Human Papilloma Virus Vaccine

I was at a Sea World a little while back and overheard two moms talking about the HPV vaccine. The first mother related that she had taken her daughter to the pediatrician and the pediatrician told her that she needed to get her daughter the HPV vaccine ASAP. The mother asked if perhaps her daughter was a little young for the HPV vaccine, and was met with a tirade from the pediatrician who asked if the mother had ever seen what genital warts looked like and told her that if she waited longer the vaccine wouldn’t be as effective. I can see why this mother would have been taken aback since the HPV vaccine is now being recommended to 9 year olds.

What is the goal of the HPV vaccine? The HPV vaccine is intended to prevent teens and young adults from contracting the human papillomavirus which can cause 

• cancers of the cervix, vagina, and vulva in women;
• cancers of the penis in men; and
• cancers of the anus and back of the throat, including the base of the tongue and tonsils (oropharynx), in both women and men.

According to the CDC, The virus is very common, though 9 out of 10 infections will clear without any treatment and many infected individuals are asymptomatic. They further state that,

“Every year in the United States, HPV causes 30,700 cancers in men and women. HPV vaccination can prevent most of the cancers (about 28,000) from occurring.”

Further glowing praise from “The Guardian” reads: “The HPV vaccine works extremely well. In the four years after the vaccine was recommended in 2006 in the United States, quadrivalent type HPV infections in teen girls decreased by 56% and decreases in prevalence have also been observed in women in their early 20s. Research has also shown that fewer teens are getting genital warts since HPV vaccines have been in use in the United States. Decreases in vaccine-type prevalence, genital warts, and cervical dysplasia have also been observed in other countries with HPV vaccination programs.”

This is despite the fact that “CDC researchers said this is also the first time a study has shown evidence of the effect of the vaccination on women in their 20s, where prevalence decreased 34%, even though vaccination rates for HPV are relatively low in the US.” And that “‘Overall, the fact that we are seeing a larger decrease overall than what we expect given our coverage rates does suggest there may be some herd protection and there also may be effectiveness from less than a complete three dose series,’ Markowitz said.”

But there’s actually a problem with this glowing praise over the HPV vaccine.

If coverage rates for HPV are relatively low, then herd immunity can’t be responsible for the decline.

(For all you vaccine proponents who seem to forget, herd immunity is the idea that when rates of vaccination are very high, the pathogen causing the disease leaves the community, thus conferring protection to the unvaccinated.)

In fact this vastly oversimplifies the decrease in genital warts, attributing it to the vaccine with absolute certainty when other factors could be at play- like the fact that comprehensive sex education gained federal support around the same time that HPV vaccine was introduced. Cervical cancer used to be a major cause of death in women, but since the advent of regular screening, mortality has dropped drastically over the last 40 years. The decline in cervical cancer predates the vaccine, so the HPV vaccine can’t be responsible for the overall decline in cervical cancer mortality either… Though I wouldn’t put it past vaccine proponents to claim that it has.

Applying the Scientific Method to Vaccination

Joy: “All these facts and opinions look the same. I can’t tell them apart. “

Bing Bong: “Happens to me all the time. Don’t worry about it”.- Pixar’s Inside Out

Ah, the scientific method. People love to bring up the scientific method when talking about vaccination. Most will tell you that the scientific method supports vaccination. Actually it doesn’t.

What is the scientific method? Some people seem to struggle with what exactly it is, so here’s the definition: “...the process by which scientists, collectively and over time, endeavor to construct an accurate (that is, reliable, consistent and non-arbitrary) representation of the world.” So we’re talking about a method for testing hypotheses to see if our ideas translate to what actually goes on in the natural world. It’s based on observation, not popularity.

The Scientific Method has four steps:

“1. Observation and description of a phenomenon or group of phenomena.

2. Formulation of an hypothesis to explain the phenomena. In physics, the hypothesis often takes the form of a causal mechanism or a mathematical relation.

3. Use of the hypothesis to predict the existence of other phenomena, or to predict quantitatively the results of new observations.

4. Performance of experimental tests of the predictions by several independent experimenters and properly performed experiments.

If the experiments bear out the hypothesis it may come to be regarded as a theory or law of nature.”

So let’s apply the Scientific Method to the idea that vaccines stop the spread of illnesses.

1. Observation and description of a phenomenon or group of phenomena.

People are not severely disabled or dying in large numbers from infectious diseases. The spread of these diseases appears to be uncommon amongst vaccinated populations.

