases that were inadequately vaccinated was 92%.

Using the same reasoning therefore, the number of cases that were adequately vaccinated was 8%.

92%/8%=11.5

Herd immunity:
Let's look at an interesting contrast of countries. As the authors state, "countries with zero indigenous measles incidence reported consistently high measles vaccination coverage for long periods".

Country - vaccination coverage - cases reported 2006-2007 - crude rate
Finland - 95% - zero - zero
Iceland - 90 to 95% - zero - zero
Slovenia - 95% - zero - zero
Slovakia - 99% - zero - zero
Hungary - 99% - 1 - 0.01

UK - below 85% - 1777 - 1.45
Ireland - 90% - 135 - 1.6
Germany - 70% - 2878 - 1.8
Italy - below 90% - 1015 - 0.85

It's a nice demonstration of herd immunity that in Finland, Iceland, Slovenia, Slovakia & Hungary, where coverage rates were about 95%, even if you're not immunised, you're still protected. In fact, for those two years, your relative risk of suffering measles was.... zero (or pretty well close to it).

Let me repeat this: if you're not vaccinated, and live in a country with a vaccination rate of 95% or higher, your risk of suffering measles, is zero.

On the other hand, from table 1, we can see that the overall rate for 2006 was 1.41 per 100,000 across Europe, and for the same year, the percentage of those cases occurring in inadequately vaccinated people was (77+17)=94%. The percentage of vaccination coverage is about 80-85% across Europe. So, 15% of the unvaccinated population accounted for 94% of cases. The relative risk therefore, is about 6.

So here's some conclusions that can be drawn:
If you're aged 5-19 years and diagnosed with measles, you're 11 times more likely to be unvaccinated than vaccinated.
If you're unvaccinated and of any age, you're 6 times more likely to get measles than not.
If you're unvaccinated and live in a country with a vaccination coverage rate of 95% or higher, your risk of suffering measles is zero (even when it's throughout the rest of your neighbouring countries).
High vaccination coverage rates (>=95%) correlates strongly with low incidence rates.

Waddayathinkofthat, Greg?

----------------------------------------------------------------
Peter McCarthy also wrote:

"Measles in Europe: an epidemiological assessment"

This is a great paper JC. A huge amount of work was put into compiling the measles cases for 2006 and 2007 across 32 countries. The results really do
speak for themselves.

The fact that vaccination coverage in countries in the decade leading up to 2006 - 2007 obviously correlates with the number of disease cases in these
years speaks volumes for the importance of sustained, high coverage vaccination.

It's important to really try and push this point home.

[Quote: Muscat et al]
For both years, 15% (n=1223) and 9% (357) of the total number of cases were infants, 29% (2352) and 23% (868) were 1–4 years of age, 38% (3110) and 49% (1896) were 5–19 years of age, and 18% (1436) and 19% (724) were 20 years or older.
(For reference: total cases 2006 - 8223 || total cases 2007 - 3909)

It's easy to see that a significant portion of the affected population are children less than 4 years old. Greg likes to argue that a lot of these children are too young for vaccination anyway so they don't count. Unfortunately, they do count when it comes to the total number of cases that we see. These children are protected from measles when herd immunity is high (see JC's percentage breakdowns - anything below 95% coverage is
bad).

So, when more than 80% of the cases in people aged 5 -19 occur in people that were not vaccinated (at all), it becomes pretty obvious that vaccines are protecting people in this age group from disease. But also! They protect the children too young to yet have full vaccination coverage, by ensuring the disease never reaches the levels of outbreak seen in the unvaccinated population.

Thanks for the paper JC.

[Greg Beattie]

John and Peter

Thanks John for putting this in a different thread.

The info you've come up with is common knowledge. Most recent reports
of measles in developed countries report very few cases, and that the
majority occurs in unvaccinated people. This is in contrast with the
examples I gave of whooping cough where it seems the majority usually
occurs in the vaccinated. It's also in contrast with measles outbreaks
prior to the 1990s. Why?

I've had this discussion with you elsewhere before, but here goes
again. Two words... laboratory confirmed. During the 1990s we
gradually changed the case definition of measles (as we did earlier
with polio). Where once it was an illness commonly diagnosed
'clinically' by doctors, we went to requiring laboratory confirmation.
Why? Because testing became easier and more readily available.
Standard medicine believed measles was caused by the virus, so the
test was simply a step toward greater accuracy. It had a huge effect
on the number of measles cases reported, though.

John, you will remember we discussed this at length on the AVN blog
site. The blog article was all about researchers in the UK who
retrospectively tested 12,000 clinically diagnosed measles cases,
around about the time lab testing became required, and found only 2.5%
could be confirmed by lab testing.
http://avn.org.au/nocompulsoryvaccination/?p=888&cpage=1#comment-4601
and
http://avn.org.au/nocompulsoryvaccination/?p=916&cpage=3#comment-4958

That's what happened when we introduced lab confirmation for cases.
The figures plummeted to only those that were confirmed as having
evidence of measles virus infection. The CDC's surveillance manual
states that "laboratory diagnosis is crucial to confirm the few actual
measles cases among the thousands of patients with suspected measles."
http://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html

Note the words "few" and "thousands". Where once "thousands" of
measles cases were notified, we now have "few", all thanks to lab
confirmation. Various studies have reported how many measles cases
remain after lab testing, and the proportion is always low. In your
example of Finland we have a country which switched to requiring lab
confirmation early (1987). However, just prior to this...

"In a series of 655 consecutive vaccinated children in whom one of the
three diseases was clinically diagnosed through 1986, measles was
confirmed serologically in only 0.8 percent (5 cases), mumps in 2.0
percent (13 cases), and rubella in 1.2 percent (8 cases)."
http://www.nejm.org/doi/pdf/10.1056/NEJM199411243312101

The cases that aren't lab confirmed are 'discarded'. So Finland's
notifications really plummeted after 1987. But that doesn't directly
address what you were putting forward: i.e. that the few cases which
are lab confirmed tend to occur in unvaccinated people. Why is this?
Well, I don't find this at all strange. Vaccination leads to
antibodies. The job of the antibodies is to help escort measles virus
from the body. Hence, little chance of lab confirmation. There may be
clinical illness but it's unlikely we'll have lab confirmation of
measles virus in vaccinated people. Those who believe unquestioningly
in the germ theory will no doubt believe that clinical illness is
prevented by this means, but I don't.

So what happens with the 'discarded' ones? We may have had 10 or 20 or
even 50 times as many cases of 'clinical' measles going by the above
rates. But just like we did with polio we no longer call these
measles. In the case of polio we have AFP figures to remind us that
the illness we used to call polio is still with us, however with
measles we have no such thing.

Here is one example though to illustrate that we're still in the same
situation we were back in the days when measles was diagnosed
clinically... and the majority is in vaccinated people.
http://www.emro.who.int/publications/emhj/1403/article8.htm

The report is of measles in Oman during 2000-2003. There were 40
confirmed cases and, as with your examples, most were in the
unvaccinated. But this paper shows us what happens when the discarded
cases are included (see Table 4). Of the total 185 clinically
diagnosed cases 134 were age-eligible to have been vaccinated. Of
these, 97 (or 72%) were definitely vaccinated. The remaining 28% were
either not vaccinated or "unknown". 72 (or 54%) had definitely been
vaccinated twice!

