Peter Gotzsche is no crank. Rather the opposite, in fact. In the world of evidence based medicine, he is one of the great heavyweights. He was a founding member of the Cochrane collaboration, is a professor of clinical research methodology at the university of Copenhagen, and has had his work repeatedly published in all the leading medical journals. His blunt honesty and willingness to speak truth to power, even in the face of personal consequences, makes him one of my personal heroes.
One year ago, Gotzsche came out with a book called ”Vaccines: truth, lies, and controversy”. Considering how hot the topic of vaccines is, you would expect the book to have be selling at a furious rate ever since it came out. Instead, it languishes in obscurity. The problem, in my estimation, is that it is too brutally honest, and that it therefore pleases no-one
No-one wants a balanced take. Most of the people who write and talk about vaccines are fundamentalists, of either the anti-vaccine or pro-vaccine variety. The anti-vaccine fundamentalists control the debate on social media (or at least they did until social media started actively censoring them), while the pro-vaccine fundamentalists control the debate in mainstream media. Both groups are only interested in reading and talking about books that feed their biases and further their one-sided agenda. But most people aren’t fundamentalists. They just want to know the truth. Which is why the book is so important.
Gotzsche begins with the sacred cow of the anti-vaccine fundamentalists, the belief that the MMR (meases mumps rubella) vaccine can cause autism. He goes in detail through the sequence of events surrounding the profit-driven scientific fraud that led to this now widespread and yet utterly false belief, making particular note of how this fraud was enabled and supported by The Lancet, which is in spite of this is still considered one of the most prestigious medical journals in the world. Apparently there is nothing a major medical journal can do that will result in a loss of its reputation. He then goes through the epidemiological evidence, much of which has been conducted in Gotszches home country of Denmark, showing that there is no link whatsoever between MMR vaccination and autism.
Immediately after destroying this central tenet of anti-vaccine fundamentalism, Gotzsche switches focus, and, after a brief interlude to discuss how morally reprehensible attempts at coercing people in to getting vaccinated are (politicians should take note!), he tears in to one of the sacred cows of the pro-vaccine fundamentalists, the belief that the influenza vaccine is beneficial and important. Over the course of a few chapters, he clarifies the evidence that exists on the influenza vaccine, going through the randomized trials and systematic reviews, and showing that there is no good evidence that the influenza vaccine has any effect on the things that matter, namely hospitalizations and deaths, nor for that matter any evidence that it does anything at all for the elderly.
Of course, this isn’t what the CDC (Centers for Disease Control) claims. With multiple examples, Gotzsche shows how the CDC website is rife with misinformation that would make even a pharmaceutical company blush. He lays out the close ties that exist between the CDC and the pharmaceutical industry. Then he shows how the CDC consistently ignores the higher quality evidence (randomized controlled trials) showing that the influenza vaccine is largely useless, and may even do more harm than good, while instead focusing on low quality evidence (observational studies, and in particular case-control studies which are notoriously unreliable) that do show benefit. I have personally noticed the CDC doing exactly the same thing with the scientific evidence of face masks. It is clear that the CDC (just like many other public health agencies) will produce the results it’s political and financial masters want, whatever those results may be, and regardless of whether they align with the science.
After discussing the influenza vaccine, Gotzsche moves on to the HPV (human papilloma virus) vaccine. This is a vaccine that is primarily given to pre-pubescent girls, with the goal of protecting them from developing cervix cancer (which is usually causes by certain strains of HPV). He goes in detail in to how the pharmaceutical companies have manipulated their trials and the subsequent post-approval surveillance in such a way as to hide evidence of harms. He also shows how the EMA (European Medical Agency) has been complicit in this, and how the agency has done it’s utmost to downplay evidence of harm once it started to appear, acting more like a shill of the pharmaceutical industry than an independent regulator. Gotzsche’s own research group has done research which suggests that roughly one in 1,000 people vaccinated with the HPV vaccine develop a serious neurological disorder as a result. Since you need to vaccinate several thousand people to prevent one death from cervix cancer, it is not at all clear that the benefit of the vaccine outweighs the harms.
Gotzsche moves on to a discussion of the vaccine for Japanese encephalitis, as a kind of teaching exercise. Since it is clear that government agencies cannot be trusted to provide balanced information, people will often have to look in to the scientific data themselves, and the chapter on Japanese encephalitis is a kind of tutorial on how to do this. For those who aren’t willing to do this kind of legwork, Gotzsche has a simple rule of thumb: If every country with an equivalent level of economic development recommends the vaccine, then it’s probably worth taking. If not, then it probably isn’t.
The main message of the book is that both the anti-vaccine fundamentalists and the pro-vaccine fundamentalists are wrong. To say that all vaccines are bad is idiotic. To say that all vaccines are good is equally idiotic. One needs to look at each vaccine individually, and weigh one’s personal risk of infection, and of serious disease if one should be infected, against the particular risks of harm specific to the vaccine.
There are many quotes in the book that I love, and which have immediate bearing on all the nonsense of the past year, such as the following: ”An expert panel is the modern version of the Oracle in Delphi, and statistical modelling is like whispering in a wizard’s ear which result you would like to hear.” Quite.
As mentioned, the book is intent on pleasing no-one. Which is probably why I like it so much. In some ways, Gotzsche reminds me a bit of Ignasz Semmelweiss, the doctor who discovered that obstetricians were killing women by delivering babies with dirty hands, and that this could easily be avoided with hand-washing, but who managed to alienate all his colleagues by calling them idiots and murderers, and thus was unable to get them to change their practice. This resulted in a delay of decades before Joseph Lister, a much more socially competent man, was able to convince his colleagues to start washing their hands before surgery.
I think most doctors are unaware that vaccines can be dangerous, and that benefits and risks therefore need to be balanced carefully. During my years in medical school, vaccinations were always presented as 100% a good thing. I don’t think I even once heard anything about the risks related to a vaccine that is in current use. I think that’s why many doctors will tend to lump anyone who in even the mildest way tries to lift the issue of risks associated with a vaccine as an ”anti-vaxxer”, and why doctors have been so unhesitant when it comes to vaccinating entire populations with an unproven new vaccine.
It is a shame that the book came out just as the covid pandemic was ramping up, and thus doesn’t have anything to say on the covid vaccines that are now in use or on the coercive ”vaccine passports”. Regardless, the contents of the book couldn’t possibly be more relevant to the present moment, when massive numbers of people are being pressured to take experimental vaccines of which we still only have a limited understanding. For that reason, the book deserves to be read and discussed widely.