2. Formulation of an hypothesis to explain the phenomena. In physics, the hypothesis often takes the form of a causal mechanism or a mathematical relation.

The hypothesis is that vaccines create immunity in the vaccinated individual by getting the immune system to recognize and then fight off infectious agents without the individual actually developing the disease. If enough individuals are vaccinated, the disease will be eliminated or eradicated in a particular area or even across the whole world.

3. Use of the hypothesis to predict the existence of other phenomena, or to predict quantitatively the results of new observations.

So based on our hypothesis we think that vaccines could be formulated for all kinds of diseases and that they could lead to a disease free world. We would expect that vaccines would eliminate most incidences of disease (maybe 80-99% if we’re going to put a number on it).

4. Performance of experimental tests of the predictions by several independent experimenters and properly performed experiments.

…And here is where we start running into problems. Studies on large populations of vaccinated and unvaccinated populations have not been carried out. We have many studies for the approval of individual vaccines, but  we do not have tests run by several independent experimenters. Even the approval tests of vaccines do not fulfill this requirement because they are tests on specific vaccines for release onto the market and they are carried out by the pharmaceutical companies who have developed them- not independent experimenters who have no stake in the outcome.

In fact, media darling Dr. Paul Offit said in his interview to PBS that such experiments comparing the health of large numbers of vaccinated and unvaccinated individuals would be impossible because people who choose not to vaccinate are so mentally incompetent that the results can’t be accurately assessed. But if we can’t run such experiments, then we’re not dealing with a scientific fact, law or even hypothesis, we’re dealing with a  matter of belief or opinion. And the government certainly has no constitutional right to force opinions, beliefs and preferences on us.

Other problems with applying the scientific method to vaccination is that arguments in favor of vaccination have been subject to a number of biases related to the scientific method. They overlook information that does not support the use of vaccination (such as lack of efficacy and modified illnesses in vaccinated individuals that are still communicable, but lack classic symptoms.) They also overlook information pointing to other improvements in health that could explain a decrease in morbidity and mortality such as nutrition and sanitation. Another common one is the idea that vaccination is so safe and so essential and so established that we don’t need to run tests and experiments comparing the health of individuals or disease occurrence in populations- especially accounting for non-classical symptoms. And everyone I have met who supports the use of vaccination seems to be falling error to the most fundamental mistake of the scientific method: assuming that the hypothesis is an explanation for the phenomenon observed.

Also problematic with the concept of disease eradication is the concept of reproducibility.

“Independent confirmation of a scientific hypothesis through reproduction by an independent researcher/lab is at the core of the scientific method.” So when we start talking about eradicating measles, polio, etc. just like we eradicated smallpox, we’re not dealing with a fact. There is no fact or law that a disease can be completely eradicated from the planet, because the declaration of eradication has only happened once. (And there are significant problems with it that are rarely discussed.) Assuming that all of the ideas eradication is based on hold true, it’s only been done once and has not yet been reproduced by anyone. Yet a great deal of public health policy is based on the hypothesis of eradication and simply assumes that it is true.

Vaccination may be popular, yes, but its current use in not based on systematic observations and experimentation.

 

 

A Modest Proposal: Bring Back Lead Paint?

Begin sarcasm:

After watching Neil DeGrasse Tyson host The Cosmos episode on the age of the earth and lead I have decided that we should go back to using lead paint. Once upon a time, lead was everywhere- including children’s toys. There were cute little PR campaigns to convince parents that lead was both useful and safe for their children. Lead was cheap and easy to use in manufacturing. It was great for businesses.

Later on a scientist named Clair Patterson found that there were abnormal levels of lead in the environment and that the only explanation was industrial lead waste. You can bet that the companies using lead in their manufacturing were absolutely thrilled with the idea of doing away with lead. So they brought in their own scientist named Robert Kehoe. Kehoe said he was the foremost expert on lead and that all his research indicated that lead levels were perfectly safe. There was no evidence that lead in paint, gasoline, and other products was harmful. Patterson was derided as a crank for decades. Everyone in the scientific community knew that lead levels were safe. It was a fact. If everyone believes it, it must be true right?

I want to be a scientific person, so I guess that means that I shouldn’t question anything that the majority of scientists and public health accept. After all, the same arguments that are being used in favor of vaccination are the same ones used to support the use of lead paint. Levels of formaldehyde in vaccines are safe, there’s no evidence of harm, and the world’s foremost authorities support its use. Ergo, bring on the lead paint.

End sarcasm.