The point here is that when clinical illness is measured (and this is
the only thing that matters to us Mums and Dads) the majority of it
occurs in vaccinated people, despite it being suspected in them less.
When lab confirmed cases are measured, we see the opposite. It is the
same as the story for polio and Hib: we are now seeing nothing but
germ reports. These are not of interest to me, and I think I speak for
most parents when I say that. Show me the real outcomes. How much
illness is occurring? I'm not in the slightest bit interested in how
many of them had a particular virus show up in a lab report. I want to
know how many were sick, and whether we made any difference to that
number.

I EXPECT to see less lab confirmation in vaccinated people. I EXPECT
doctors to be less likely to diagnose measles in patients who they
have vaccinated for it. I also EXPECT a reduction in cases after we
change the case definition to a more restrictive one. Who wouldn't? In
fact, who would compare numbers before and after such a drastic
change?
Thanks
Greg

[mtp_69_i]

[Quote: Greg]

"Where once it was an illness commonly diagnosed
'clinically' by doctors, we went to requiring laboratory confirmation.
"

This really makes me laugh because your whole point following this
statement completely goes against the whole GNM mantra that

"if something looks like measles, and smells like measles, and tastes
like measles, then it must be measles."

Anyway, that's not to say I disagree with your statement. However, I
think to try and use it as a platform to state that; lab testing has
shown that really very few people ever had measles to begin with, is
incorrect.

First of all. The NEJM paper regarding Finland you quote, clearly
states that following introduction of the MMR vaccine in 1982 a
significant decline in MMR cases observed with the number of measles
cases reported in 1985 (344) representing an 87% decline compared to
the average annual number of measles cases in the 5 years prior to
introduction of the vaccine (2,704 cases were reported annually from
1977 - 1981).

This suggests a reduction in CLINICALLY diagnosed measles cases
following intro of the vaccine because

IMPORTANTLY!

"Discarding" of non-serologically confirmed cases ONLY began in 1987
so a reduction in measles cases was already observed CLINICALLY
following the introduction of Finlands national MMR immunisation
program. Check the paper if you don't believe me.

REPEAT// The measles vaccine reduced the incidence of CLINICALLY
diagnosed measles prior to the introduction of definition by lab
testing in 1987.

[Quote: Greg]

I'm not in the slightest bit interested in how
many of them had a particular virus show up in a lab report. I want to
know how many were sick, and whether we made any difference to that
number.

You can have it all though Greg! And you do! We can see how many
were sick (see JC's paper along with your Finland paper), you can see
how many actually had the disease for which a vaccine exists
(diagnosed clinically and/or serologically) AND you can see that we
have made a difference to that number through the use of vaccines.
Easy!


But things are starting to get a bit sad for you Greg.

You start trying to argue that you've been right all along because it
turns out not all cases of clinically diagnosed measles actually turn
out to be measles (your Oman paper). In the same paragraph you openly
acknowledge that most laboratory-confirmed cases of measles were in
the unvaccinated!

I'm really sorry Greg, but there is a big problem here. Your
statements show that you know the vaccine is protecting the vaccinated
from the disease in question and the REAL cases occur in the
unvaccinated. Thus, you know that vaccines are protective.

All of this nonsense about how you don't believe the clinical tests
can really show that the vaccinated people didn't have measles because
the antibodies hid all of the measles

[Quote: Greg]

Vaccination leads to
antibodies. The job of the antibodies is to help escort measles virus
from the body. Hence, little chance of lab confirmation. There may be
clinical illness but it's unlikely we'll have lab confirmation of
measles virus in vaccinated people. Those who believe unquestioningly
in the germ theory will no doubt believe that clinical illness is
prevented by this means, but I don't.

is just clutching at straws.

Have a read of one of the immunology text books JC has recommended to
you. If you have measles, it will be detected by the test. If you
don't have measles, it won't. It's that easy. Sure, the immune
system of a properly vaccinated person will definitely protect them
from measles by eliminating it quickly, but these tests are performed
on people presenting at a doctor or at hospital with measles-like
symptoms. If they have measles it WILL be detected.


Now,

[Quote: Greg]

The point here is that when clinical illness is measured (and this is
the only thing that matters to us Mums and Dads) the majority of it
occurs in vaccinated people, despite it being suspected in them less.

This makes no sense. What are you talking about? Here's my best
interpretation of your points here.

1.) The majority of clinical illness diagnosis occurs in vaccinated
people because they (generally) make up the majority of the population
(not hard to understand).
2.) It's suspected in the vaccinated less because they are vaccinated
and when lab tests are performed, these suspicions are proved valid.
Why is that interesting? Why does that matter to mums and dads?

[Quote: Greg]

we are now seeing nothing but
germ reports. These are not of interest to me, and I think I speak for
most parents when I say that.

Are they uninteresting to you because they prove that unvaccinated
people make up the majority of people actually affected by vaccine
preventable diseases? I think yes. Your disinterest is disappointing
but predictable. However, I think you are absolutely wrong that you
speak for most parents. Vaccination rates in developed countries
speak to that. Thinking you speak for most parents belies the truth
that you may not really have as tight a grip on how vaccination as a
preventative measure against disease is readily understood phenomenon
among the general population.

Finally,

[Quote: Greg]

I EXPECT to see less lab confirmation in vaccinated people. I EXPECT
doctors to be less likely to diagnose measles in patients who they
have vaccinated for it. I also EXPECT a reduction in cases after we
change the case definition to a more restrictive one. Who wouldn't? In
fact, who would compare numbers before and after such a drastic
change?

So, you expect to see less vaccinated people infected with diseases
against which they are vaccinated. So you agree then that vaccines
are protective against these diseases. Great!

This last point about changing the definition of measles. Firstly,
the definition hasn't changed, the symptoms are the symptoms. But! We
are able to show now that often, these symptoms may be common to a
number of diseases (See Box 1 of -- http://www.mja.com.au/public/issues/187_03_060807/dur10061_fm.html).
I chuckle again while writing this, thinking about all of the GNM
nonsense floating around on this discussion board.

However, It is an important point. I do wonder though. Given the
dramatic decline in incidence of diseases like measles in the last few
decades, would it not be fair to suggest many doctors might never
encounter a bone fide case of say, measles? 100 years ago when such
disease were prolific and doctors routinely encountered these
diseases, I (like you, if I interpret your statements here correctly)
would probably believe a doctors clinical diagnosis of measles,
because they saw so many cases. These days, we rely on laboratory
tests for confirmation because (thankfully) most doctors (in first
world countries at least) rarely encounter these sorts of diseases and
thus, they
1.) rely on confirmation because of lack of experience with such
diseases
2.) wouldn't anticipate such an infection given the low prevalence of
these diseases in the general population (thanks vaccines!)
3.) require lab conformation because it is now the gold standard for
diagnosis and all cases involving the diseases we are talking about
must be reported to the proper authorities, necessitating definitive
diagnosis.

Anyway, I was really happy reading your reply, because it shows that
you really do understand most of the concepts people like Katie, JC
and I are trying to explain. I'm beginning to think this is just an
intellectual debate for you and that deep down, you can see how
vaccines are saving lives every day.

