This is the fourth installment of debunking the book “Turtles All the Way Down” (written by “Anonymous”, and edited by Children’s Health Defense lawyer Mary Holland and Children’s Health Defense Publisher Liaison Zoey O’Toole). Because this is a fairly long book, I’ll be spreading my posts out over 10 more reasonably digestible pieces. This is the next installment in the series – debunking Chapter 4 “Epidemiology 101”.
As in the previous three installments, I will present quotes or paraphrases of statements from the chapter with their associated debunks, and answers to the questions at the end of each chapter. Statements that are repetitive will be addressed only once or twice even though they might appear several times within the chapter.
This chapter serves as a descriptor of the various major epidemiological techniques and research strategies, as well as basic descriptions of what constitutes a randomized controlled trial. It also illustrates the difference between finding an epidemiological correlation, versus a physiological mechanism of how something happens biologically. In general, these introductory descriptions are reasonable. However, they are subtly wrong enough that the unitiated may take the authors word and then accept the distortions that are going to be set up in chapter 5 and beyond. Here, I show you exactly what those distortions are.
- The answer is that the term causal link has a different meaning in medicine than in exact sciences like chemistry and physics… In medicine, however, the situation is radically different. Such certainty doesn’t exist.
The reality of the matter is that the authors are demonstrating a substantial lack of knowledge of human biology. We are able to watch individual cells move about and do their daily business. We are able to read a large fraction of the human genetic code. We are able to able to create animations of how power generating molecular machines in our bodies work. We are able to replace enzymes in many genetic diseases, such as Pompe disease. We are able to diagnose rare genetic conditions. We are able to perform heart surgery on babies weighing less than 1 kg, to remove extra blood vessel connections that shouldn’t exist. We are able to deliver babies with a level of safety that the Ancient Romans would only have dreamed of. We are able to perform heart surgeries on babies before they are born. It’s clear we don’t know every last molecular interaction in the human body, but we know a very large number of ways the body works. I could make this entire debunk about this one point, but this statement is simultaneously an attempt to set up antivax tropes in the next chapter and a profoundly lazy attempt to gloss over excellent medical research that has directly addressed this point. - To date, science has no definitive answers as to why one gets cancer while the other does not.
This is an entire subspecialty of genetics, the research into tumor suppressor genes. One of the roles of tumor suppressor protein p53 is exactly to help people not get cancer. One of an entire class of anticancer drugs is known as immune checkpoint inhibitors, whose invention was based upon knowing the roles of the immune checkpoints in cancer. This is a recurring theme in this entire book – the lack of reading on the part of the authors is not sufficient evidence by itself, to claim that something doesn’t exist. - Similarly, if a vaccine increased the risk of a certain side effect, the vaccine would be considered a cause of the side effect, even if it did not occur in every vaccinee.This is a distortion of what actually happens. The most contemporary example of this is the rollout of the COVID vaccines. A fair number of people on the web point to the OpenVAERS system (described in previous Turtles debunks) as evidence of mass, coordinated attempts to ignore vaccine side effects and causation. The authors almost see their own internal logical error – they explicitly say that epidemiological studies cannot prove causation on their own; they must be paired with biological studies to show a mechanism. They fail to see the error when they say, in previous chapters, to use VAERS for what it is not designed to do, which is to demonstrate causation. The sentence quote above is a veiled attempt to ask the reader to believe whatever VAERS reports say, indicate that a vaccine is causative of a side effect. VAERS has a disclaimer on its front page to remind the reader to explicitly not do this (and how to use VAERS properly is described in previous posts linked at the bottom of this page). Again, another recurring theme throughout this book is, that the readers are so disorganized that they can’t even stick to their own rulebooks.
- A typical example is the “Back to Sleep” campaign, begun in 1994, which recommended laying infants on their backs, as opposed to their stomachs or sides, in order to reduce the risk of “crib death” (SIDS). This recommendation is made despite the fact that medical science still does not know exactly why back sleeping appears to be safer for babies.
The authors neglect that current pediatric science knows a great deal about SIDS. Our brains have several automatic functions, and one of those functions is the control of breathing. In a typical adult, if we are sleeping and our airways are obstructed by something, provided the rest of the body is healthy, we’ll awake and readjust our position to sleep more effectively. How we know our brains control our breathing comes from decades of neurological research into how certain areas of the brain work; in large part this is thanks to the research of neurologists dealing with patients who survived a stroke. When certain areas of the brain were injured due to lack of oxygen, the researcher would have been able to figure out the function that is no long working, which would be a big clue into the proper function of the particular segment of brain that was injured. In infants, one of the suspected mechanisms of SIDS is the disordered control of breathing – meaning, when the infant has an airway blockage, the infant is not able to reposition quickly enough before they suffocate. Another suspected mechanism is related to the normal transmission of information from the segment of the brain controlling breathing via neurotransmitters (one of the fundamental units of information in the brain). While all the mechanisms of Sudden Infant Death Syndrome are not yet worked out, there is a campaign from the American Academy of Pediatrics to encourage as many infants as possible to be put to sleep on their backs in a spartan, toy free crib. Why? There is actual incontrovertible evidence that fewer babies died over time when the babies were put to sleep on their backs. Despite the fact that the likely multiple mechanisms of SIDS have not been worked out in their entirety, placing a baby on the back carries minimal harm to the baby. There was an opportunity to decrease infant death – and so that opportunity was taken. Research into the actual mechanisms of SIDS can occur at the same time, without having to delay giving the general public an opportunity to get an easy and cheap tool to decrease sudden infant death. The Back To Sleep campaign directly addresses one of the hypothesized mechanisms of SIDS – if the baby’s airway is blocked due to a suboptimal sleeping position (like rolled against a toy), position the baby in an unblocked position to begin with so that they don’t have to worry about a blocked airway during sleep. Inevitably, this discussion is accompanied by a discussion of why “mainstream scientists won’t admit vaccines cause SIDS” – that’s because they don’t cause SIDS. A specific statistical relationship would have been observed in the epidemiology of SIDS, and that relationship is not there. - It is important to understand – and this point will come up again later in the book – that epidemiological studies, no matter how well done, cannot rule out a causal link between two phenomena (such as a vaccine and a new autoimmune condition) for an individual.