 

The Anti-Vax Crackpot Article From the New York Times: A Rotavirus Story Full of Crap

“The implementation of rotavirus immunization programs will require scientists and health officials to work effectively with the media to ensure that the public is informed about both the risks and benefits of the new rotavirus vaccines, particularly since the media may be the public’s principal source of such information”- Clinical Microbiology Review, “Rotavirus Vaccines: An Overview”

The “I Was An Anti-Vax Crackpot” article from the New York Times. This little beauty has been making its way around the internet. But after reading it, I have my suspicions about its veracity. Here’s why:

The reasons this woman supposedly gives for not vaccinating are not typical of most non-vaccinating parents. This is the biggest red flag with this article, and I’m basing that on having interviewed literally hundreds of non-vaccinating parents over the past few years. I have yet to hear anyone say that they would rather someone else’s child suffer harm to save their own, relying on herd immunity for protection. Not once. (This is because we know that herd immunity is like Santa Claus- a nice story that doesn’t actually exist. Failure rates for many vaccines are such that there is no way to establish 80-99% immunity in a population and diseases like measles and pertussis in vaccinated individuals often don’t present with classical symptoms even though infected vaccine recipients can still pass these diseases to others. For examples from medical and public health literature, see here.)

Off the top of my head, the reason I have heard the most frequently is bad reactions after vaccination. Other reasons that I have heard frequently are that the parents had encountered research that showed that vaccines were not very effective at preventing diseases (negating the whole herd immunity sacred cow- no pun intended), their children were frequently sick despite receiving full and timely vaccines, they were second or third generation non-vaccinating families, or they were concerned about the MTHFR gene and the possibility of vaccine reactions. The explanation this woman alleges is more in line with the media perpetuated myth about why people choose not to vaccinate than the reality. Of course, most pro-vaccinating individuals don’t really know or attempt to understand why others refuse vaccines- personally I think it’s because they are afraid that our reasons have some validity.

Oh and BTW, many non-vaccinating parents are actually extremely fearful of your courageous little vaccinated angels spreading live viruses to their children through vaccine shedding. It’s one of the most common fears I hear about from non-vaccinating parents about vaccinated children.  Table 5 from Edelman’s section on adjuvants in Vaccine Adjuvants: Preparation Methods and Research Protocols states that the spread of a live vectored vaccine to the environment is a “real or theoretical risk” with vaccines. (He doesn’t specify which.) For my part, my children went to a birthday party where they were around several fully vaccinated children (it’s very likely they were the only unvaccinated children present) and then came down with chickenpox about week later. (Where’s my Law and Order episode about vaccinated children getting my unvaccinated children sick with a deadly disease?)

This is a very convenient advertisement for Paul Offit and his rotavirus vaccine. It is extremely interesting that this woman claims that rotavirus changed her mind about not vaccinating and that she also claims that reading Paul Offit’s books helped her to “wake up”. Paul Offit is one of the inventors of the Rotateq vaccine- a vaccine that is relatively new for a disease that no one thought too much about in developed countries fifteen to twenty years ago. It is extremely necessary for Mr. Offit to keep reaping the financial rewards of his vaccine that people not question its usage. For its continued widespread use, people need to believe that rotavirus is a serious illness in developed countries for otherwise healthy children. This little New York Times piece is certainly trying to present that view.

For a sampling of Dr. Offit’s tactics, take a look at this interview PBS did with him for the ever so diplomatically named documentary, “The War on Vaccines”. You will actually read him calling not vaccinating for measles as playing Russian roulette. We’re talking about a disease with a fraction of the morbidity and mortality of cancer in the United States. For comparison, recall that the CDC states that  “In the United States, measles caused 450 reported deaths and 4,000 cases of encephalitis annually before measles vaccine became available in the mid-1960s.” Here are the estimates of numbers for cancer in the United States for 2016 from the American Cancer Society: “About 1,685,210 new cancer cases are expected to be diagnosed in 2016 and… about 595,690 Americans are expected to die of cancer in 2016, which translates to about 1,630 people per day.” Another example of his biases include his claim that a study comparing parents who vaccinate and don’t vaccinate would be fundamentally flawed because parents who vaccinate and those don’t are so fundamentally different. Parent who don’t vaccinate, he claims would be less likely to think their child has a problem because they think that not vaccinating will prevent developmental problems and other health problems. He does not think that parents who vaccinate could be subject to the same bias in reverse.