On Jan 3, 11:14 pm, Greg Beattie <pcmedics...@gmail.com> wrote:
> John and Peter
>
> Thanks John for putting this in a different thread.
>
> The info you've come up with is common knowledge. Most recent reports
> of measles in developed countries report very few cases, and that the
> majority occurs in unvaccinated people. This is in contrast with the
> examples I gave of whooping cough where it seems the majority usually
> occurs in the vaccinated. It's also in contrast with measles outbreaks
> prior to the 1990s. Why?
>
> I've had this discussion with you elsewhere before, but here goes
> again. Two words... laboratory confirmed. During the 1990s we
> gradually changed the case definition of measles (as we did earlier
> with polio). Where once it was an illness commonly diagnosed
> 'clinically' by doctors, we went to requiring laboratory confirmation.
> Why? Because testing became easier and more readily available.
> Standard medicine believed measles was caused by the virus, so the
> test was simply a step toward greater accuracy. It had a huge effect
> on the number of measles cases reported, though.
>
> John, you will remember we discussed this at length on the AVN blog
> site. The blog article was all about researchers in the UK who
> retrospectively tested 12,000 clinically diagnosed measles cases,
> around about the time lab testing became required, and found only 2.5%
> could be confirmed by lab testing.http://avn.org.au/nocompulsoryvaccination/?p=888&cpage=1#comment-4601

> andhttp://avn.org.au/nocompulsoryvaccination/?p=916&cpage=3#comment-4958

> clinically... and the majority is in vaccinated people.http://www.emro.who.int/publications/emhj/1403/article8.htm

[JC]

Greg,

The length of your posts is yet again in indirect proportion to your
grasp of the information. Nothing in your reply addresses the paper
presented, apart from proposing a fantasy with respect to diagnosis.
Here's a study of two consecutive years of over 12,000 cases of
measles across Europe, and you offer in reply a study of 40 confirmed
cases in Oman. Well done. In the UK, the measles cases were
laboratory confirmed in 98%, and overall it was 65% which is
impressive given the different health systems involved. Even in the
paper you quoted, the authors say "This is possibly due to a decline
in incidence of measles over the years in Oman which tends to produce
a reciprocal effect of an increase in the number of false
notifications (over-diagnosis)".

"Vaccination leads to antibodies. The job of the antibodies is to help
escort measles virus from the body. Hence, little chance of lab

confirmation." or disease I would say. You forget to appreciate that
the vaccination leads to IgG, yet laboratory testing is on IgM
indicating acute infection. Too simplistic again Greg. Have you been
chatting to Tristan about this? It sounds like one of his ideas.

"Show me the real outcomes. How much illness is occurring?" That's
what I showed you Greg. Illness caused by the measles virus. I know
of no one else who is discouraged by increasing accuracy in diagnosis
- most would welcome it, yet it's something that the anti-vax lobby
struggles with. Remember the cars Greg? There's lots of cars on the
road, but you need to figure out which ones are going to kill your
child, like measles. Many diseases present in similar ways, and
that's why laboratory diagnosis is essential.

By the way, Greg, I am also a "Dad", and I'm more concerned if the
disease my child has is going to kill them, or whether they'll get
over it without any long term complications. I appreciate the
simplistic version of the germ theory that you and Tristan subscribe
to cannot accept that there is a difference between similar diseases
(ala GNM) but that's your defect to deal with.

"I want to know how many were sick" No you don't. You are only
interested in mortality, and you've said it before. You don't care
about morbidity or notifications Greg, and nor do you care about the
suffering of children. You've said and implied this many times
before. Honestly, are you just making this up as you go, because
you're not being very consistent.

"In fact, who would compare numbers before and after such a drastic

change? " You would Greg, and you often do with your mortality
graphs, useless as they are.

So what do we have today in this paper, which you so far have avoided
addressing?

If you're aged 5-19 years and diagnosed with measles, you're 11 times
more likely to be unvaccinated than vaccinated.
If you're unvaccinated and of any age, you're 6 times more likely to
get measles than not.
If you're unvaccinated and live in a country with a vaccination
coverage rate of 95% or higher, your risk of suffering measles is zero
(even when it's throughout the rest of your neighbouring countries).
High vaccination coverage rates (>=95%) correlates strongly with low
incidence rates.

John

[mtp_69_i]

[Quote: Greg]

"Where once it was an illness commonly diagnosed
'clinically' by doctors, we went to requiring laboratory confirmation.
"

I'm not in the slightest bit interested in how
many of them had a particular virus show up in a lab report. I want to
know how many were sick, and whether we made any difference to that
number.

You can have it all though Greg! And you do! We can see how many
were sick (see JC's paper along with your Finland paper), you can see
how many actually had the disease for which a vaccine exists
(diagnosed clinically and/or serologically) AND you can see that we
have made a difference to that number through the use of vaccines.
Easy!


But things are starting to get a bit sad for you Greg.

You start trying to argue that you've been right all along because it
turns out not all cases of clinically diagnosed measles actually turn
out to be measles (your Oman paper). In the same paragraph you openly
acknowledge that most laboratory-confirmed cases of measles were in
the unvaccinated!

I'm really sorry Greg, but there is a big problem here. Your
statements show that you know the vaccine is protecting the vaccinated
from the disease in question and the REAL cases occur in the
unvaccinated. Thus, you know that vaccines are protective.

All of this nonsense about how you don't believe the clinical tests
can really show that the vaccinated people didn't have measles because
the antibodies hid all of the measles

[Quote: Greg]

Vaccination leads to
antibodies. The job of the antibodies is to help escort measles virus
from the body. Hence, little chance of lab confirmation. There may be
clinical illness but it's unlikely we'll have lab confirmation of
measles virus in vaccinated people. Those who believe unquestioningly
in the germ theory will no doubt believe that clinical illness is
prevented by this means, but I don't.

is just clutching at straws.

Have a read of one of the immunology text books JC has recommended to
you. If you have measles, it will be detected by the test. If you
don't have measles, it won't. It's that easy. Sure, the immune
system of a properly vaccinated person will definitely protect them
from measles by eliminating it quickly, but these tests are performed
on people presenting at a doctor or at hospital with measles-like
symptoms. If they have measles it WILL be detected.


Now,

[Quote: Greg]

The point here is that when clinical illness is measured (and this is
the only thing that matters to us Mums and Dads) the majority of it
occurs in vaccinated people, despite it being suspected in them less.

This makes no sense. What are you talking about? Here's my best
interpretation of your points here.

1.) The majority of clinical illness diagnosis occurs in vaccinated
people because they (generally) make up the majority of the population
(not hard to understand).
2.) It's suspected in the vaccinated less because they are vaccinated
and when lab tests are performed, these suspicions are proved valid.
Why is that interesting? Why does that matter to mums and dads?

[Quote: Greg]

we are now seeing nothing but
germ reports. These are not of interest to me, and I think I speak for
most parents when I say that.

Are they uninteresting to you because they prove that unvaccinated
people make up the majority of people actually affected by vaccine
preventable diseases? I think yes. Your disinterest is disappointing
but predictable. However, I think you are absolutely wrong that you
speak for most parents. Vaccination rates in developed countries
speak to that. Thinking you speak for most parents belies the truth
that you may not really have as tight a grip on how vaccination as a
preventative measure against disease is readily understood phenomenon
among the general population.

