Sometimes there are weeks where I decided to take care of something that’s been in the old Blog Fodder Folder on my computer and that I’ve been meaning to do a post about. Usually, because many of these are not time-sensitive, they get pushed back in priority whenever something that is time sensitive catches my attention. Of course, as I like to say, I’m a a bit like Dug the Dog in the movie Up is with squirrels when it comes to blog topic. I’m easily distracted by a shiny new bit of science or pseudoscience that interests me. In any event, I’ve been meaning to look at something I’ve been seeing popping up on antivaccine social media, specifically the Vaccine Guide.

It’s the creation of a woman named Ashley Everly, who, believe it or not, is someone I haven’t heard of before. (I know, I know, right?) She’s currently running an antivaccine group, Health Freedom Idaho, whose website is also chock full of all manner of quackery, including naturopathy, chiropractic, and other alternative medicine. She lists herself as a toxicologist, even though her LinkedIn profile shows no evidence that she is, in fact one. Sure, she has BS in environmental toxicology from UC-Davis and worked as an intern in the California EPA Office of Environmental Health Hazard Assessment for a little over a year, but that’s about it. No MS, no PhD, no evidence that she ever worked as a toxicologist anywhere. Let’s just put it this way. I have a BS in Chemistry (with Honors!), but I never called myself a chemist.

Antivaxers, though, think this is a fantastic resource:

Let’s just put it this way. Ashley Everly is no toxicologist, and even in this strange antivax website, it shows. Also, I’m kicking myself. How is it that I never really encountered something announced a year ago until recently?

The Vaccine Court and National Childhood Vaccine Injury Act of 1986

Of course, science talks, and BS walks; so I decided to look at Vaccine Guide itself. At first I didn’t know what to make of it. There’s a menu bar on the left, with topics such as NCVIA/VICP/VAERS. If you click on that menu, there’s a submenu with a variety of topics, but there doesn’t appear to be much in the way of original content. For example, the link to National Childhood Vaccine Injury Act of 1986 (which has, of course, been extensively discussed here many times), there’s just a link to screenshots of the act itself, with specific passages highlighted in yellow. No context is given, just the raw source with some highlighting. In this case, Everett highlighed passages like “Sets forth a table of injuries deemed vaccine-related for compensation purposes” and “Limits awards for actual and projected pain and suffering and emotional distress to $250,000.” Why? Who knows? But data without context tend not to be very helpful.

Here’s another example. There are screenshots from Bruesewitz v. Wyeth (2010), a legal decision from which antivaxers frequently cherry pick and misrepresent a passage concluding that vaccines are “unavoidably unsafe.” John Snyder wrote about this on SBM when the ruling was originally made, and you can find more here and here and here. Basically, the case was about whether a section of the “NCVIA preempts all design defect claims against vaccine manufacturers, and the Supreme Court ruled 6-2 that the NCVIA preempts all design-defect claims against vaccine manufacturers brought by plaintiffs who seek compensation for injury or death caused by vaccine side effects. This doesn’t mean that there remains no recourse for parents who think that their child was injured by a vaccine because of a design defect, just that they can’t bypass the Vaccine Court and go directly to state or federal courts. As for “unavoidably unsafe,” it’s a terrible term meant to communicate that there are some products whose benefits outweigh their risks but do have risks that can’t be eliminated completely. Vaccines could qualify. Their benefits clearly outweigh risks, but there are tiny risks that can’t be entirely eliminated due to the nature of the product. Naturally, Everett highlights “unavoidably unsafe.”

