The recent Digital Clubbing column on anti-vaxxers, was not primarily about Professor Tim Noakes, writes Alastair McAlpine. 'But it necessarily included him because, any way you slice it, he has been publicly spreading dangerous and untrue information about vaccines. And his letter to MedicalBrief simply compounds the error…’
Professor Tim Noakes is not just another “researcher”. In fact, along with Professor Lee Berger, and maybe Professors Ross Tucker, Bongani Mayosi, and Heather Zar, he is the closest thing South Africa has to a "rock star" scientist. What he says and writes carries weight. It is absolutely no coincidence that the low carbohydrate high fat (LCHF) diet that he so enthusiastically promotes is now a commonplace phrase in South Africa. Because he is a household name, ideas he espouses will necessarily be more closely scrutinised than most, especially when these ideas are controversial, or go against scientific consensus.
On a personal note, I was lectured by Professor Noakes in second year at the University of Cape Town (UCT). He gave some lectures on physiology and sports medicine, and I still have a paper of mine that he marked, where I had answered a question on the benefits of running enthusiastically and correctly. ‘Great answer! Thought about a career in sports science?’ he scribbled in the margin. I was beaming: a great scientist had taken the time to encourage a lowly medical student. In addition, as an enthusiastic (albeit mediocre) ultra-marathon runner, I have read ‘Lore of Running’ twice. Noakes’ description of running the Comrades Marathon is one of the finest ever penned – true, and beautiful.
Digital Clubbing was not created to belittle or besmirch Professor Noakes. It’s a column where bad science that can potentially harm people, especially in a local setting, is examined and critiqued. There are no sacred cows, and I will not shy away from honest criticism, regardless of the stature of those I’m criticising. I make no apologies for the fact that nutritional science and vaccines are close to my heart, so it is perhaps inevitable that we have butted heads. It is also my responsibility to my patients and to the readers to show that even great scientists can err. Because, make no mistake, vaccine denialism is on a par with Aids denialism in terms of how unscientific it is.
The last column, on anti-vaxxers, was not about Tim Noakes. But it necessarily included him because, any way you slice it, he has been publicly spreading dangerous and untrue information about vaccines. And his letter to MedicalBrief simply compounds the error.
I was really hoping to write about something else this week, but Noakes’ letter is so ill-conceived, and replete with errors, and his stance on vaccines so ambivalent and worrying, that we need to delve into just what he has been promoting.
In philosophy, there is something called the “duck test”: ‘If it looks like a duck, swims like a duck and quacks like a duck, it probably is a duck’. This idea is designed to show that if people behave in a certain way, you can usually make a reasonable guess about their identity.
Professor Noakes says he is not "anti-vaxx", but his actions and behaviour on Twitter and in public would suggest that he is at the very least a vaccine-sceptic, and his letter this week only demonstrates that further.
His views first became worrying when he tweeted on 23 August 2014, "Dishonest science. Proven link between autism and early immunisation covered up?" The tweet linked to an article that purported to show that a "whistleblower" in the US Centers for Disease Control had identified that a sub-group of individuals (in this instance, African-Americans) were at a high risk for developing autism after the measles, mumps and rubella (MMR) vaccine. The claim was completely bogus, of course, and is a classic example of what happens when people with an agenda (in this case, Brian Hooker and Andrew Wakefield) retrospectively torture the data enough: it will confess to something, if only by chance (amusingly, they do NOT report that every other sub-group showed NO association between MMR and autism).
Hooker and Wakefield are both notorious anti-vaxx advocates. Both have had papers retracted due to serious methodological flaws (the Hooker "whistleblower" piece that Noakes linked to has been retracted). Both have appeared in the overt anti-vaxx propaganda film, Vaxxed – From Cover-Up to Catastrophe.
The report was thoroughly debunked, by many sources, including David Gorski at Science Based Medicine. Noakes was criticised by many – including by Nathan Geffen from GroundUp in an article Tim Noakes and the responsibility of experts – but never apologised nor retracted the tweet, instead responding that he was merely drawing attention to scientific malfeasance.