Finally,

[Quote: Greg]

I EXPECT to see less lab confirmation in vaccinated people. I EXPECT
doctors to be less likely to diagnose measles in patients who they
have vaccinated for it. I also EXPECT a reduction in cases after we
change the case definition to a more restrictive one. Who wouldn't? In
fact, who would compare numbers before and after such a drastic
change?

> John and Peter
>
> Thanks John for putting this in a different thread.
>
> The info you've come up with is common knowledge. Most recent reports
> of measles in developed countries report very few cases, and that the
> majority occurs in unvaccinated people. This is in contrast with the
> examples I gave of whooping cough where it seems the majority usually
> occurs in the vaccinated. It's also in contrast with measles outbreaks
> prior to the 1990s. Why?
>
> I've had this discussion with you elsewhere before, but here goes
> again. Two words... laboratory confirmed. During the 1990s we
> gradually changed the case definition of measles (as we did earlier
> with polio). Where once it was an illness commonly diagnosed
> 'clinically' by doctors, we went to requiring laboratory confirmation.
> Why? Because testing became easier and more readily available.
> Standard medicine believed measles was caused by the virus, so the
> test was simply a step toward greater accuracy. It had a huge effect
> on the number of measles cases reported, though.
>
> John, you will remember we discussed this at length on the AVN blog
> site. The blog article was all about researchers in the UK who
> retrospectively tested 12,000 clinically diagnosed measles cases,
> around about the time lab testing became required, and found only 2.5%
> could be confirmed by lab testing.http://avn.org.au/nocompulsoryvaccination/?p=888&cpage=1#comment-4601

> andhttp://avn.org.au/nocompulsoryvaccination/?p=916&cpage=3#comment-4958

> clinically... and the majority is in vaccinated people.http://www.emro.who.int/publications/emhj/1403/article8.htm

[Greg Beattie]

John and Peter

I'm sorry but you entirely missed the essence of my previous post. If
you think I was suggesting "lab testing has shown that really very few
people ever had measles to begin with", it's clear you're oblivious to
my position. I'll take the blame for not communicating it well enough.

In this thread we're discussing notifications and I'll be arguing,
among other things:

1. that notifications are a poor source of data for this purpose
(actually I'll go further and say that in my opinion anyone who
proposes doing so is either ignorant of the basics of science, unaware
of the nature of notifications, or dishonest, if they don't state or
at least acknowledge the vulnerabilities).

2. that even if we consider notification data to be valid for this
purpose, the examples you present are not inconsistent with either
side of the debate. They are however inconsistent with other examples
(e.g. whooping cough)

Now, to flesh it out a bit more. First, you say that you provided an
example with 12,000 cases and I presented one with 40 cases to
counter. No, my example didn't counter yours at all. In fact, it
concluded the same as yours. The reason I put it up was because it
provided a rare example of what happened when lab-confirmation could
be factored OUT and the vaccinated proportion recalulated (note the
word 'rare'). I explained that when I put it forward.

But the really basic question is why are you using notifications to
build your case? Do you think they are valid indicators of incidence
to start with? I mean... it's obvious they're not complete. Are they
representative? Can you outline the steps that have been taken to
ensure they are? Are you aware of influences which might make them
unsuitable for this? Again, can you outline any steps that have been
taken to adjust for these? Are case definitions reasonably constant
and standard? Also, why do we collect this data? What's its intended
purpose? Is it to illustrate trends, and help us assess the impact of
interventions, or something else? As you can probably pick up, I don't
automatically place faith in data that I know is incomplete and open
to influence. I'd like you to build a case first as to why we should
use it as a proxy for incidence.

But, in the meantime... you've put forward these measles examples in
good faith and I've argued that they are not inconsistent with my
position. I've explained why this is, but I'll go over a few points
that I think you've not caught on to.

Standard medicine is steered by the germ theory. Today, if you find
measles virus then it's counted as measles. If not then it's
discarded. We who think the germ theory is fundamentally flawed
obviously think this is a pointless division. We aren't going to want
to split up the measles cases in such an arbitrary fashion, but that's
the way the world has gone. So now almost all of the collected data is
coloured very deeply by this supposition. It just so happens that this
is also very self-serving for those who wish to argue the success of
their vaccine programs (all of standard medicine). Why? Because they
get to define that success in terms that suit them.

Studies abound demonstrating that vaccines lead to sero-conversion. So
they can be expected to reduce the liklihood of a germ hanging around
in a body. Not always but it can be expected fairly consistently.
That's where you jump up and down and say "see... you DO believe they
work!". No, I don't. Those of us who are not wedded to the germ theory
do NOT think microbe=illness, and when we look at the non-germ-
specific data we see no value (e.g. AFP, meningitis, clinically
diagnosed illness etc).

If kids are sick with a common syndrome and you reckon you can prevent
it then show us the money. Don't go away into your dark room and come
back out with a mere fraction of the cases and declare "these are the
only ones we want you to count". We don't buy your story about the
germs being the primary problem, so we say take that out of the
equation. If you really are doing something good it will still show up
in a reduced number of sick kids.

And when you do want to show us the (non-germ-theory-based) data to
demonstrate this, please note: we expect you to have data that is
either complete or representative (and demonstrably so). We also
expect you to satisfy us that it's either free of extraneous
influences which might affect the outcome being measured, or that such
influences can be adjusted for, or at the very least acknowledged up-
front.

Now finally... here's one for you, since you seem to think there is
value in notification data. What about whooping cough? In the USA
notifications for it have been consistently increasing ever since the
late 1970s, when the vaccine was mandated for school entry. The key
points there are "increasing" and "since the vaccine was mandated".
That has gone on for more than 30 years now... and use of the vaccine
has also increased. They even vaccinate adults now. And as I mentioned
was happening 20 years ago, reports still suggest the majority of
notifications are in vaccinated people (the opposite of your measles
examples). The situation in Australia is similar.

So, since you like to use this data I'll put the question back to
you... waddayathink?

Greg

On Jan 4, 11:37 pm, mtp_69_i <drpjmccar...@gmail.com> wrote:
> [Quote: Greg]
>

[mtp_69_i]

Dear Greg,

First off, you seem to have stopped trying to argue against any of our
points directly and instead are repeating the same statements in each
post. If you have a real point to make, it helps if you can support
it in more ways than just saying it is so.

For instance,

[Quote: Greg]

But the really basic question is why are you using notifications to
build your case? Do you think they are valid indicators of incidence
to start with? I mean... it's obvious they're not complete. Are they
representative? Can you outline the steps that have been taken to
ensure they are? Are you aware of influences which might make them
unsuitable for this? Again, can you outline any steps that have been
taken to adjust for these? Are case definitions reasonably constant
and standard? Also, why do we collect this data? What's its intended
purpose? Is it to illustrate trends, and help us assess the impact of
interventions, or something else? As you can probably pick up, I don't
automatically place faith in data that I know is incomplete and open
to influence. I'd like you to build a case first as to why we should
use it as a proxy for incidence.

This (quoted), is just more straw clutching. If you are skeptical
about the data collection then come up with some reasons why. Is it
possible you haven't actually read the paper and thus are a little
confused about how they got the info? Is this making you scared? The
details of how the notification data etc from the Muscat paper were
collected is readily presented therein.