Basically, the vast majority of the website consists of screenshots of various documents and studies with passages of text that Everly apparently considers important. Yes, there are links to the source, apparently, but why Everly chose to construct this website that way, I don’t know. Under the the Vaccine Injury Compensation payout link, she highlights the figure of $4 billion paid to Vaccine Court Claimants over the last 30 years. In reality, I discussed before, when taken in context of the billions of doses of vaccines to hundreds of millions of children given during that time it’s not really that large a figure. In another link, she displays a screenshot of an explanation of the Vaccine Adverse Events Reporting System (VAERS), while leaving out any mention of the other vaccine safety monitoring systems, such as the Vaccine Safety Datalink (VSD). Why do I mention this? VAERS is the least reliable system because it’s a passive reporting system, subject to underreporting of some things and lawsuit-related overreporting (or making up) of adverse events for other things. VSD is an active system that doesn’t rely on passive reporting. That’s why antivaxers rarely mention it or the other active reporting system out there, such as the CDC’s VSD and the FDA’s Post-licensure Rapid Immunization Safety Monitoring System (PRISM). Everly also includes a screenshot of a report from Harvard Pilgrim medical group on VAERS reports that found some underreporting in VAERS and proposed a new automated system. Apparently the CDC didn’t show much interest, which has led to the usual antivaccine conspiracy theories. My guess is that it’s because there are already two active reporting systems (VST and PRISM), making turning VAERS into a third one unnecessary, but I don’t know for sure and could be wrong.

Vaccine Guide on the “toxins gambit”

Another major section is Vaccine Ingredients/Excipients/Contaminants. Basically, what follows is a list of cherry-picked studies, many from the usual antivaccine suspects with whom regular readers of this blog have become familiar, such as Christopher Shaw and Lucija Tomljenovic. The choice of these articles is deceptive, too. For instance, one link, Hyperosmolality in small infants due to propylene glycol, links to a screenshot of a paper finding that propylene glycol can cause hyperosmolarity (very simply—or maybe simplistically—too much solute dissolved in the blood) in the multivitamin preparation used in parenteral (IV) nutrition. Now, you know (I presume) and I know (as do all doctors and medically knowledgeable people) that there’s a huge difference from a very tiny amount of propylene glycol in a vaccine and injecting a much larger amount of it intravenously, but the average person coming across this link in Vaccine Guide will likely react with fear that vaccines could cause hyperosmolarity.

Another study is hilarious in its cluelessness. It’s a study from 2003 that concludes that thimerosal induces DNA breaks and cell death in cultured human neurons. What’s left out is that, yes, thimerosal can cause DNA breaks and apoptosis in cultured human neurons, but not at any concentration you’d ever see in the blood of an infant receiving a thimerosal-containing vaccine. We’re talking micromolar-level concentrations, which would require a large and toxic dose of thimerosal to attain in the bloodstream. Never mind that no childhood vaccine in the US contains thimerosal as a preservative any more, and only some adult flu vaccines still use it. A real toxicologist would know that this paper is not evidence that thimerosal from vaccines kills neurons.

Some of the screenshots are just to abstracts, which is a real head scratcher to me, given that you can get the text of these abstracts just by searching PubMed. For instance, there’s this abstract. It’s a study of coating nanoparticles with polysorbate 80 (Tween-80), which is sometimes used as a stabilizer in vaccines. The idea was to use it as a means of targeting the nanoparticles to the brain. If you know antivaccine pseudoscience, you know that antivaxers frequently claim that vaccines ingredients (such as tiny DNA fragments) get into the brain to cause autoimmunity and inflammation, and you know how Everyly’s choice of this cherry picked study is meant to imply that the polysorbate 80 in vaccines is a means of getting all those imagined nasty “toxins” from vaccines into the brain.

I could go on and on here, but there’s so much more to get to. If you want to know more about these “toxins,” the Children’s Hospital of Philadelphia (CHOP) Vaccine Education website has a great page explaining each vaccine ingredient, why it’s there, and whether it has any toxicity. As I said, this is what I like to call the “toxins gambit,” and I’ve explained a bit about it, too.

Vaccine Guide on vaccine package inserts

There’s one whole section that contains nothing but screenshots of vaccine package inserts. This is what I like to refer to as “argument by package insert.” It’s a ploy that ignores the fact that package inserts are not medical documents, but legal documents. They are, to put it briefly, a “CYA” document. As such, they list every adverse event ever reported in any clinical trial, whether the event is related to the vaccine or not. Antivaxers love to point to package inserts that note that autism was reported in clinical trials of vaccines used for FDA approval, even though if you actually look at the study you’ll see that there was no evidence that the vaccine had anything to do with autism. Also, as we keep writing again and again, there are numerous epidemiological studies failing to find a link between vaccines and autism.

