Sunday, October 01, 2017

Vaccine Aluminum: Another Antivaxxer Attempts Math

A screenshot of a scientific table caught my eye when it was shared via Twitter by an antivaxxer that I had previously described related to her difficulty with chemistry and math (Vaccine Formaldehyde:  An Antivaxxer Attempts Math).  Back then, she was "emcc2" with the same twitter profile picture but had changed her name and twitter handle not too long after that blog post (most antivaxxers are accustomed to ascribing coincidences to causality and, in this case, I admit it did make me wonder...) to "4health" aka "Vbalance03".  The discussion was regarding vaccine aluminum and a provaxxer, Dorit, had provided a study by Mitkus regarding aluminum.  4health responded:

This marked up version of the table was not from the Mitkus study in 2011.  It was a study by Yokel in 2008 and it's obvious to really anyone that it has been marked up in a way that wouldn't have been published in this form.  The date on the table (2008) also gives this away.    

The reason I recognized this screenshot is because another antivaxxer, Harold Clarkson aka RGTWINGBLKMAN aka boglethemind, is the one I assume who marked up the original Yokel table with some pretty bad math during the course of a long Twitter discussion regarding vaccine aluminum.  Harold, like all antivaxxers, claims that vaccine aluminum is dangerous and a neurotoxin that results in neuroinflammation somehow related to autism.  Harold has an issue with an extremely detailed article by a BBB (blood brain barrier) scientist I linked to about vaccine aluminum and how the bioavailability of aluminum is very small even compared to oral aluminum ingestion.

During the course of this discussion, Harold made several factual errors that he has also neglected to acknowledge to date even before this latest math disaster.

(1)  He mistakenly believed that the FDA limits for vaccine aluminum is 5 mcg/kg/day. 

What Harold never admitted to (instead playing the very Dunning-Kruger-esque "I'm educating you..." card), is that this limit is not the one established for vaccine aluminum.  This limit is for parenteral (IV) administration of aluminum - typically in the form of parenteral nutrition (TPN).  The actual limits for vaccine aluminum set by the FDA is:

Harold was the one to be educated on this point.

(2)  It gets worse.  One would assume that anyone arguing about vaccine aluminum would at least know that vaccines are not, in fact, given IV.  This fact seemed to have escaped Harold's knowledge when I pointed out to him that, by definition, vaccines cannot have 100% bioavailability because they are not given IV.  This explains why he made his error above.

(3)  Harold tries to pass off numbers from a study on aluminum by Flarend claiming that the numbers in his homemade table was "real math" from the study but, as it turns out, these were not actual figures from the study.  He backpedaled later that the numbers he originally claimed were from the study, were actually what he (incorrectly) "calculated".  

(4)  Oddly, after pointing out his dishonesty regarding his fabricated numbers from the Flarend study, he starts demanding I "retract" what I said and threatening me for unclear reasons.  When asked what I would "regret", he avoided answering.

(5)  Harold's latest claim to which he still hasn't acknowledged his basic math and logic errors, is the dissemination of the marked up table referred to above.  He continued to tweet this table several times believing himself to be clever in "correcting" Yokel's table and its use in the BBB Scientist's article.  Here it is again.

Here's a bigger version to see the wrong calculations he made.

Now, where to start.

In the purple box at the top, he's trying to adjust the table according to the amount of oral feedings that an infant takes on a roughly daily basis at around 6 months of age and average weight of 5.8 kg.  These numbers look right to me and can be corroborated in the Children's Hospital of Philadelphia page about vaccine aluminum.   (scroll down to "Quantities of aluminum in other substances")

Error #1 - Harold didn't calculate the range of daily Al absorbed for oral intake correctly.  The authors used oral intake for adults and  took the smallest daily Al exposure divided by an average weight of an adult and then multiplied by the lowest amount of absorption for the low end of the range.  Harold should have used the highest daily Al exposure (the amount he inserted for a typical 6 month old) divided by an average weight of a 6 month old and then multiplied by the highest amount of absorption for the high end of the range:

650 mcg divided by 5.8 kg then multiplied by 0.003 = 0.336 mcg/kg/day rather than 0.11 mcg/kg/day - 3 orders of magnitude higher.  This is an important error to correct.

Error #2 - in the line for vaccine aluminum amounts, in the column entitled "absorption", it says "100 eventually" which is odd to list this as (1) there is no 100% bioavailability of an IM/SQ injected vaccine (and demonstrates why there's a difference between bioavailability and absorption) and (2) the daily rate is being determined here and we know that aluminum adjuvant (AA) is absorbed very very slowly following injection.  In other words, it isn't simply absorbed in one day.  The correct absorption should be based on the Flarend study of 0.6%.  (BBB scientist explains why he came to this figure in his article). Harold missed this (or ignored it) & at one point, even tried to claim "100% bioavailability".  