And this,

[Quote: Greg]

Standard medicine is steered by the germ theory. Today, if you find
measles virus then it's counted as measles. If not then it's
discarded. We who think the germ theory is fundamentally flawed
obviously think this is a pointless division. We aren't going to want
to split up the measles cases in such an arbitrary fashion, but that's
the way the world has gone. So now almost all of the collected data is
coloured very deeply by this supposition. It just so happens that this
is also very self-serving for those who wish to argue the success of
their vaccine programs (all of standard medicine). Why? Because they
get to define that success in terms that suit them.

Is still more straw clutching. You're point here is that you'd rather
live in the dark ages when laboratory testing and vaccinations weren't
available.

To say,

"we aren't going to want to split up measles cases in such an
arbitrary fashion"

is really laughable, Greg and it's just your opinion which is deeply
coloured by your stance against vaccines.

We aren't splitting up measles cases, Greg. We are taking a bunch of
people with similar symptoms and putting all the ones with measles on
one side, and putting all of the other cases where measles is not
present on another. As far as all of this nonsense about how germ
theory skeptics don't appreciate lab testing goes, you don't
appreciate it because it exemplifies how vaccines actually do reduce
incidence of disease. It's sad that in the face of the evidence you'd
rather dig in your heels and nay-say but what can I do about that.
However, to suggest the whole thing is designed to argue the success
of the vaccine program as you do here

[Quote: Greg]

It just so happens that this
is also very self-serving for those who wish to argue the success of
their vaccine programs (all of standard medicine). Why? Because they
get to define that success in terms that suit them.

is really bordering on serious paranoia.

From here, things just get worse for you Greg.

[Quote: Greg]

Studies abound demonstrating that vaccines lead to sero-conversion. So
they can be expected to reduce the liklihood of a germ hanging around
in a body. Not always but it can be expected fairly consistently.
That's where you jump up and down and say "see... you DO believe they
work!". No, I don't. Those of us who are not wedded to the germ theory
do NOT think microbe=illness, and when we look at the non-germ-
specific data we see no value (e.g. AFP, meningitis, clinically
diagnosed illness etc).

None of this makes any sense if you don't give it some context. All
this says is

"I understand how vaccines work, and that they do work, but I'm gonna
say they aren't helpful in preventing disease anyway."

I have no idea what (eg AFP, meningitis, clinically diagnosed illness
etc) means. There is no context.


Then we get to,

[Quote: Greg]

If kids are sick with a common syndrome and you reckon you can prevent
it then show us the money. Don't go away into your dark room and come
back out with a mere fraction of the cases and declare "these are the
only ones we want you to count". We don't buy your story about the
germs being the primary problem, so we say take that out of the
equation. If you really are doing something good it will still show up
in a reduced number of sick kids.

I already showed you that from the Finland paper.

In 1985 an 87% reduction in measles cases compared to the annual
average for the 5 years leading up to when vaccines were introduced in
1982.

Remember?

Lab testing only came in in 1987.

The reduction observed in 1985 was purely from clinical diagnosis.

And finally,

[Quote: Greg]

A lot of nonsense about whooping cough.


You expect us to get the data for you? This is your point Greg, back
it up mate. You can start with telling us what the vaccine coverage
for whooping cough is like in populations experiencing outbreaks
recently.

Can you do that Greg, huh? Your post about whooping cough has no
facts, no references, just a bunch of supposition from a deluded
person clutching to the last straws of their arguments against
vaccination.

[JC]

Greg,

"But the really basic question is why are you using notifications to

build your case?" Because it's a very specific and sensitive measure
of disease. Pretty simple. Remember the confounders behind mortality
rates? They don't apply with notifications. Sure it has other
confounders, but different ones.

But let's get to the guts of this Greg. You say you don't believe in
the germ theory - a very dumbed down and simplistic version
admittedly, but let's call it the germ theory. Well if you don't,
what do you believe in? Surely you have an alternative. Instead of
asking us for figures and data, why don't you go ahead and finally
declare what it is you believe in? What's your justification for
lumping all diseases together that are remotely similar? Modern
medicine enjoys finding out what causes diseases, because it can lead
to vastly different treatments and prognosis, yet you have some belief
that these points are irrelevant. What's your justification for
rejecting so much of what is known about diseases?

Go on Greg. I'll put the question back to you. What do you believe
in? What's your theory of disease? And of course, what's your proof
of it? This is a debating site Greg, and the debates can, therefore,
go both ways. So why don't you put your money where your mouth is and
espouse the Greg Beattie theory of disease. I can't wait.

John

[Greg Beattie]

Quoting Peter >>"None of this makes any sense if you don't give it

some context. All this says is

"I understand how vaccines work, and that they do work, but I'm gonna
say they aren't helpful in preventing disease anyway."

I have no idea what (eg AFP, meningitis, clinically diagnosed illness
etc) means. There is no context."

Peter
My apologies. I forget you have come into this group only recently.
Clinically diagnosed illness refers to illness which is diagnosed via
physical examination and history etc... not according to which microbe
is found in lab tests. Regarding the reference to AFP (acute flaccid
paralysis), you will find this has been discussed at length in the
"Polio in China" thread.
https://groups.google.com/group/vaccination-respectful-debate/browse_thread/thread/b1e7c1b1b0c39e76?hl=en

With the reference to meningitis, this was discussed in the "Vaccines
save lives?" thread from about Nov 9 onward.
https://groups.google.com/group/vaccination-respectful-debate/browse_thread/thread/964c5a098a21153e/78773b394727e473?hl=en&

But you can find a further discussion of it starting here. (note: John
was part of this. His name was 'Michael').
http://avn.org.au/nocompulsoryvaccination/?p=946&cpage=3#comment-5278
Thanks
Greg

[Greg Beattie]

Peter

Quote >> "A lot of nonsense about whooping cough.

You expect us to get the data for you? This is your point Greg, back
it up mate. You can start with telling us what the vaccine coverage
for whooping cough is like in populations experiencing outbreaks
recently.

Can you do that Greg, huh? Your post about whooping cough has no
facts, no references, just a bunch of supposition from a deluded
person clutching to the last straws of their arguments against
vaccination."

Again, my apologies Peter. The increase in whooping cough
notifications in USA has been discussed previously here (can't
remember which thread) and is common knowledge so I assumed you were
aware of it. You can read about it here, although there are many
articles if you do a search. Scroll down the page and find a graph of
notifications showing the increase (one for deaths also).
http://www.kpbs.org/news/2010/dec/14/immunized-people-getting-whooping-cough-experts-sp/

From this article
>>
• For pertussis cases in which vaccination histories are known,
between 44 and 83 percent were of people who had been immunized,
according to data from nine California counties with high infection
rates. In San Diego County, more than two thirds of the people in this
group were up to date on their immunizations.

• Health officials in Ohio and Texas, two states also experiencing
whooping cough outbreaks, report that of all cases, 75 and 67.5
percent, respectively, reported having received a pertussis
vaccination.