Vaccine Guide on asymptomatic transmission and shedding

Next up is a section on asymptomatic transmission and shedding. Regular readers will know that a favorite antivaccine trope is to claim that attenuated live virus vaccines “shed” the virus and that that shedded virus is dangerous to those around them. It’s their answer to herd immunity in that they want you to believe that it is the recently vaccinated, not the unvaccinated, who are a danger to unvaccinated children. It’s very clear that the claim that children shed virus and are thus potential vectors for infection is important to antivaccinationists because it allows them to portray others as equally, if not more, the cause of outbreaks than their children, but is there anything to it? Regular readers can probably guess the answer to that question. The answer, of course, is that there’s far less to the issue of virus shedding than meets the eye. For one thing, virus shedding can only occur with live virus vaccines, such as the rotovirus vaccine, oral polio virus vaccines (which are not really used in the US any more because of a one in 2.7 million risk of paralysis from the vaccine strain of the virus), or intranasal flu vaccines.

Of course, there’s a difference between shedding and causing disease. For one thing, the strains of virus used in live attenuated virus vaccines are just that—attenuated. They’ve been weakened in some way so that they don’t cause the actual disease. Otherwise, a live virus vaccine would be the equivalent of giving the disease to the person vaccinated, which would rather sabotage the whole point of vaccination in the first place, which is to produce immunity to the disease without the vaccinated person actually having to suffer through the disease itself. (Scratch that, it would be exactly the same as giving the person the disease.) The question, then, is whether secondary transmission (transmission of the vaccine strain virus to others who haven’t received it) is a major concern. The answer to that question, is no, as these articles entitled Secondary Transmission: The short and sweet about live virus vaccine shedding and Live Vaccines and Vaccine Shedding, show.

We learn from the former article that these are commonly given live virus vaccines:

MMR – the combination measles, mumps, and rubella vaccine

Vavivax – the varicella or chicken pox vaccine

rotavirus vaccines – including two oral vaccines, RotaTeq and Rotarix

Flumist – the nasal spray flu vaccine

oral polio vaccine – the original oral polio vaccine (sometimes called the Sabin vaccine). Again, this has been replaced in the United States by the inactivated polio vaccine (Salk vaccine)

We also know that:

the MMR vaccine doesn’t cause shedding, except that the rubella part of the vaccine may rarely shed into breastmilk (since rubella is typically a mild infection in children, this isn’t a reason to not be vaccinated if you are breastfeeding though). What about the rare case of a person developing measles after getting the MMR vaccine? In addition to being extremely rare, it would also be extremely rare for a person to transmit the vaccine virus to another person after developing measles in this way.

the chicken pox vaccine doesn’t cause shedding unless your child very rarely develops a vesicular rash after getting vaccinated. However, the risk is thought to be minimal and the CDC reports only 5 cases of transmission of varicella vaccine virus after immunization among over 55 million doses of vaccine.

the rotavirus vaccine only causes shedding in stool, so can be avoided with routine hygiene techniques, such as good hand washing, and if immunocompromised people avoid diaper changes, etc., for at least a week after a child gets a rotavirus vaccine

transmission of the live, nasal spray flu vaccine has not been found in several settings, including people with HIV infection, children getting chemotherapy, and immunocompromised people in health-care settings

In other words, the claim that virus shedding is a serious problem is yet another bit of antivaccine nonsense. It’s true that some pediatric cancer centers used to caution the parents of immunosuppressed patients to keep their children separated from recently vaccinated children, but that was more out of an abundance of caution than anything else. Indeed, guidelines from the Immune Deficiency Foundation state a

Close contacts of patients with compromised immunity should not receive live oral poliovirus vaccine because they might shed the virus and infect a patient with compromised immunity. Close contacts can receive other standard vaccines because viral shedding is unlikely and these pose little risk of infection to a subject with compromised immunity.

Of course, in the Vaccine Guide, these studies are all presented without context and are clearly cherry picked, and, of course, the oral polio vaccine is not used in the US any more. Basically, shedding is very uncommon, and transmission of vaccine strain virus to other individuals is incredibly rare.

