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January 15, 2016 Archives

This is the human face of smallpox:

Child with Smallpox Bangladesh.jpg

Photo Credit: Content Providers(s): CDC/James Hicks This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #3265.

Smallpox is now extinct in the wild: the last known case was in 1977.

And this is what Judy Wilyman has to say about the vaccine that eradicated smallpox virus, in her strongly anti-vaccine PhD thesis - you'll find the quote on page 15 of the main document

Vaccination as a preventative public health strategy was first used by Edward Jenner in the late 18th century (Hays 2000). It was used in the fight against smallpox for ~150 years but its efficacy was never tested in controlled clinical trials that exposed a large number of participants to the smallpox virus and compared the outcome to a control group (Wallace 1898).

This is simply unbelieveable. Does Wilyman genuinely think that this would be an ethical approach to addressing the development of a smallpox vaccine? Really? And equally unbelieveable is that this was not regarded as a signficant issue by either her supervisor or those who examined the thesis.
Smallpox is now extinct in the wild, so many people will never have seen a case of it. (This was possible partly because humans are the only known reservoir for the virus.) It's hard to imagine, given the rigorous literature reviews normally expected of a PhD candidate that Wilyman might be ignorant of the disease and its effects1: the most common, severe form of the disease killed a large proportion of those infected with it. Wikipedia tells us this:
The disease killed an estimated 400,000 Europeans annually during the closing years of the 18th century (including five reigning monarchs), and was responsible for a third of all blindness. Of those infected, 20-60 percent - and over 80 percent of infected children - died from the disease. 
Survivors were scarred for life.
It is frankly appalling to see that a PhD candidate thinks it would be in any way ethical to carry out a controlled trial of a vaccine against a virus where the known outcome would have been death for up to 60% of those involved. And yet the supervisor and examiners let this pass?

1 Mind you, she also has this to say (also on page 15):

The fact that developing countries are still rife with infectious diseases today suggests that depending on vaccines to prevent disease in countries with poor environmental and nutritional conditions is questionable
It's almost as if she doesn't know why smallpox is extinct, and polio nearly so.
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One of today's big stories, in the blogosphere and elsewhere, is of the University of Wollongong's decision to award a PhD to a thesis that promotes a strongly anti-vaccination take on the policies and science relating to immunisation. Fellow NZ scibloggers Helen Petousis Harris and Grant Jacobs have already commented on it, and over on Respectful Insolence Orac has his usual thorough take on the issue.

The University of Wollongong has defended the awarding of the PhD to this particular thesis:

The university says it accepted a PhD thesis from a controversial anti-vaccine advocate on the basis that universities promote freedom of thought and it adhered to international standard protocol.

"As a leading research-intensive university, the University of Wollongong values intellectual openness, freedom of opinion, diversity of ideas, equity, and mutual respect," a spokesperson from the University of Wollongong said in an official statement.

"UOW does not restrict the subjects into which research may be undertaken just because they involve public controversy or because individuals or groups oppose the topic or the findings."

The spokesperson provided a form that outlines the requirements that must be met in order for a PhD to be accepted and which they said the university complied. "UOW ensures research is undertaken according to strict ethical and quality standards," they said.

And therein lies the rub. Universities do value diversity and freedom of opinion (it would be a sad state of affairs if they did not), but that opinion should be evidence-based. Academic freedom (another phrase aired in this and similar contexts) is not the freedom to say whatever one likes, whenever one likes, without considering the quality of the opinions being expressed.

New Zealand's Academic Audit Unit has discussed this concept at some length. It notes that academic freedom is an important contribution to the community. And for that reason, again, it's important that the opinions expressed under the aegis of academic freedom are accurate and research-based - because if they are otherwise there is the potential to do real harm in the community.

I am not flying a kite here. Helen has already commented on how the views expressed in this thesis, as exemplified by (but in no way restricted to) the abstract, are not based on current best practice and understanding around vaccination. But the thesis is highly likely to be held up by organisations such as the 'Australian Vaccination Network' and the 'Vaccine Resistance Movement' as evidence that vaccines are not only useless but in fact bad for us. If this then results in a drop in vaccination rates, then vaccine-preventable diseases will increase in frequency in the community: this is just what happened in the UK after the publication of the now-retracted report that linked MMR vaccination with autism.

The authors of the AAU monograph go on to note the links between that critic and conscience role in universities and the quality of the research (& teaching) done at the institutions. And this is, I think, the key here: those opinions which we express should be underpinned by good-quality research. In the case of the thesis discussed here, the quality of that research, and the degree to which it was scrutinised by both the supervisory panel and the external examiners, must - as Helen, Orac, and others have already shown - be called into question.

One pressing question is whether the thesis was subject to expert scientific scrutiny in both the development and examination phases. This is because a considerable portion of it discusses not policy but issues of actual science (Chapters 7 through 10), and as Helen's said, quite a bit of that discussion is not based on the modern mainstream scientific literature. For example, as Orac's already noted, the thesis claims that there is a plausible link between vaccination and the development of autism. No such link has been demonstrated, but it's a frequent claim on many antivaccination websites and social media pages. And sadly, it appears that even the offer of scienfitic review and commentary was rejected:

John Dwyer, emeritus professor of medicine and president of the group Friends of Science in Medicine, says Ms Wilyman has challenged well-established concepts in science without the data to support her conclusions. Peter McIntyre, director of the National Centre of Immunisation Research and a WHO adviser, said he had offered to discuss the research with Ms Wilyman but found her “not willing to entertain” evidence contrary to her views.

And then there's the statement that vaccine-preventable diseases have not been shown to be a serious risk to the majority of children in Australia. This runs against the actual historical evidence. I suppose that between 10 & 20 cases of paralytic polio per 100,000, the figures reached during epidemics, don't sound all that much, but that doesn't include non-paralytic forms of the disease. Children under 5 are at greater risk than anyone else. Or pertussis (whooping cough): Australia had around 10,000 cases in 2009. Most cases of this disease are in children under 10, and every year infants die from it; those too young to be immunised are at particular risk, and rely on herd immunity. And let's not forget measles: this remains a significant cause of death in young children, on a global basis, and is easily spread across open borders.

All this information is readily available and it's staggering that it was glossed over in this way, or went unchallenged during the writing and examination of the thesis. Freedom of opinion is one thing; freedom to ignore or misrepresent information that doesn't fit one's narrative, in the development of a PhD thesis, is something else.

EDIT: Orac has added a further commentary, hot off the press.

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Recent Comments

  • Alison Campbell: Thanks, Beth - another one for my reading list. read more
  • Beth: That book "Smallpox and its Eradication" is very informative and read more
  • Beth: She didn't actually say that the efficacy should have been read more
  • Alison Campbell: Thanks, Beth; my thoughts exactly. I was horrified to see read more
  • Beth: Here were my comments about the smallpox passage: p. 105 read more
  • Alison Campbell: ooooh you are awful, herr doktor! read more
  • herr doktor bimler: incomplete molecular structure This sounds like something from a bad read more
  • Alison Campbell: I wouldn't mind if he kept his strange beliefs to read more
  • Grant: Yeah. Feeding instructions needed. On one hand hilarious anyone thinks read more
  • herr doktor bimler: The milk goes in the puss. Not the other way read more