• Today, the rate of disease in some California counties is as high as
139 per 100,000, rivaling rates before vaccines were developed.<<

For Australia, vaccination coverage data can be found here.
http://www.health.gov.au/internet/main/publishing.nsf/content/cda-cdi3501l.htm

And notications here (select 'Notification rates' and 'Pertussis').
You will see a roughly 80-fold increase in rates in the past 20 years,
all in parallel with increasing vaccination.
http://www9.health.gov.au/cda/Source/Rpt_4_sel.cfm

So yeah... before we go too much further what are your thoughts about
using these figures as a proxy for incidence? I mean, I haven't
actually concluded anything out loud about this... like I haven't said
this proves the vaccine is no good. I've just asked for your thoughts.
You jump up and down when notifications look good for your argument,
but what do you think when they don't look so good? Personally, I
don't think they are good indicators, as I said earlier. And note: we
haven't touched on the potential for bias in diagnosis yet.

Rather than tell you what I think are the problems with notification
data (I'm sure you already know) I've asked you to put a case as to
why we should accept them as a proxy for incidence. I think this is
fair as you're presenting this data, and it's not a complete picture
of incidence. (Actually, John presented it. But you seem to have
adopted it.)

In addition to the whooping cough example, you might like to tell us
what you think about AFP notifications, after reading the "Polio in
China" thread. If you believe notifications are valid indicators of
the effect of vaccines, what do you think of the 5-fold increase in
AFP reports in the past 15 years of the global effort to eradicate
polio?

Would you say polio vaccination has led to a 5-fold increase in
paralysis, or would you say in this case they are a poor data-set?

Thanks
Greg

On Jan 7, 12:45 pm, mtp_69_i <drpjmccar...@gmail.com> wrote:

[JC]

Greg,

Are you going to come forward with your theory of disease or are you
continuing to withhold your knowledge from the group? I'm earnestly
looking forward to hearing about it, and I can't wait to see how
consistent it will be, fully backed up with verifiable references and
evidence both from laboratory experiments and clinical outcomes. In
the meantime....

If you're aged 5-19 years and diagnosed with measles, you're 11 times
more likely to be unvaccinated than vaccinated.
If you're unvaccinated and of any age, you're 6 times more likely to
get measles than not.
If you're unvaccinated and live in a country with a vaccination
coverage rate of 95% or higher, your risk of suffering measles is zero
(even when it's throughout the rest of your neighbouring countries).
High vaccination coverage rates (>=95%) correlates strongly with low
incidence rates.

and also with respect to whooping cough, using Meryl Dorey's logic...
2001 - whooping cough cases 9541, vaccination rate 70.6%
2007 - whooping cough cases 4864, vaccination rate 95%
... suggesting that improving vaccination rates decrease cases. But
of course, that, like your references, is flawed as your comparing
childhood vaccination rates to whole of population incidence. I
would've thought that you'd be aware of the flaw though...

John

[mtp_69_i]

Dear Greg,

This thread has been dedicated to European measles. I think it would
be most pragmatic is we could stay on topic with this. Otherwise we
run the risk of starting yet another "debating science" thread. It
might help if the moderators would assist in ensuring posts stay as on
topic as possible (noting of course, the large amount of reading you
are already doing. Thanks)

Greg, you have not addressed my rebuttals to your conflict about
decreases in clinical diagnosis prior to the introduction of
laboratory testing for measles (the Finland paper). Do you then
submit that the measles vaccine resulted in a clinically observable
reduction in measles cases that has since been supported by lab
testing?

Nor have you responded to my pointing out that the data for both
clinically diagnosed and laboratory confirmed cases of European
measles from JCs paper are provided in said paper. Have you looked at
this? Do you have any comments/questions?

I have started a thread based on a paper from 2011 regarding possible
explanations for recent increases in pertussis incidence here -->
http://groups.google.com/group/vaccination-respectful-debate/t/5cfee8f5748941f9

I have also started a thread about recent data looking at immune cell
responses to challenge by antigens here --> -->
http://groups.google.com/group/vaccination-respectful-debate/t/336e635ac7db94f5

I would welcome any discussion over these paper with regard to
pertussis or "germ theory" there


Finally, I guess one thing I could postulate here with regard to
measles (but applicable to all vaccine preventable disease featured in
your mortality graphs) is; given you suggest that lab testing is
shifting the goal posts by excluding many cases of (say) measles that
were clinically diagnosed but not confirmed by lab results and thus is
used to hide the number of vaccinated people affected by a disease
they have been clinically diagnosed with, would you agree that perhaps
the actual number of measles cases has always been lower than what we
once thought?

If this were true, could it then not also be true that in reality the
large reduction in so called measles deaths (prior to lab testing as
shown in your graphs), was not actually reductions in measles deaths
at all, but reductions in deaths caused by diseases with similar
symptoms that have been resolved through our improvements in living
standards?

It makes great sense that better hygiene, sanitation and nutrition
would generally improve the mortality rate of a nation. But what if,
through no fault of their own, doctors have historically over reported
incidence of specific diseases because of a lack of understanding
about the different causes of specific symptoms (ie. a lack of
suitably broad differential diagnoses)?

If this were the case, it would be very difficult to know where within
your graph the true "starting point" of deaths due to measles began,
and when it began it's decline.

I'm not trying to use this to argue against your graphs and thus, am
not trying to build a "strawman argument" (I had never even heard that
term before joining this discussion group). It's something I've just
started thinking about over a beer while responding to your post
tonight. While anticipating your response to the deficiencies in your
discussion thus far (noted above), I wonder what you think about
this. In the interest of staying on topic though, perhaps we should
try and keep any discussion related to this as close to measles as
possible.

On Jan 9, 8:27 am, Greg Beattie <pcmedics...@gmail.com> wrote:
> Peter
>
> Quote >> "A lot of nonsense about whooping cough.
>
> You expect us to get the data for you?  This is your point Greg, back
> it up mate.  You can start with telling us what the vaccine coverage
> for whooping cough is like in populations experiencing outbreaks
> recently.
>
> Can you do that Greg, huh?  Your post about whooping cough has no
> facts, no references, just a bunch of supposition from a deluded
> person clutching to the last straws of their arguments against
> vaccination."
>
> Again, my apologies Peter. The increase in whooping cough
> notifications in USA has been discussed previously here (can't
> remember which thread) and is common knowledge so I assumed you were
> aware of it. You can read about it here, although there are many
> articles if you do a search. Scroll down the page and find a graph of

> notifications showing the increase (one for deaths also).http://www.kpbs.org/news/2010/dec/14/immunized-people-getting-whoopin...

>
> From this article
>
> • For pertussis cases in which vaccination histories are known,
> between 44 and 83 percent were of people who had been immunized,
> according to data from nine California counties with high infection
> rates. In San Diego County, more than two thirds of the people in this
> group were up to date on their immunizations.
>
> • Health officials in Ohio and Texas, two states also experiencing
> whooping cough outbreaks, report that of all cases, 75 and 67.5
> percent, respectively, reported having received a pertussis
> vaccination.
>
> • Today, the rate of disease in some California counties is as high as
> 139 per 100,000, rivaling rates before vaccines were developed.<<
>

> For Australia, vaccination coverage data can be found here.http://www.health.gov.au/internet/main/publishing.nsf/content/cda-cdi...