Effectiveness/Outbreaks/Herd Immunity

This is a bit of a grab bag, but if there’s a common theme it’s that vaccines don’t work, herd immunity is a myth, and outbreaks aren’t due to the unvaccinated. For example, Everly links to a commentary that notes that antigen-specific antibody titers don’t always correlate with protection. She also links to studies showing this. Well, duh! Immunologists have known this for, like, forever. That doesn’t mean that vaccines don’t work. She also links to an 1992 abstract describing a three patient case series of patients with high tetanus antibody titers who still contracted tetanus. That one was a head scratcher, too. Why did she include this? Who knows? I couldn’t find another case series like it; so this tells me that it’s very likely quite rare for patients with high antibody titers after tetanus vaccination to be susceptible to tetanus.

Everly also links to a story about an LA Countywide outbreak of pertussis. The problem of waning immunity due to the the pertussis vaccine is one that’s been known for a while. Indeed, I wrote about it seven years ago, and Steve Novella wrote about it in 2010 and last year.

The implication when antivaxers point to pertussis outbreaks and waning immunity is nothing more than the Nirvana fallacy. Basically, to them, if a vaccine doesn’t protect 100% with absolutely no risk of problems, it’s crap and not worth being used. Ditto with Everly’s invocation of the Fordham mumps outbreak five years ago.

Giving the game away, Everly also links to an article co-authored by antivaccine lawyer Mary Holland in a law review journal that claims that herd immunity “does not exist and is not attainable.” How did I miss this utterly hilarious article? Two lawyers going all Dunning-Kruger and claiming that it’s impossible to achieve herd immunity, which is just nonsense.

Vaccine Guide on the necessity of vaccines

Right off the bat, it’s easy to see where Everly is coming from. Through her choice of papers, she’s trying to imply or argue that vaccines aren’t necessary. For instance, she links to a 1977 article by John and Sonja McKinlay, The Questionable Contribution of Medical Measures to the Decline of Mortality in the United States in the 20th Century. It’s the same article that antivaxer J.B. Handley cited a mere year ago in attacking vaccines, and I discussed in detail its irrelevance to the question of whether vaccines work back then. She also links to some mortality graphs, which show declining mortality due to various vaccine-preventable diseases dating to before the introductions of the relevant vaccines. She even links to a graph showing declining mortality from tuberculosis and typhoid, noting there was “no widespread vaccination” but a “similar decline.” It’s the “Vaccines didn’t save us” gambit writ large, where antivaxers ignore the improvements in survival due to better medical care before the introduction of the vaccine and also ignore tha massive decline in disease incidence and morbidity after the introduction of vaccines. It’s an intellectually dishonest gambit, one we’re well familiar with here. For instance, in 2012 Steve Novella demolished Julian Whitaker’s use of the trope, and I’ve written about it before as well.

Another ploy she uses is to link to a CDC article on the contribution of water treatment and clean drinking water to the decline in cholera and typhoid. This historical observation would be disputed by no one, but it’s also irrelevant. We don’t routinely vaccinate for cholera and typhoid in the US. She also links to studies supposedly supporting treatment of vaccine-preventable diseases, such as a 1990 paper touting vitamin A for measles. It’s also a paper about supplementation with large doses of vitamin A (400,000 IU) in children in South Africa with severe measles complicated by pneumonia, diarrhea, or croup. Of course, this study says nothing about vitamin A preventing measles, and it’s always better to prevent serious infectious disease than to treat it later after it’s become serious enough to endanger life. Even the review article Everly includes concludes that vitamin A should “be used for the treatment of measles as recommended by WHO in children admitted to hospitals in areas where the case fatality rate is high.”

Particularly vile is her inclusion of this CDC article on polio. The article itself is fine, but what Everly underlines seems to make the deceptive case that polio is no big deal:

“Up to 95% of all polio infections re inapparent or asymptomatic. Estimates of the ratio of inapparent to paralytic illness vary from 50:1 to 1000:1 (usually 200:1).”

“Approximately 4%-8% of polio infections consist of a minor, nonspecific illness without clinical or laboratory evidence of central nervous system invasion.”

These syndroms are “indistinguishable from other viral illnesses.”

“Fewer than 1% of all polio infections result in flaccid paralysis.”