When challenged about these tweets, Noakes responded to me: "What we should be hearing from you, sir", and linked me to a study by the same Hooker, that purported to show that thimerosal in vaccines renders them unsafe. There are just two problems: except for the flu vaccine, none of the current childhood vaccines contain thimerosal, and repeated studies have shown the compound itself to be safe.
He has repeatedly linked to articles by Mark Hyman and Joseph Mercola, both of whom are known anti-vaccine advocates, and responded to journalist Katharine Child’s assertion that "vaccines do work" by linking her to a known anti-vaxx book called Dissolving Illusions: Disease, Vaccines and the Forgotten History– an anti-vaxx text by a Suzanne Humphries, that apparently shows the "ineffectiveness" of vaccines, but has in reality been thoroughly debunked.
Last year, he did an interview with Gareth Cliff, where he expressed extremely worrying views. I won’t go into it in detail, because Jacques Rousseau has done a fine job already, but it was clear that Noakes was deviating further and further from good science, and he confirmed this when he advised his Twitter followers that he had important information on vaccines, but that he was unwilling to share it publicly because "The activists (who have no interest in the truth)" might smear him. "I think you might be very disturbed", he finished.
Finally, when we look at Noakes’ letter, a number of worrying issues emerge. As noted in my article, anti-vaxx sentiment assumes many guises, and I am happy to concede that Noakes does not fall on the extreme end of the spectrum (he does not reject all vaccines). But it is clear that he has serious issues with many of them, particularly modern ones. The issue is: are these beliefs reasonable?
He states that "our profession is under increasing marketing pressure to presume that there are no long-term health consequences associated with the growing promotion of vaccinations for a range of illnesses that were not considered targets of immunisation when I was growing up." He then states that since he and other survived quite well without them, do we need them?
When Tim Noakes was six-years-old, there were 693,803 cases of measles in the UK. Thanks to the vaccine, that number is now down to 1,642. Measles vaccination has resulted in an 84% drop in deaths between 2000 and 2016.
Rotavirus was the number one cause of diarrhoeal disease in South African children. The new rotavirus vaccine reduces hospitalisation from severe diarrhoeal disease by between and 45 and 80%, and up to 96% in those vaccinated under 1-year, and has been estimated to have saved 170,000 deaths per year, with no significant side effects noted.
The new pneumococcal vaccine reduces invasive pneumococcal disease by 89%, with less dramatic, but no less important, effects on otitis media and pneumonia.
Hepatitis B vaccine provides protective antibodies in >95% of individuals, and countries where Hepatitis B was endemic, such as Taiwan, have brought their cases of Hepatitis B infected individuals from 9.8% to 0.7% in just 20 years after universal coverage was introduced.
The meningococcal vaccine (not part of the public-sector schedule in South Africa, but available in private) is effective in 69% of cases in the first 8 years.
In terms of safety, numerous studies have shown that vaccines, while not 100% safe (nothing in life is), are generally well-tolerated, and that serious adverse effects are very rare.[5-7] There is also strong evidence that the MMR vaccine is NOT associated with autism.
The list goes on and on. Vaccines are generally safe and reduce both mortality and morbidity. So which diseases that he "survived quite well without" would Noakes not wish to vaccinate against? Which vaccines, exactly, would he ‘cull’ from the current childhood schedule? And why?
He goes on to correctly state that serious side effects of vaccine are rare (0.000001% to be exact) but raises issues about “less obvious damage to health”. And, it’s here where things really fall apart. He quotes a study from Mawson and colleagues which seems to show that children who were vaccinated were more likely to suffer allergies and other maladies.
So, let’s look at this study. Firstly, Noakes always talks about conflicts of interests and how these can affect outcomes. This one was sponsored by a known anti-vaccine group, associated with anti-vaxx advocate and failed actress Jenny McCarthy, "Generation Rescue". The author, Anthony Mawson, is a vocal defender of the MMR hoax perpetrator, Wakefield, and has even defended his original study which is now acknowledged as a fraud.