>
> And notications here (select 'Notification rates' and 'Pertussis').
> You will see a roughly 80-fold increase in rates in the past 20 years,

> all in parallel with increasing vaccination.http://www9.health.gov.au/cda/Source/Rpt_4_sel.cfm

[Greg Beattie]

John

Perhaps you would like to take a sober look at my previous post and
think about things. If you wish to use notification data, there are
some examples that support your argument and some that don't. That
means you have a choice. You can:

a) take the good with the bad... admit that the data for whooping
cough and AFP makes vaccination look bad, but, for measles, makes it
look good

b) put your hands over your ears and keep repeating the measles
example out loud, over and over (this is what you're doing)

c) look for reasons why the figures let you down in some areas

d) take a good look at the figures... their completeness, accuracy,
influences, and controls and safeguards, etc, and decide whether they
are suitable for the purpose.

Unlike mortality data, which in developed countries is complete (i.e.
all deaths are registered), incidence can only be sampled. Whenever we
take samples we need to be careful that the method we use will result
in valid samples that are representative of the larger group we
extrapolate them to. Given that notifications are a 'sample', I invite
you to tell us why you feel they are valid. What controls and
safeguards are in place to ensure that these figures are
representative of the true incidence of illness?

Thanks
Greg

On Jan 8, 10:26 pm, JC <jc_bige...@yahoo.com.au> wrote:

[Greg Beattie]

Peter
Yeah, I can see why you want to start a new thread but I'd rather you
address my questions here because I'm attempting to discuss the
validity of using notifications for our arguments. The measles
examples support one side of the debate and the whooping cough (WC)
examples support the other. And we can change these around. For
instance, I can find measles examples which will support mine, and I'm
sure you can find WC examples to support yours. In fact, I expect you
will find more examples overall than I will because I believe the
notification system is geared toward under-reporting illness in the
vaccinated, and over-reporting it in the un-vaccinated.

And you can research reasons to explain the examples I provided, just
as I provided reasons to explain your examples. Rest assured there has
been much speculated about the increase in WC notifications. It's a
real thorn in the side of vaccine supporters so a lot of effort has
been made to explain it. Far fewer are interested in providing
alternative explanations for your measles examples, because everyone
is happy with giving the vaccine the credit. But there ARE other
explanations, as you've seen here. So we both may have explanations
for the examples that don't support us, but those explanations are not
likely to be entertained by the other side (you referred to mine as a
fantasy).

At this stage I want to know from you whether you're happy to use
notifications as if they represented true incidence. I'm not. That's
why you don't see me running around claiming that polio vaccine has
caused a 5-fold increase in paralysis, or that WC vaccine has caused
an 80-fold increase in WC. I don't believe those are valid
conclusions. Neither do I believe yours are because I don't believe
the figures are suitable for assessing real trends. I believe they are
more suited to assessing trends in reporting behaviour, which is known
to be influenced by many factors including publicity, health
department warnings etc.

I mean, these figures were never meant to be used in this way. The
notifiable diseases setup is simply a public health surveillance tool
which enables quick responses to outbreaks etc. Used as such they're
fine. But somewhere down the track someone decided to pull them out
and use them to show that vaccines made a difference. It probably
seemed OK at the time.

I'm happy to have a good discussion about their suitability for this,
and I think I've provided enough justification for my insistence that
you outline the controls and safeguards that are built into the system
to deal with the obvious vulnerabilities.

I see the problems that need an answer as follows:

1. estimates of participation vary widely, but I have seen studies
which claim that only a few percent of the likely cases were reported
to the system, and other studies claiming 90-something percent
(different illnesses, different times, different areas). I have also
seen papers suggesting the reporting rate in your measles examples was
about 45%, one bemoaning the fact that even after substantial
publicity 45% was all that was achieved. Can we measure the
completeness of reporting at a given time? What if it goes from 90% to
9% after a vaccine is introduced, simply because doctors think the
problem has been addressed? How do we know when it's 90% and when it's
9%? What's in place to control for this?

2. Are doctors as likely to report a vaccinated case as they are to
report an un-vaccinated case? Remember, we are not dealing with the
complete picture. We don't know how many cases are not reported, nor
their make-up. With mortality we don't have to worry about these (both
1 and 2) because the figures are complete. With notifications, are
there any safeguards for this?

3. Are doctors less likely to suspect an illness in the vaccinated?
Diagnosis is not always straightforward. When diagnoses are clinical
how much weight might doctors place in the vaccine status of the case?
Are they more likely to diagnose croup in the vaccinated, and whooping
cough in the unvaccinated? Where diagnosis is laboratory, are tests
more likely to be requested in the unvaccinated? This bias is well
documented but unquantifiable. Are there any controls in place? Are
adjustments made?

Each of these has the potential to significantly alter the shape of
the data. If there is no adjusting for them then I think we should put
the data back in the cupboard. No self-respecting scientist would
entertain using such a poor data-set. If I were doing up a business
plan and my data were compromised in this way I would not use it.
Would you?

Thanks
Greg

On Jan 10, 10:17 pm, mtp_69_i <drpjmccar...@gmail.com> wrote:
> Dear Greg,
>

[Greg Beattie]

Peter

Sorry, I neglected to address your other points. First, regarding
declines in measles incidence prior to increasing requirement for lab
confirmation. Please see the 3 points in my previous post, and note
that measles vaccine was first used in Finland in 1975, although MMR
was introduced in 1982 with greater coverage. My view is that we may
expect a reduction in numbers through selective reporting and bias in
diagnosis, coincident with these years. The other view is that the
vaccine protected people. Either or both may be correct.

Now to your thoughts about changes in diagnosis and their effect on
mortality figures. I agree that mortality figures suffer from some of
the same influences as notifications, such as bias in diagnosis and
changes to definitions. Their big advantage over notifications though
is that they are complete - not a potentially biased sample. Their
other advantage is that cause of death can be expected to be preceded
by more scrutiny than a typical notification.

Would I agree that perhaps the actual number of measles cases has
always been lower than we once thought? No. I neither agree nor
disagree. To me measles is a handle. It was used to describe people
with fever, coryza, rash, Kopliks spots etc. Today, those who support
the germ theory insist we should only call it measles if rubeola virus
is found in lab tests. The clinical illness may be identical, but the
definition has changed. What you're asking me is which definition do I
believe is correct. As I'm not a germ theory supporter, I probably
would have to side with the older one as being the more useful. But
the point is there is no meaningful comparison before and after the
change.

The mortality graphs I've shown so far cover a period where there were
grey lines between measles, rubella, scarlet fever, chicken pox,
smallpox and many others. I imagine there were deaths recorded as
measles which might have, under different circumstances, been recorded
as something else. On the other hand, I imagine there were probably
many the other way around. None of us has any way of knowing how much
the causes of death may have been interchangeable.

The one thing we do know is that deaths from infectious illness fell
substantially before the vaccines arrived. Clinical diagnosis was a
real art and doctors categorised these deaths according to their
symptom-complex. Measles had a typical presentation... as with all
illnesses it was not always an easy call but the call was made.

If we would like to speculate that measles deaths were over-reported
in the pre-vaccine days, then we would have to accept that scarlet
fever, small pox, chicken pox etc were under-reported (as those extra
measles deaths will have to go somewhere). This will add to the
argument that other illnesses declined even more efficiently without a
vaccine (scarlet fever, chicken pox) or that they declined less
efficiently with one (smallpox).