There are quite a few relevant real life examples where this is wrong by being absolutist, and those include the rotavirus vaccine, polio vaccine, and thimerosal. An old iteration of the rotavirus vaccine was found to cause intussusception in a subset of infants who received it. The rotavirus vaccine trials used for licensure didn’t pick it up, but intussusception is not a minor affair, meaning it can cause a baby severe intestinal injury, bleeding, or death. Before that association became well known, it was feasible to both conduct epidemiological studies, and conduct research into the reason why it happens. Ultimately, the CDC discovered this valid association, and the rotavirus vaccines have been updated accordingly to decrease that risk. Actual rotavirus disease is one of the leading causes of infant mortality around the world (and one of the causes of severe life-threatening vomiting/ diarrhea in US children) – and so maintaining access to protection against this disease is critical. While rotavirus vaccine intussusception was occuring only in a small fraction of children, the vaccine community made it their duty to make the vaccines better. This was established by epidemiological and mechanistic studies working together.
The story of thiomersal goes back to the search for a safe and effective preservative for some of the early iterations of the vaccine (it reaches back to the 1930s). It is logical that vaccine manufacturers and end-users alike don’t want mold or bacteria to grow in their vaccines before they reach the arm of a patient, and so in the search for a safe and effective preservative, thiomersal was studied and used in early childhood vaccines. As time passed there were concerns for the toxicity of mercury and its relationship with autism, but the people generally expressing these concerns have a poor command of the biochemistry behind thiomersal. There is mercury metal, ethylmercury, and methylmercury, which are the three versions of mercury relevant to this discussion. When the thiomersal molecule reaches the body, it is broken down into two molecules, one of which is ethylmercury, which through the normal metabolic processes of the body, is eliminated. Methylmercury is generally a product of bacterial interactions with the metallic mercury atom, and this is stored in the body for much longer, and is part of the reason why there are intake limitation recommendations on tuna for example. Mercury metal looks nice in thermometers, but hopefully is not something that everyday people are exposed to, as this has well established toxicities. The key point here is that thiomersal, in the concentrations present in vaccines, did not have consistent evidence demonstrating that it was a genuine threat to health and safety. The preservative was removed anyway as a precaution. The corollary argument given by dedicated antivaxxers is that thiomersal is related to autism. If that were actually true (which it is not), removal of thiomersal should have caused a decrease in total yearly autism diagnoses. The actual number of diagnoses has risen, due to multiple reasons. The toxicity of something must always be analyzed in the context of the amount the human body is being exposed to, as well as its chemical format. This was established by epidemiological and mechanistic studies working together.
The story of the polio vaccine actually begins with the efforts to make an inactivated and attenuated version of the poliovirus (the Salk and Sabin vaccines). Ultimately, several companies rose to the challenge of mass producing the immunization, and initial studies indicated that this was a very safe and very effective vaccine. Crowds were coming out and lining up to receive the product, since just in the US alone, nearly every family knew someone who was paralyzed by polio. The problem came when a specific company did not inactivate their inactivated virus vaccine well enough, and mistakenly delivered live virus to some children. This caused paralysis in a subset of those children and became a significant incident known as the “Cutter incident”. Just like in all the other cases, epidemiologic studies and mechanistic studies worked together to solve the problem and in the United States, only the inactivated vaccine is currently used. The downsides of the oral polio vaccine are discussed in a later debunk dedicated to a chapter describing the “mysteries” of the polio vaccination.
One of the likely mechanisms of COVID vaccine myocarditis were not worked out in actual heart tissue until 2023, but its epidemiology and highest risk groups (teen boys and young men) was worked out by separate epidemiologists well before 2023. I have discussed the topic elsewhere, in detail, on Science Based Medicine. The reason Vioxx caused heart attacks, and was ultimately pulled off the market, was not well known initially, but the epidemiological research went on in parallel with the research into the biological mechanism.Overall, the chapter attempts to mix in the No True Scotsman fallacy, use fake experts, and attempt to engage in distortions of the truth. It was reasonable of them to include some basic lessons in epidemiology in the beginning of the chapter, but the descriptions of our major epidemiological concepts were just wrong enough that it took a discerning eye to help see where the distortions were (their attempts to set up distortions in the next chapter). Just because epidemiological studies cannot show a biological mechanism, doesn’t mean they shouldn’t be taken seriously and be used to guide studies into the biological mechanism. In the previous debunk, I illustrated how the VAERS system and accompanying vaccine safety monitoring systems detected vaccine induced thrombotic thrombocytopenia, just like they should have. Epidemiologic studies do not deserve criticism for not being able to do something that they were not designed to do, and VAERS is not the be-all and end-all of vaccine safety monitoring.
The complete series
- The Grand Debunk of the antivaxxer book “Turtles All the Way Down” (part 1/10)
- The Grand Debunk of the antivaxxer book “Turtles All the Way Down” (part 2/10)
- The Grand Debunk of the antivaxxer book “Turtles All the Way Down (part 3/10)
- The Grand Debunk of the antivaxxer book “Turtles All the Way Down (part 4/10)