“Many persons with paralytic poliomyelitis recover completely…”

“The death-to-case ratio for paralytic polio is generally 2%-5% among children…” She also adds a footnote reading “Less than 1% of all polio infections result in ‘paralytic polio.’ Of those cases “2-5% result in death among children.” She also conveniently leaves out highlighting “…and up to 15%-30% for adults (depending on age). It increases to 25%-75% with bulbar involvement.”

Everly’s implication, as I said above, is clearly that polio is no big deal, that for the vast majority of people it’s just a mild self-limited disease, and that even many of those who get paralytic polio recover. Well, alrighty, then! Seriously, there is no facepalm great enough to do justice to this scientific ignorance.

Vaccine Guide on adverse reactions and miscellaneous topics

The last ostensibly “scientific” section of the Vaccine Guide includes a selection of screenshots of papers claiming adverse reactions. It includes a cherry picked selection of truly horrible papers by antivaxers like Gayle DeLong, Christopher Shaw and Lucija Tomljenovic, Russell Blaylock, Christopher Exley, Theresa Deisher, Yehuda Shoenfeld, and more, plus commentary by David Kirby (what a blast from the past).

We’ve discussed many, albeit not all, of these particular antivaccine “scientists” and pundits here, some on several different occasions over the years. Their “research” does not in any way demonstrate that vaccines cause autism, “ASIA” (Shoenfeld’s creation), autoimmune disease, sudden infant death syndrome, diabetes, or any of the other myriad conditions and diseases for which antivaxers blame vaccines. Ashley Everly’s inclusion of these articles, with her highlighted passages, has but one purpose: To convince parents that there is good scientific evidence that vaccines cause harms that they do not cause and that they cause these harms at a high rate.

There’s also a section on Incentives/Marketing/Misconduct. You can predict what’s on there, of course. For instance, there’s a link to Del Bigtree’s ludicrous ICAN lawsuit, as well as to Peter Gøtzsche and Tom Jefferson’s article claiming that the Cochrane review on the efficacy of the HPV vaccine ignored evidence of bias. Remember that Tom Jefferson and Peter Gøtzsche have both flirted with antivaccine groups and have made borderline, if not outright, antivaccine statements.

You get the idea.

Ashley Everly reacts

I started writing this on Saturday and finished writing it yesterday morning. In the interim, I became aware of a Friday post at #vaccinesworkblog on the Vaccine Guide by Kathy Hennessy. The post mentions some of the same things and some things I didn’t mention, while not covering some things that I did. So I like to think that the two posts complement each other. On Saturday, it was noted that Ashley Everly had responded to the criticisms on Facebook:

The amusing thing is that Everly focuses largely on the fact that Hennessy dissected Everly’s utter lack of qualifications as a toxicologist and how she claims the status of toxicologist to give a veneer of authority that is unjustified and ignores all the substantive criticisms of her cherry picking and selective highlighting of studies and articles in a manner designed to make it appear that vaccines are dangerous and ineffective. Instead, Everly pulls the “pharma corruption” gambit, the pharma shill gambit, and seems oblivious to her own strategy. Here’s what I mean. She writes:

But somehow they’ve concluded that my Vaccine Guide, a resource I have made freely available, which: 🔹 Contains NO personal commentary (this is *purposeful*, so that people can think for themselves and not accuse me of “twisting” or “misinterpreting” the information), 🔹 Gives links to the original sources of the articles, and 🔹 Is simply a depository for research that the medical system, the media, and our regulatory agencies are not telling us about… …is biased, dangerous, cherry-picked, etc. Hm… from my perspective, to *not* share this information with people, is misleading and “cherry picking”.

See what I mean? Everly seems utterly oblivious to what any editor knows. The choices of articles and the choice of text to highlight in her Vaccine Guide tell a story. It’s not objective to choose article to present and specific text from those articles that you consider important, while leaving little “footnote” comments about some of the text you’ve highlighted. It’s not letting people “think for themselves”; it’s telling them what Ms. Everly believes they should take away from the articles and abstracts.