So, I think it's six of one and half a dozen of the other. But I
sincerely appreciate your thoughts, and I'm looking forward to
continuing with the graphs in the "vaccines save lives?" thread.
Thanks
Greg

[JC]

Greg,

As I don't drink alcohol, I can assure you that I'm always looking at
things in a sober fashion. In my line of work, one slip could be
disastrous.

"admit that the data for whooping cough and AFP makes vaccination look

bad, but, for measles, makes it look good" Why would I do that?

For whopping cough, maybe you haven't read the figures...

2001 - whooping cough cases 9541, vaccination rate 70.6%
2007 - whooping cough cases 4864, vaccination rate 95%

Vaccination rate increased, and cases dropped! Looks good to me.

AFP? A potpourri of over twenty different diseases that you claim are
all polio? Absolutely ridiculous basis for a conclusion.

I'd say it all looks good for vaccination, and thanks for admitting
that measles vaccination is effective in reducing measles cases.
First time you've done that to my memory.

I'd like you to explain how mortality and notifications are similar.
Are all mortality cases correctly diagnosed? Are they all laboratory
confirmed, or clinically diagnosed? So I can turn your question back
to you... with regards mortality, "what controls and safeguards are in

place to ensure that these figures are representative of the true

incidence of illness?".

See Greg, you need to look at all data to see the big picture. In
developed countries, overall mortality has decreased, so one would
expect mortality from these diseases to also decrease over time. It's
pretty simple, isn't it? However, these diseases DO kill, and what a
shame it would be to have someone die unnecessarily when it could be
so easily prevented. This is especially so in developing countries,
where overall mortality is still high. Notification rates are another
method of tracking disease, and if you think the reductions are solely
due to sample bias, when they have been so dramatic, you're living in
a fantasy world.

Speaking of which, I've made a thread just for you, to present your
theories on disease. I'm sure someone who has studied this in so much
detail must have an idea of how disease comes about, if not in part
due to microbial organisms.

John

[Greg Beattie]

Quoting John

>>"For whopping cough, maybe you haven't read the figures...
2001 - whooping cough cases 9541, vaccination rate 70.6%
2007 - whooping cough cases 4864, vaccination rate 95%
Vaccination rate increased, and cases dropped! Looks good to me."

John
Here are the reports for the past 20 years.
From http://www9.health.gov.au/cda/Source/Rpt_4_sel.cfm

1991 - 332
1992 - 800
1993 - 4413
1994 - 5574
1995 - 4190
1996 - 4780
1997 - 12237
1998 - 5670
1999 - 4361
2000 - 6001
2001 - 9541
2002 - 5571
2003 - 5097
2004 - 8750
2005 - 11165
2006 - 9764
2007 - 4864
2008 - 14292
2009 - 29799
2010 - 34794
2011 - 37880

As you can see your two cherry-picked figures are in there. But
doesn't the fuller picture make you feel just a shade dishonest?
Greg

[Greg Beattie]

Quoting John

>> "AFP? A potpourri of over twenty different diseases that you claim are all polio? Absolutely ridiculous basis for a conclusion." <<

John
AFP stands for Acute Flaccid Paralysis. What I said was AFP
notifications have increased 5-fold in the past 15 years, coincident
with the global eradication initiative for polio. If you think
notifications are valid indicators of trends then you must accept that
acute flaccid paralysis is now 5 times greater since the drive to
eradicate polio. Do you?
Greg

[JC]

Greg,

AFP is not a vaccine preventable disease. It's notifications are
consistent with an increased surveillance programme. There has been no
new surveillance programmes for measles. Chalk, meet cheese. What has
happened to notifications for polio, which is vaccine preventable? And
measles, for that matter?

John

[JC]

Greg,

Just a shade dishonest? I couldn't agree more Greg. That's what Meryl
Dorey
did in Woodford with her whooping cough stats, and over on that
discussion thread I used the years I quoted as an example of how
cherry picking is wrong.

I'm glad that you also think this is dishonest.

John

[Greg Beattie]

John

Meryl selected two figures to illustrate the increase in whooping
cough reports. And although she was reporting the truth, and
illustrating that with two figures, you say she's being dishonest.

You select two figures that show a reduction, and conclude whooping
cough has decreased, which is the opposite of the true picture. You
are being dishonest, but you are trying to wiggle out of it by saying
that Meryl did something similar....?

Good grief. People often select a couple of figures to illustrate
their point. It's easier than reeling off 20 of them. But you have to
be honest when you do it... not deliberately dishonest. That's the
difference between what you did and what Meryl did. Her example was
honest, yours wasn't.
Greg

[Greg Beattie]

John

It makes no difference whether AFP is so-called 'vaccine preventable'.
You explain the worldwide 5-fold increase in paralysis reports as
being due to an increase in surveillance for it. That sounds
reasonable. Given that you now acknowledge notifications are affected
by things other than actual illness trends, the next challenge is to
contemplate what other circumstances may cause an increase or decrease
in reporting behaviour. Finally, I'd like an answer to my question as
to what controls are in place to ensure this doesn't colour the data.
Thanks
Greg

[JC]

Greg,

AFP is a clinical picture, and there are over thirty different causes
for it, including trauma (i.e.: an injured spinal cord). Clearly, the
other causes are not vaccine preventable, and so therefore AFP is
not. You're mixing notifications from a screening programme with
notifications from a tested sample, and therein lies your confusion.
AFP is independent of polio by and large now that polio rates are so
low. Polio notification rates are indeed a good measure of disease
incidence however, as would be polio mortality data. Do you have both
of those at hand?

John

[Greg Beattie]

John
You didn't answer the question:

"Given that you now acknowledge notifications are affected by things
other than actual illness trends, the next challenge is to contemplate
what other circumstances may cause an increase or decrease in
reporting behaviour. Finally, I'd like an answer to my question as to
what controls are in place to ensure this doesn't colour the data."

I won't ask again, so if you choose to avoid it this time, you've
won... whatever that means to you.
Greg

[JC]

Greg,

Notifications are certainly prone to reporting bias, and this is
demonstrated currently in India where the reports of AFP have risen in
line with an improved surveillance programme. With regards mortality
screening the same bias can occur, as people who die may or may not be
tested for diseases that they are not suspected of succumbing to. So
no system is perfect. Welcome to the real world. It's not an excuse
to throw the baby out with the bathwater though is it?

John

[Greg Beattie]

John
It's funny you should be welcoming me to the real world. I've been
inviting you in for a while. I agree there is no perfect data-set, but
mortality is by far the best we have because it is complete.
Notifications are not complete, which means influences have the
potential to affect sample size and shape in a much greater way.

We have no idea how many cases of measles etc were out there but
weren't reported to the system, either because they didn't visit the
system or because the report wasn't sent in, or because the diagnosis
was wrong. Mortality figures are only subject to the last of these
three, and one would expect less so than notifications.

Remember, not everyone goes to a doctor to start with. But for those
who do, on the say so of one doctor after a brief encounter with a
patient, a subjective decision is made about diagnosis, as well as
whether or not to report it. With deaths, EVERY death is recorded.
Greg

[JC]

Greg,

Every death may be recorded, but what guarantee do you have that every
death was investigated fully? How do we know that the diagnosis was
correct on the death certificate? What safeguards are in place for
that, Greg?

John