Another assertion from his interview that I have not been able to find corroborating evidence for is the Delaware pertussis outbreak. He says that in 2006 there was an outbreak of pertussis in Delaware that was reported in the CDC’s Morbidity and Mortality Weekly Report and that most of the incidents of pertussis were in school age children ages 5-9. I have not been able to find a MMWR bulletin that meets this particular description. However, I did find one that detailed a pertussis outbreak in Kent County, Delaware in an Amish community during September 2004 through February 2005. This was published on August 4, 2006. This report details that most of the cases were preschool age children. (And in fact the charts published with this report showed that the breakdown by age group of pertussis cases in the Amish community differs substantially from the United States as a whole. The majority of the pertussis cases in the United States actually occur in adults with children ages 11-14 second.)

If this is the outbreak of pertussis he was referring to, there is something very ironic about it and that is that pertussis was still present in vaccinating households. Of the 123 patients ages 6 months to 5 years in the interviewed Amish households, almost one in four (24%) had records of receiving three or more doses of DTP or DTaP. (And another 5% had records of receiving 1 or 2 doses of DTP or DTaP.) The rate of vaccination for the interviewed households where clinical pertussis had been discovered was 45% not vaccinating any children, 42% vaccinating at least some children and 14% declined to give information about vaccination status. So out of the 40 households with at least one clinical pertussis case reporting at least some level of vaccination, 35 cases of pertussis were present. And out of 43 households with at least one pertussis case reporting no vaccination, 88 cases were present. But then of course, this may not account for vaccinated cases that do not meet the clinical definition see this news story, this dispatch from the CDC and this study.

But let’s take her story at face value, that there are no other competing interests and she is genuinely telling the truth. There are still several problems with using this tear-jerker as a rationale for the necessity of vaccination:

Rotavirus is deadly- if you live in a third world country. Malnutrition, poor healthcare and bad living conditions all contribute to rotavirus’ death toll in less developed countries. However, even the Clinical Microbiology Review in their overview of rotavirus and its vaccines state that rotavirus is generally not deadly in developed countries and that the goal of the vaccine isn’t necessarily to prevent death, but rather decrease hospitalizations for rotavirus. So unless she has been starving her children and permitting them to live in squalor or they are otherwise immunocompromised, rotavirus is not actually deadly for her children. (And she grew up just fine without the vaccine herself.)

The Rotavirus vaccine actually causes slightly greater rates of gastrointestinal upsets like nausea vomiting and diarrhea. It’s considered successful because there are fewer hospitalizations for rotavirus, not because it actually prevents the disease. I’m not joking. Again this comes the Clinical Microbiology Review in their overview of rotavirus and its vaccines. Direct quote: “Pooled data from the large phase III and two smaller phase III trials showed that in the week following the first dose of RotaTeq, the incidence of fever and irritability did not differ between vaccine and placebo recipients. Diarrhea and vomiting occurred more frequently among vaccine recipients than among placebo recipients (10.4% versus 9.1% and 6.7% versus 5.4%, respectively).” And rotavirus is only deadly to children in developed countries in the loosest sense: “Rotavirus gastroenteritis results in only 20 to 70 childhood deaths per year in the United States.” The CDC places the number of deaths of children in the US under the age of five to be 1 in 200,000 before the advent of mass rotavirus vaccination. (They don’t specify how many are immunocompromised out of this number). For a point of comparison, consider that the Vaccine Injury Compensation program has awarded 556 payouts for 2016 so far.  So far more people are receiving vaccine injury payouts annually than are dying from rotavirus. Rotavirus accounts for about 600,000 deaths worldwide annually- slightly less than the number of deaths from heart disease in the United States annually, for a point of comparison. 

Another direct quote from Clinical Microbiology Review: “A realistic goal for a rotavirus vaccine is to duplicate the degree of protection against disease that follows natural infection. Therefore, vaccine program objectives include the prevention of moderate to severe disease but not necessarily of mild disease associated with rotavirus. An effective rotavirus vaccine will clearly decrease the number of children admitted to the hospital with dehydration or seen in emergency departments but should also decrease the burden on the practicing primary care practitioner by reducing the number of office visits or telephone calls due to rotavirus gastroenteritis.” Rotavirus vaccination is not completely about eliminating the disease and creating herd immunity, but rather decreasing hospital and doctor visits.

The quote I used at the beginning of this post goes on to say that information from the media must be factual and accurate to gain support. However, if people were told the full story of rotavirus and its vaccines- that the disease is almost never causes death to American children and that the vaccines don’t necessarily keep children from developing gastrointestinal symptoms- rotavirus vaccination might be less popular. And if people started questioning rotavirus vaccination, they might start questioning measles, mumps, rubella, varicella, hepatitis B, pertussis, and tetanus for 2 month old babies.