My guess is that if she sees my post she’ll pull out the same clueless tropes, even though I’ve already addressed them. I also predict she’ll try to return the favor, given that there are so many cranks (like Mike Adams) who have written defamatory articles about me on social media, and ignore my substantive criticisms. Whatever she does, in her Facebook post above, Everly refers to a Facebook post of hers from February:

An excerpt:

So if you’ve seen articles/posts/comments floating around that I’m “not a toxicologist” because I don’t have a PhD… Full disclosure: I don’t have a PhD! I don’t have a masters degree. I chose to start a family while I was young, rather than pursue a graduate degree. Then I ended up with a vaccine injured kid and became engrossed in the subject of toxic substances in vaccines and their effects on the human body. And this is why I’m here, 8 years later. I do have a Bachelor of Science in Environmental Toxicology. You might not know what that entails. Here are some of the courses I took: Physics (3 courses) Genes and gene expression Biology & biochemistry (4 courses) General & organic chemistry (5 courses) Applied statistics for biological sciences Environmental fate of toxicants Quantitative analysis of environmental toxicants Legal aspects of environmental toxicology Biological effects of toxicants (2 courses) Health (toxic) risk assessment Toxicology in industry ———— #1. You don’t have to have a masters or PhD to work as or be considered a toxicologist. #2. I know how to read and interpret scientific research, check for design flaws, bias, etc. #3. Doctors and immunologists are not educated in the field of toxicology and toxic substances are used in the manufacture of vaccines. #4. No one is more dedicated to investigating an issue, than a mother whose child has been harmed and may experience more harm unless thorough knowledge and understanding is obtained. #5. I currently work as a consultant for Health Freedom Idaho.

I laughed out loud when I read this. My undergraduate chemistry degree appears to have been significantly more rigorous in its requirements than Ms. Everly’s undergraduate toxicology degree, and I never called myself a chemist, even though I did briefly work in industry in a spectroscopy laboratory in the 1980s. The part about her working as a consultant for Health Freedom Idaho is particularly hilarious, given that a brief glance at its webpage reveals it to be an antivaccine advocacy group that also buys into just about every form of quackery used to treat “vaccine injury” that there is. Actually, the part about her knowing how to read and interpret scientific research is even more hilarious, given her credulous cherry picking of antivaccine “studies” and deceptive highlighting of legitimate studies to promote fear, uncertainty, and doubt about childhood vaccines.

To me, it doesn’t matter whether Ashley Everly is a legitimate toxicologist or not. I can point to quite a few full-fledged MDs and PhDs who are antivaccine. What matters most is her promotion of antivaccine pseudoscience. If you don’t believe me, look at Hennessy’s description of a “debate” between a real pediatrician and this “toxicologist.” I think the key observation is this one:

Ashley is asked if there is even one vaccine she would say is important. She likes that Idaho is for parent’s rights and that people are not aware of how much harm vaccines can cause. So, she will not pick a vaccine to recommend.

If there is any one reliable indication that a person is antivaccine, it’s dancing around this question and not being willing to name even one vaccine that you consider to be safe and effective enough to recommend. If a person can’t even concede that one vaccine is effective and safe, she’s definitely hard core antivaccine.

I also have to wonder if the printed edition of Vaccine Guide is a massive violation of copyright law; after all, if the book is just reprints of scientific papers with Ashley Everly’s highlighting and occasional written comments, I can imagine very easily that publishers would not take kindly to it. Heck, even using screenshots on a website might catch their attention.

In summary, the Vaccine Guide is nothing more than a collection of screenshots of cherry-picked studies and articles, many the typically bad science used to justify antivaccine beliefs an many just abstracts (which makes it difficult to interpret them). Even the studies that are legitimate and decent science are intentionally made to seem to support antivaccine pseudoscience by Ashley Everly’s highly selective use of highlighting. (Basically, Everly appears to be trying to be GreenMedInfo without even the pretense of commentary that Sayer Ji provides.) If you’re looking for reliable information on vaccines, the Vaccine Guide is not the source you want, not on the web and especially not in a printed edition for a cool $90 or even for $5 a month for access to the “full” version of the Vaccine Guide. If what I’ve sampled is a representative sampling of the full version (and I’m sure it is), the Vaccine Guide is nothing more than a particularly strange variety of antivaccine propaganda.