The Introduction

I didn't intend for this to be a long post, but I guess I am long winded. The intro to this book sets out what the later chapters will discuss. As such it's appropriately light on facts. There were a few statements, however, that stood out to me as worth commenting on. Namely:

1. Siri's implication that you should trust him as a vaccine lawyer more than a vaccine scientist
2. Siri's description of anti-vaxx and pro-vaxx parents
3. Siri's asinine claim that he is not biased against vaccines

He also sets up the coming attractions for later sections of the book in a way that has me dreading the next stretch of his writing.

Scientists v Lawyers

Siri mentions that as a lawyer he his held to a higher standard of evidence than medical researchers. This is risible. It implies either a complete misunderstanding of academic research or a complete misunderstanding of standards of evidence in court. The two standards are orthogonal so comparing the two is an apples to oranges comparison in my opinion. But since Siri brought it up let's briefly compare the court and scientific experiment as methods of arriving at the truth of natural phenomena. As Siri is a lawyer who as far as I know practices exclusively in civil court, I will be using the standards of civil law here.

Civil Law

Civil cases in the United States attempt to adjudicate disagreements between two parties in order to determine which one is more likely to have the law on their side. Prevailing in a civil trial can happen by convincing the finder of fact (can be a judge or jury, depending on the specifics of the case) that the facts are on your side by a preponderance of the available evidence. In the case of a jury trial in California at least you must convince 9 of the jurors that the facts are more likely than not on your side. You can also prevail by convincing the judge that even if the facts your opponent alleges are all on their side it wouldn't matter because it wouldn't amount to violating any law.

For a simplified example if my neighbor sues me for defamation for calling him a "piece of shit" I could prevail by disputing the facts: showing that I didn't in fact call him a "piece of shit" or that my calling him a "piece of shit" didn't cause him actual harm, or that he was literally actually a "piece of shit" (this last one would probably be difficult). I could also prevail by convincing the judge that even if I called him a "piece of shit" and it caused him harm that my assertion that he was a "piece of shit" was not a factual claim but merely my opinion, and therefore not defamation. In order for my neighbor to prevail he would need to establish the facts: that I called him a "piece of shit", that he is not actually a "piece of shit", and that my calling him a "piece of shit" caused him real damages, by convincing the judge or jury that those facts are both more likely than not true. He would also need to convince the judge that calling someone a "piece of shit" is a literal factual claim and not just a figure of speech or a matter of opinion.

When it comes time for a court to make a determination about the nature of reality, they rely on expert testimony. So if a court has a case that hinges on whether a vaccine side effect was the source of harm for a child, both sides will call experts with as much relevant experience as possible to testify as to whether they think the vaccine caused the harm. The outcome may then hinge on which of the experts has a more impressive resume or gives a more convincing testimony. This is obviously a flawed way to get at the truth, but it's flawed in ways that make sense given that judges and juries cannot be made to be knowledgeable on the state of the art of a given vaccine in order to rule on a case. It also may explain why Siri seems to think attacking the character of these experts is a valid way to attack the notion of vaccination. After all, implying a conflict of interest is a good way to discredit your opponent's expert testimony.

This process is good at what it's good at, but as a determinant of truth about the world it leaves a lot to be desired. The standard of proof is necessarily quite low because it's an attempt to resolve a dispute. One party has to win and one party has to lose so it's fair that the standard of evidence is just "more likely than not", but that standard is really weak for determining the nature of reality. It also uses either a judge or a jury to decide who proved those facts more effectively. This nod to democracy is nice in order to make the process feel fair and democratic to those whose livelihoods may depend on the outcome of a civil trial, but truth isn't the sort of thing that's up to a vote and convincing 9 random citizens of something doesn't mean much in terms of whether it's true.

Clinical research trials

The clinical research trial process, on the other hand, is designed to give us a good understanding of natural phenomena. Specifically it is good at telling whether a given drug is effective at treating a certain condition, and at identifying what common side effects may arise from taking the drug. It involves numerous rounds of development and testing before moving on to animal trials and then finally 3 or sometimes 4 rounds of human clinical trials. For a drug to pass a round of this trial that round needs to collect statistically significant evidence that the drug is safe and effective when compared to the current best alternative. There are a number of ways to determine statistical significance, one of the most widely used is having a p-value of 0.05 or less. This means that any related data in the study needs to have less than a 5% chance of occurring if the variables are in fact unrelated. Since there are at minimum 3 rounds of clinical research trials in humans, that should mean that at the end of a well designed trial there should be less than a 0.0125% chance that a given result is by chance.

