TY - JOUR T1 - Evidence evolves over time and should be based on data not opinion JF - BMJ Evidence-Based Medicine JO - BMJ EBM DO - 10.1136/bmjebm-2019-111222 SP - bmjebm-2019-111222 AU - Hawkes, David Y1 - 2019/09/23 UR - http://ebm.bmj.com/content/early/2019/09/22/bmjebm-2019-111222.abstract N2 - Since the introduction of vaccines against certain types of human papillomavirus (HPV), there have been concerns voiced by those critical of the use of these vaccines. These arguments often follow similar patterns and use similar discussion approaches such as raising unfounded questions about safety or using ‘scary’ terms without context (eg, toxins). A recent manuscript by Little and Ward1 provided a representative example of the type of arguments made by vaccine critics that appear to have merit on first examination but which fail when more thoroughly investigated,2 and especially over time as the evidence base demonstrating vaccine safety increases.3 4Little and Ward, like many other critics of the HPV vaccine, raise the issue of toxicity. In particular, they raise concerns about Polysorbate 80 and its relationship with infertility. They state that up to the age of 12, children receive a combined 0.8 mg of Polysorbate 80 administered through the Australian childhood vaccination schedule. This figure should not be considered a cause for concern, as 0.8 mg of Polysorbate 80 (the cumulative dose over 12 years) is &gt;90 000 times lower than the acute exposure dose (based on rat intravenous LD50 of 1790 mg/kg5) for a 41 kg 12-year-old girl or &gt;6700 times lower for a 3 kg infant. The animal study,6 … ER -