Errors #3 and #4 is his calculation of the daily AA absorbed in mcg/kg/day - this one I just can't figure out why Harold chose to do it this way - it makes zero sense.  The green box demonstrates his calculation of the amount of AA in mcg/kg/day.  The authors took the aluminum concentration and, when calculating the daily aluminum exposure, used 20 injections over 6 years to determine the daily AA exposure.  For example, using the higher end for dose:

850 mcg x 20 injections divided by 2160 days (6 years) = about 8 mcg/day.  To determine the daily Al exposure in mcg/kg/day, you just divide 8 by 20 kg (the weight of an average 6 year old) = 0.4 mcg/kg/day.  (the authors assumed 100% absorption).

Harold wants to substitute vaccines given over 6 months  (rather than 6 years) and use the average weight of a 6 month old (instead of a 6 year old).  The correct math should be (for the higher end of the range):

8 mcg/day divided by 20 kg (weight the authors used) x 0.006 (the actual daily absorption from Flarend) = 0.0024 mcg/kg/d.    This number is quite a bit smaller than the higher end of the range of AA absorbed orally (the one he calculated incorrectly). To find out how much AA that is for a 6 month old, you would multiply this rate (0.0024 mcg/kg/d) by 5.8 kg (average weight of a 6 month old) = 0.01392 mcg/day.

Why Harold multiplied the daily AA absorption by 20 kg and then divided by 5.8 kg is the mystery.  That makes no mathematical sense at all as this is a rate already expressed in mcg/kg/day.

But there's a further problem that Harold seemed to ignore entirely....

Error #5 - this error was actually in his favor.  I think in his fervor to generate what he thought was a "slam dunk win" in this "corrected" table, he didn't realize that the amount of vaccine given - the AA concentration and daily AA exposure are still for a 6 year old given 20 injections.  He should have adjusted these numbers to account for the amount of AA given in the first 6 months of life.  This amount increases the calculations significantly but, in the end, given the daily bioavailability of about 0.6%, it's still not as much as what a child can consume on the high range of oral intake.

The correct numbers would be (at least in my office):

Al "concentration" = hep b x 1, pediarix x 3, prev x 3, HiB x 2 = 500 mcg (I'm using the highest possible - it's actually usually 250 mcg) + (850 mcg x 3) + (225 mcg x 2) + (125 mcg x 3) = 3875 mcg

Daily Al exposure = 3875 mcg divided by 180 days = 21.5 mcg.

Using a daily bioavailability of 0.6%, the amount of daily AA absorbed = 21.5 divided by 5.8 kg x 0.006 = 0.022 mcg/kg/day.  

Comparing this number to what's absorbed via ingestion, AA exposure is either 3x more via vaccine OR 15 times less than ingestion depending on whether an infant is breastfed or formula (soy) fed.  A corrected table would look like this:

Admittedly, you can argue about the use of Flarend's 0.6% daily bioavailability given that some of the vaccine doses are given on the same day, but what I'm really just addressing is the math Harold presented and why both his math and his logic was deeply flawed and frankly in error.

I've waited 3 days for Harold to come forward and admit his math errors and finally just got tired of asking him to do it for himself.  I assume that he couldn't reconcile his own math which was clearly wrong.  This is just another example of antivaxxers who lack the basic knowledge of pharmacology, immunology, and, well, math but choose to argue against vaccines anyways.  Poorly done, at that, and certainly not to their credit.  

***edited to add (1 October 2017):  Now Harold believes that I am the author of the BBB Scientist article about vaccine aluminum.  I just had to throw this in as yet another error that he's made in the course of this long exchange.  And because it's just plain funny.

 ***edited to add (6 October 2017):  Now Harold believes I'm a "bot" and has made a "formal request" to have his "rebuttal" added to my blog.  He's even resorted to making threats as well.  This just keeps getting more entertaining....

Thursday, July 13, 2017

Day 9 (1 July 2017) – Guayaquil, Ecuador to OKC - Adventures by Disney Ecuador and Galapagos Islands Tour (23 Jun – 2 July 2017)

For the first time in over a week since we started our Adventure, we slept in a bit this morning.  We didn't really have any plans and our flight didn't leave until almost 11 pm.  I spent part of the morning working on my blog and researching things to do in Guayaquil.  When Seth and Rhys finally got up, we decided to just have some lunch at the hotel before heading out to do a little sightseeing.  We got packed up, left our suitcases with the bell desk, and went to the hotel cafe where we just had the buffet which featured a lot of traditional Ecuadorian food including empanadas, fried fish, fried plantains, ceviche, etc.  It was quite good but very expensive - the buffet lunch for the 3 of us was over $100.