This is a process that is not without valid criticism. The replication crisis, p-hacking, the need for participants to volunteer instead of being randomly selected from the population, and the expense of the process necessitating a big-money sponsor to test a new drug are all issues that have been brought up in good faith. None of these invalidate the entire field medical science. If the argument that Siri is going to make is something like that the government should fund an independent medical research organization to run parallel stage 3 trials to ensure that drugs that are brought to market are independently verified then I probably don't have a lot of disagreement with him. I suspect he's going to instead insist that we simply ignore that the studies show that vaccines are safe and effective ways of limiting the spread and impact of infectious diseases because the clinical trial process is not, in fact, perfect.

Parents

Here Siri points out how brave, intelligent, brave, smart, sexy, brave, and brilliant anti-vaxx parents are compared to the sheep who vaccinate their children. This has the chapter's only citation, to support the idea that more educated parents are less likely to vaccinate their kids. I'm going to assume this is true for the sake of argument, because it is not relevant to the truth of the matter as far as I'm concerned, and because it makes sense that it would be true. It's still the case that the vast majority of educated parents choose to get the full schedule of vaccinations for their kids. Being educated also doesn't mean that they are correct. After all the most educated people in the world on vaccine research are the vaccine researchers that this book is claiming cannot be trusted.

He also claims that anti-vax parents are more informed than parents who get their kids vaccinated on the data behind vaccinations. I have no doubt this is true. The point of public health policy is to get people to make the right decision without having to think about it. If you're anti-vaxx it's because you care about the issue more than the average person so you probably read about it more than the average person. In the same way I suspect the average flat-earther is more informed than the typical person of the experimental evidence that proves the earth is round, because you have to know quite a lot about the arguments for the status-quo in order to have even remotely convincing arguments against it.

Siri also briefly points out that we expect parents to research safety of things like car seats and bassinets so we should also expect more parents to research vaccine safety. This is a false equivalence. The way parents research car seats and bassinets is to look up what car seats and bassinets are endorsed by the expert organizations that research car crashes and safe sleep respectively. They do not typically pore through car crash data or scientific papers on SIDS risk. The equivalent research for vaccines would be to look on the CDC's website, see the vaccine schedule that they recommend and then ask their pediatrician for something like that, maybe bringing up some modest concerns like "I'd like to delay the hepatitis B vaccine given that the mother has tested negative, could we administer that at 6 months instead of at birth?".

Bias

In the final section of the intro Siri discusses his own bias. According to him, he is biased only towards parents having the freedom to choose whether or not to vaccinate. I can't know whether he himself believes this, but this claim is absurd. While we can't know what's inside someone else's head, we can look at the evidence we do have for bias and on that basis if anyone is biased against vaccines, Aaron Siri is biased against vaccines.

Aaron Siri has a clear financial interest in anti-vaxxers being right. He is a partner at a law firm that specializes in lawsuits about vaccine injuries. If everyone agrees that vaccines are overwhelmingly safe and effective then this business is going to be limited to only a small number of modest lawsuits. If vaccines are believed to be unsafe then huge class action lawsuits against the agencies who pushed them on people are in the cards.

Aaron Siri clearly started writing this book after already believing that vaccines were harmful. At some point he may have started researching vaccines with the only bias towards "freedom". That point definitely predates him becoming partner at a law firm that specializes in Vaccine Injury litigation. To be clear: in a vacuum this is fine. Vaccines can cause injuries, and people injured by vaccines deserve to be made whole. But Aaron Siri did not at any point during the writing of this book have a neutral perspective on the topic.

Perhaps most importantly, if vaccines are overwhelmingly safe and effective then Aaron Siri's recent status as an anti-vaxx figurehead has involved him increasing the number of sick and dead children for profit. That isn't his intent, but if he's wrong about vaccines that is what he has accomplished. If the data does show that vaccines are safe and effective then in order for Siri to accept that he would have to accept that the world would be a better place if he had never been born. This is a tough pill for anyone to swallow so I cannot imagine it does not bias his thinking when looking at the data.

Coming up

He ends his intro saying he would "love to jump into vaccine safety because it is probably the most interesting part of the book". For once I agree with him so I was extremely annoyed when he said he's instead going to spend the first two or three parts of the book not talking about the data on how safe and effective vaccines are. Frankly, this makes me feel like 1/2 to 3/4ths of the book are going to be a waste of time. I don't care about the individual "experts". I have no idea how nice, honest, or caring a person Jonas Salk was. He may have in his personal life been a saint or a monster, it does not matter to me. I care that before the polio vaccine was developed thousands of people were sickened and hundreds killed by the disease every year in the US, and since its introduction those numbers have dropped to 0 most years. The US has seen 3 polio deaths in my entire lifetime. In the year my father was born 7 people (mostly children) died of the disease every day. To be fair, that was an exceptionally bad year for polio during a surge of infections during the late 40s, but even a good year in the first half of the 20th century saw 2 children die every day in the US of this disease. So again, I don't care at all about who the experts are, I care about the data.