The article was initially published as an abstract on a predatory "pay to publish" journal but was retracted due to numerous errors. It appeared again in another low-tier journal, the Journal of Translational Science, before it was retracted again. It was, hilariously, peer-reviewed by a chiropractor.
So far, so dodgy, but it gets worse. The author claims the study was cross-sectional, but in reality, it only focused on home-schooled children, which introduces significant confounders into the group: home-schooled children are less likely to be vaccinated and their parents have different health-seeking behaviour than school-going kids. It was relatively small (666 subjects) and data was obtained by a survey.
That only a third of the children were fully vaccinated demonstrates that this cohort was in no way representative of children in the US.
Also, asking parents to remember when their children got sick is notoriously unreliable, especially when no attempt to verify their illnesses was made.
The paper also claims that vaccines in pre-term infants was associated with (duh duh duh…), neuro-developmental delay. The only problem is, pre-term infants are known to be at a high risk for neuro-developmental delay already. Mawson’s numbers are so low, and his use of statistics so suspect, that any links he may have drawn have to be taken with a huge pinch of salt.
So, what do we have from Noakes to back up his claim that vaccines are deleterious to children’s health? A single study, retracted twice, by a known Wakefield supporter, involving a small, unrepresentative sample, with multiple confounders, and questionable use of statistics. That he thinks this study is in any way persuasive, given the massive body of evidence showing benefit, is laughable.
His other reference is a link to a known anti-vaxx website, which cherry-picked a whole bunch of bizarre studies to support their agenda. For someone who claims not to be anti-vaxx, Noakes sure does link to a lot of questionable websites.
To wrap up: what we have is perhaps the most prominent scientist in the country, with enormous gravitas among many in the general public, who has repeatedly, and unreservedly, used public platforms to express views that are vaccine-hesitant at best, and outright anti-vaxx at worst. He may say he isn’t antivaxx, but his actions demonstrate the opposite, and could cause real harm to some of the most vulnerable in our society – children. Instead of lashing out at the messenger who points this out, he would do well to reflect, and hopefully, stop his damaging message.1. Parker SK, Schwartz B, Todd J, Pickering LK. Thimerosal-containing vaccines and autistic spectrum disorder: a critical review of published original data. Pediatrics. 2004;114(3):793-804. 2. Velazquez RF, Linhares AC, Munoz S, et al. Efficacy, safety and effectiveness of licensed rotavirus vaccines: a systematic review and meta-analysis for Latin America and the Caribbean. BMC Pediatr. 2017;17(1):14. 3. Pavia M, Bianco A, Nobile CG, Marinelli P, Angelillo IF. Efficacy of pneumococcal vaccination in children younger than 24 months: a meta-analysis. Pediatrics. 2009;123(6):e1103-1110. 4. Ni YH, Chen DS. Hepatitis B vaccination in children: the Taiwan experience. Pathol Biol (Paris). 2010;58(4):296-300. 5. Maglione MA, Das L, Raaen L, et al. Safety of vaccines used for routine immunization of U.S. children: a systematic review. Pediatrics. 2014;134(2):325-337. 6. Braun MM, Mootrey GT, Salive ME, Chen RT, Ellenberg SS. Infant immunization with acellular pertussis vaccines in the United States: assessment of the first two years' data from the Vaccine Adverse Event Reporting System (VAERS). Pediatrics. 2000;106(4):E51.
7. Halsey NA, Hyman SL. Measles-mumps-rubella vaccine and autistic spectrum disorder: report from the New Challenges in Childhood Immunizations Conference convened in Oak Brook, Illinois, June 12-13, 2000. Pediatrics. 2001;107(5):E84. Noakes Letter[/link] Aided by the likes of Noakes, anti-vaxxers are causing real damage[/link]