Joseph Mercola, D.O. should be well known to readers of SBM for reflexively opposing science-based medicine while providing an endless stream of misinformation on his blog, advocating detoxification, homeopathy, the tapping of meridians chiropractic and more at his clinic, and peddling a treasure trove of vitamin supplements, foods, and Mercola-endorsed devices (on sale at his site for your convenience, no conflict of interest there!).

Nothing seems to personify the evil of modern medicine to Dr Mercola more than the concept of vaccination, and Gardasil, the vaccine against human papillomavirus (HPV), has been drawing a good deal of his ire of late.  Case in point is this train-wreck of a post comparing the recent Toyota recall to Gardasil entitled “Time for the Truth About Gardasil.”  The post is ill-named.

It begins:

Cervical cancer accounts for less than 1 percent of all cancer deaths — so it was somewhat surprising when the U.S. Food and Drug Administration fast-tracked approval of Gardasil, a Merck vaccine targeting the human papilloma virus that causes the disease.

Cervical cancer tallied 11,982 new cases of cervical cancer and 3,976 deaths in 2006, not to mention the non-cervical cancers for which it is also responsible.  Worldwide it has an even greater impact as the second leading cause of cancer in women.  Unless Dr Mercola is trying to tell us that he considers the prevention of several thousand deaths per year in the US alone a waste of effort, the fact that cervical cancer isn’t one of the leading causes of cancer death in the US is irrelevant to the FDA’s approval of Gardasil.

I’m certain the actual point Dr Mercola is trying to make is that in his opinion, Gardasil was inadequately tested prior to release, and that he does not accept the data supporting its efficacy or safety.  The fact is that it was tested on over 20,000 women in stage 3 trials where both its safety and efficacy profiles were excellent while identifying a few rare but legitimate side effects, and that post-licensure studies after over 23 million doses have supported the original licensure data (I covered this topic at some length here, as has Dr David Gorski here).  If Dr Mercola insists on having such exceedingly high standards for the safety and efficacy of a vaccine, surely he holds the myriad concoctions and other products he endorses and sells on his site to the same standard.  Surely.  Right.

He then continues:

As of the end of January 2010, 49 unexplained deaths following Gardasil injections have been reported to the Centers for Disease Control and Prevention’s Vaccine Adverse Event Reporting System.

Mercola implies that the 49 “unexplained” deaths are in fact due to Gardasil (there were 48, not 49 on my check on April 2^nd, 2010).  There are two major problems with this statement.  First and foremost, an unexplained death is, by definition, unexplained.

Second, of the deaths associated with Gardasil reported to CDC’s VAERS, the majority of them are explained.  At the time of the post-licensure review published in JAMA in August of 2009, there had been 32 deaths reported following Gardasil injection occurring between 2 to 405 days after the last injection. This is the breakdown of those 32 reported deaths after investigation:

Eight of the reports were second-hand reports that could not be verified. Four were manufacturer reports with no identifying information for confirmation or medical review… Causes of death (of the remaining 20) included 4 unexplained deaths, 2 cases of diabetic ketoacidosis (1 complicated by pulmonary embolism), 1 case related to prescription drug abuse, 1 case of juvenile amyotropic lateral sclerosis, 1 case of meningoencephalitis (Neisseria meningitidis serogroup B), 1 case of influenza B viral sepsis, 3 cases of pulmonary embolism (1 associated with hyperviscosity due to diabetic ketoacidosis), 6 cardiac-related deaths (4 arrhythmias and 2 cases of myocarditis), and 2 cases due to idiopathic seizure disorder.

Keep in mind that over 23 million doses of Gardasil had been administered in the US at this point.  It would be remarkable if none of those millions of women had died within a year or so of receiving the vaccine.  A rate of death similar to that of the control population with a random smattering of causes should be expected, and is exactly what is found.  As always, correlation does not necessarily mean causation, and Dr Mercola is deprived of his greatest source of rhetoric against Gardasil.

Not that it will stop him from jumping another shark:

By contrast, 52 deaths are attributed to unintended acceleration in Toyotas, which triggered a $2 billion recall.

Holy false analogy, Batman!  He’s comparing apples to… I don’t know, mops or something.  Where to begin?  Let’s just accept the number of 52 deaths for now.  These deaths are not simply associated with unintended acceleration in Toyotas, they are attributed to them.

These are two very different things!  If Dr Mercola wants to compare 52 deaths attributed to defective Toyotas, he needs to compare it to zero deaths attributed to Gardasil, not 49.  On the other hand, if he wants his analogy to use the 49 deaths associated with Gardasil, he needs to figure out how many people have died from any cause within a year or so of riding in a Toyota.  Methinks the number will be slightly higher than 52.

Not to mention that he completely ignores the starkly different risk/benefit ratios of using Gardasil and driving a Toyota.  No one risks developing cancer or dying from not driving a Toyota.

He concludes:

There has been no recall for Gardasil, however. In fact, it is required for sixth-grade girls in D.C., Maryland, Virginia, and many other states. Merck denies any of the deaths are related to its vaccine — and of course, it is difficult for the grieving parents to prove they were.

No, Merck doesn’t deny the deaths are related to the vaccine, the data does.  There has been no recall of Gardasil because no recall is warranted, and in the meantime the vaccine is protecting millions from contracting HPV and the cancers it can cause.

My heart goes out to the grieving families to whom Dr Mercola refers; their loss is tragic regardless of its cause.  But their grief is being needlessly compounded, and the memory of those lost insulted, as Dr Mercola insists on misrepresenting the conditions of their deaths and callously exploits their loss to spread misinformation and fear of vaccination.