I had looked it up online and decided that we could climb the 300+ Las Penas steps up the Santa Ana hill then walk the Malecon to the iguana park.  It was all within a few miles of each other so we took a taxi from the hotel to Las Penas. 

A word about the taxis in Guayaquil.  I had also looked into whether Uber was a better option but reviews said that taxis were plentiful and inexpensive which turned out to be very true.  We never paid more than $4-5 for each trip we made.

It took us a little bit to find the steps - we actually went up one way and came down the actual steps.  This part of Guayaquil was really neat - little public areas everywhere.  

We climbed to the top of the hill where there was a light house and a church.  We climbed some more up to the top of the lighthouse - the view was pretty cool.

On the way down the actual steps, we could see that they were numbered.  We also went by a local who was selling crabs out of a bag.  I just had to find out how much the crabs were so I asked another local how much he was selling them for.  They were 5 crabs for $1!! I couldn't believe it.

I wasn't quite sure what the Malecon was - I thought it was a big shopping center but now in retrospect, I think it was just the big public area or "mall" that went right along the river.  It was a nice walk.

We soon got to the iguana park - there were so many of them everywhere and they let us get pretty close to them. People were feeding them banana peels and lettuce.  They were a lot like the lava lizards in that when they got upset or mad, they started doing "push ups".

We walked around for a bit until we found a taxi and took it to the Mall de Sol that we had seen from the bus on the way to the hotel.  We figured there would be someplace to eat in this mall and decided to try the Noe Sushi Bar but it turned out that the restaurant wasn't actually in the mall so we hopped on another taxi to the restaurant.  The sushi was pretty good.

We took one more taxi back to our hotel and then hung out in the lobby as we waited for our ride to the airport.  Lauren met us in the lobby and let us know that our flight was delayed - it would be almost midnight before we would be leaving but everyone decided to go ahead and head for the airport at the appointed time.  This was not a big deal as we were flying business class and had access to the airport lounge where we hung out for a couple of hours.  The flight to Miami was great - the business class seats on this plane were awesome but we arrived into Miami over an hour late and knew that we would miss our connecting flight.  Fortunately, they were able to re-route us through Dallas and we still ended up getting home around the same time.

This was a fantastic trip.  I was dreading the snorkeling but after a few times, I felt much more confident in the water.  I'm so glad that Rhys chose this trip and am most impressed with the conservation of the Galapagos Islands.  There was very little in the way of a time change so no jet lag, the currency and electrical currents were the same as the US which was great.   Our Guides, Lauren and Robby, were really fabulous - just as we've always come to expect from Disney and what makes Adventures by Disney stand out.  We're looking forward to our next Adventure in 2018:  an Adult Exclusive Adventures by Disney trip to China for Seth's 50th birthday.

Monday, July 10, 2017

Day 8 (30 June 2017) – San Cristobal to Guayaquil, Ecaudor - Adventures by Disney Ecuador and Galapagos Islands Tour (23 Jun – 2 July 2017)

This time, both Seth and I were up at around 5:30 am as it was just starting to get light outside. We finished our packing and then headed off to the library to get some coffee. We went upstairs to upper deck and could see that we had already arrived into San Cristobal. We realized this was the first time all week we had seen houses or buildings. The frigates were all circling above us.

We went downstairs for our last breakfast on the ship and Lauren found us and gave us our certificates for having crossed the equator on a ship. Plenty of people cross the equator on a plane but not many do it on a boat. We had crossed from the southern hemisphere where we landed (Baltra) and the crossed back to the northers hemisphere in the middle of the night the other day.

We ate our breakfast pretty leisurely (we actually found out from Lauren and Robby that there are ABD “black lists” and apparently you have to do something pretty egregious to be black listed from ABD) and then made a final check of our cabin, grabbed our carry ons, and then headed to the library to wait for our group to deboard. Robby let us know that the ship was preparing special packets for us of food for lunch which we picked up from reception on our way down to the pangas. It was the last time that dolphins and frigates would be called and I’m sure we’ll all miss those bulky red life vests we had to wear almost every time we boarded a panga.

We boarded the pangas and said goodbye to the Santa Cruz II. We were headed to the pier where we were told was like sea lion city and, indeed, we did see a bunch of sea lions playing in the water as well as some just laying on the steps. We dropped off our larger carry on bags that they kept for us in the back of a pick up truck while we were on our last excursion to the tortoise preserve.