Pieces like this are probably not written to convert non-vaccinating individuals to vaccination- no care has been taken to actually address the concerns of non-vaccinating parents. Since this article plays to the perceptions and fears of vaccinating parents, I think it is more likely that the goal of this piece is to keep vaccinating parents vaccinating by presenting people who question vaccines as morally corrupt and ignorant.

As for me, well, the only time my kids have ever had severe diarrhea was when we all got food poisoning- and no vaccine would have helped that one!

 

 

 

It’s Not a Charity- It’s Just Marketing

My husband and I have never owned a changing table.

When we started having kids, we were really tight on money and space, so we had to pick and choose what was most crucial. There are certain no-brainers (like a carseat and a baby carrier). But as we went down the list of all the things we “needed” for our first baby, I realized my parents had never owned a changing table either. They raised three children and changed plenty of diapers without one and we all turned out just fine. And for that matter, my grandparents never owned a changing table, my great-grandparents had never owned a changing and my great-great grandparents… well, you get the idea. So what did people do before changing tables existed?

It’s quite simple. They changed their babies on a floor or table with some sort of changing pad underneath. Throughout thousands and thousands of years of human history, parents didn’t have changing tables and diaper changes went just fine. Ditto on Baby Einstein, Exer-saucers and baby swings. We’ve never owned a baby monitor either. The best way to keep our kids asleep was to put them in a baby carrier, so none of the sleep gadgets have ever been necessary. If you really want any of these items though, more power to you.

I went through a similar process with the flu vaccine. I remember being in college when I first started hearing admonitions to get a flu shot. I never did. I’d had the flu several times and it wasn’t pleasant, but it certainly wasn’t deathly. Maybe elderly people needed one, but I figured I’d probably be fine. I rarely got the flu anyway. And, I reasoned, it’s not like the flu was a serious disease like other diseases that vaccines existed for. (Of course at the time I didn’t know that according to the CDC, the flu shot is actually less effective in elderly and infant populations, the people who are supposed to be at the greatest risk for flu complications. It’s considered most effective in young, healthy people who are least likely to get sick to begin with. Now that’s some good marketing!)

However, I noticed many people who were buying in- literally- to the whole flu shot thing. All of the sudden, an illness that these people had once considered an unpleasant, though not serious, part of life suddenly became a crisis. I saw friends running out to get to flu shots, standing in line, calling their pediatrician’s office repeatedly to see if the flu shot was available. Despite having the flu themselves multiple times and recovering just fine, my friends were now convinced that the flu was a lethal threat to their health and their children’s health. (And even if they became sick after getting a flu shot they still extolled its virtues.) Suddenly something they had never needed before became indispensable.

Of course the same thing is happening for Millennial parents with chickenpox, rotavirus, hepatitis A and hepatitis B. Our generation is doing the same thing our parents did- buying into marketing messages that the diseases we and our grandparents, parents and friends lived through are deadly. It was interesting to hear my parents reasoning on why they felt I needed to have the MMR vaccine even though they had had measles (and mumps and rubella) as children and did just fine. My dad said that truly the measles wasn’t a big deal to anyone when he was a kid, but the doctors said that all babies should get an MMR vaccine now so he figured they knew best. My mother said that no one understood how big a threat measles was at the time. My mother-in-law said that she had to spend a few days at home with the shades drawn and that was simply too awful to allow anyone to endure- even for lifelong immunity. It’s marketing, folks. Convince people that they need something they didn’t think they needed before.

Now, it’s at this point when most people will start saying that I just don’t understand how terrible things were during the pre-vaccine era, that I’ve gotten used to a world where I don’t have to live in fear of deathly illnesses taking my child’s life and that I simply take it for granted. That type of “post-reality thinking” is a problem. Llike the number of people who have gotten used to living in a USA that is still relatively free and prosperous and now think the government stages shootings and terrorist attacks to keep people fearful and keep the military and police around). But I don’t think it’s a valid argument about vaccine refusal. Take a look at the public health documents from the pre-measles vaccine era or around the time the polio vaccine was introduced. There’s no talk of massive deaths from measles. In fact, the the Vital Statistics Report on mortality in the US between 1900 and 1950 is actually quite optimistic about the future of the public and mentions nothing about measles being a serious public health threat. The Vital Statistics Report from 1955 states that the polio vaccine couldn’t be responsible for the decrease in polio deaths because polio had decreased across all age groups not just children- who were the primary recipients of the polio vaccine.