The ride on the bus to the tortoise reserve took about 45 minutes but the cool breeze coming into the bus felt great. There seemed to be orange trees everywhere.

Once we arrived at the tortoise preserve, we went through the front gate and were immediately treated to a huge tortoise just inside the gate. At first, I thought it was a statue until it’s head moved. We were guided one last time by Indi who explained all about the tortoises, their funny, saddle shaped shells, how to tell their age (older = fainter lines on the shell that had been rubbed off with time) and how to tell their gender (males have much bigger tails). The adult males are much much bigger than the females weighing up to 600+ pounds. They moved very very slowly.

We were taken on the trail and saw a few tortoises along the way until we reached the back of the preserve where the young tortoises were kept. We were told that they had about 50+ adult tortoises and about 109 baby tortoises in the preserve. Tortoises usually just deposit their eggs and leave them to hatch on their own providing no protection to the hatchlings so at this preserve, the eggs are picked up, marked, and put in incubators until they hatch. Apparently, the gender of the tortoise can be determined by how warm the eggs are kept which I found to be fascinating. The new baby tortoises go through different areas of the nursery from boxed enclosures for the first few years to small outdoor enclosures for another few years, and then when they’re older, they are released to the general population of tortoises or to the wild on the island.

We headed back towards the front of the park via a different path and come upon several areas where the tortoises were being fed. It was amazing to see them so up close.

When we reached the front of the sanctuary, we had the opportunity to use the bathroom one more time before reboarding the bus. We were taken back into town and dropped off to do a little shopping – only about 30 minutes or so. We picked up a few small souvenirs – a tea bag box for Amina, some magnets, some stickers, couple shirts and a cap for Seth.

Meeting back at the point where we were dropped off, we boarded different buses this time to get to the airport which really wasn’t very far at all – we could have walked it. We picked up our carry ons and then checked our luggage in. We went through security and then sat in a large room waiting to board but it turns out that the flight into San Cristobal was delayed due to mechanical reasons so we had an extra hour wait. It was a good thing we got those lunch bags – we ate our lunches and then the airline actually gave us some juice and snacks as well. Our plane finally arrived and we boarded from both the front and back of the plane so that went a lot faster.

The flight to Guayaquil was pretty unremarkable. When we arrived, we made our to way to baggage claim and picked up our suitcases then followed Robby and Lauren out of the airport onto a waiting bus. Porters took our suitcases in the airport and loaded them on the bus for us.

The ride to the hotel took the better part of an hour in Guayaquil – the largest city in Ecuador. The traffic was interesting – there are no lane lines marked on the streets. We checked into the Hilton which was packed with people – there was some sort of veterinarian conference going on at the same time. The rooms are nice and spacious. We waited for our suitcases to arrive and then headed downstairs to the bar with our complimentary drink vouchers to grab a drink before we met the rest of the Adventurers in the lobby at 6:30 for the last time. They took us to the Portofino restaurant in the hotel which was closed just for our event.

For dinner, I had the Serrano ham with melon, a seafood bisque, tenderloin with baked potato, and crunchy apple pie for dessert.

 We enjoyed 2 guitars who played traditional Ecuadorian music as well as 2 dancers who did some traditional dances for us during dinner. We were also given our final pin of the trip.

After dinner, we viewed the slide show from the trip which is always a nice recap of everything we did all week. What was particularly awesome was that after the slide show, Lauren air dropped some picture postcards, instructions on accessing all the pictures from the trip online, as well as a copy of the slide show video to each of us. That was particularly nice because our internet connection at home isn’t the greatest and it probably would have taken ages to get that video downloaded.  *edited to add:  our Adventures by Disney Farewell video slide show has now been uploaded to my smugmug account.

We were given our departure information. Some families had a very early flight at 6 am for which they would need to leave the hotel at around 3:30 am. (OUCH!). Our flight didn’t leave until almost 11 pm so we had the entire day to spend in Guayaquil. Late check out was 2 pm or until 6 pm for an additional $100. We had no plans and I know Rhys and Seth were looking forward to sleeping in.

We said goodbyes and exchanged hugs with our fellow Adventurers. We also got a copy of everyone’s email addresses. Guide tip envelopes were passed out. As always, this Adventures by Disney trip introduced us to some of the nicest people and we seemed to really click with several of the families. Nobody loves the end of a vacation but I’m so glad for the things that we saw and the people that we met.  

Next post:  Day 9, 1 July 2017 - Guayaquil, Ecuador to OKC