Yes, popular thought is that this type of line of thinking is just a fallacy, but maybe the problem is a sort of reverse fantasy- that measles, mumps, rubella and chickenpox really were serious threats and we live in a world that is so much safer because of pharmaceutical technology. After buying into vaccination, we have to tell ourselves a story about why we need it now.

Proponents of vaccination seem to believe that vaccines are practically a charitable cause for pharmaceutical companies- something that makes very little money but has enormous benefit. It’s all marketing. The same thing that spurs us on to buy the handbag with the designer label, spend huge amounts on a wedding (even though spending large amounts on a wedding is correlated with higher divorce rates), and get that changing table, play mat and baby swing.

 

Wearing the Big Sign that Says: “Lie to Me! PLEASE!”

“It didn’t come from the Government down. There was no dictum, no declaration, no censorship, to start with, no! Technology, mass exploitation, and minority pressure carried the trick, thank God. Today, thanks to them, you can stay happy all the time, you are allowed to read comics, the good old confessions, or trade journals.”– Ray Bradbury, Fahrenheit 451

“Remember the firemen are rarely necessary. The public stopped reading of its own accord. You firemen provide a circus now and then at which buildings are set off and crowds gather for the pretty blaze, but its a small sideshow indeed, and hardly necessary to keep things in line.”– Ray Bradbury, Fahrenheit 451

“Love me love me/ Say that you love me/ Fool me fool me/ Go on and fool me/ Love me love me/Pretend that you love me.”– “Lovefool”, the Cardigans

“And the big lie is always present when we get played. To be a chump (not merely the victim) is to be open to the big lie. Not merely open to it, eager to buy into it.”– Seth Godin

Question: What would happen if entrepreneur/author Tim Ferriss were to interview me on one of his podcasts?

Answer: No one knows for sure, but it would probably stoke up more controversy than any of his other podcasts. (And he’s interviewed Dr. James Fadiman about micro-dosing with psychedelics for therapeutic use and chemist Patrick Arnold, known as the “father of prohormones”, controversial substances used by some athletes convicted of doping.)  He would need to consult his attorney for one helluva disclaimer. His sponsors might pull out. He could receive a lot of very bad press for a time.

A little while ago I was listening to a podcast between Tim and Ryan Holiday (author of The Obstacle Is the Way, a book I highly recommend to anyone). Over the course of the interview, Tim brought up an experience he had when he had been asked to speak at a large, prestigious university (UCLA, if I am remembering correctly). He had been asked what he perceived the greatest threat to be to America. And he responded that he felt like the greatest threat to America was the kind of over sensitivity towards offending people that causes us to avoid discussing uncomfortable subjects in an honest and open manner. (Which he pointed out to his audience is often perpetuated by idealistic young college students.) Ryan brought up the book Fahrenheit 451 by Ray Bradbury, saying that when he had read it initially as a teenager, he thought it was about a totalitarian government that wanted to keep its people from thinking and becoming educated. However, upon a second reading as an adult, he noted that it wasn’t a government mandate that led to the burning of all the books. It was the desire of the people themselves to avoid dealing with unpleasant ideas. (See the above quotes from the book.)

That vaccination may not be as effective or safe as we have thought is probably one of the most unpleasant of these unpleasant ideas.

Saying that vaccination is anything less than lifesaving- even certain vaccines on the current American schedule that are not considered important by other developed countries- is considered heretical in the United States. When Jenny McCarthy was granted a spot on “The View”, I remember people saying that because she is an advocate for vaccine choice and believes her son’s autism was caused by vaccines that she should not be hosting such a popular talk show. Her views were just too dangerous. (Comments such as these were frequently preceded with phrases such as “I’m against censorship, but…”.)

You can throw actual facts and statistics from public health records and medical journals at vaccine believers until you’re blue in the face, but unless they are open to hearing a different point of view, you will probably be met with a broken record response of the following statements: “Vaccine save lives”, “People used to die from mumps/rubella/measles”, and “Which deadly disease do you want your child to catch?”

The biggest problem with our culture of vaccines, biased media coverage and even public health measures and legislation promoting vaccination lies in the fact that the vast majority of Americans want so badly to believe that vaccines are 99.999999% safe and effective- despite all evidence to the contrary. The only thing that gives these public health agencies, the medical establishment, the government, pharmaceutical companies, schools, and your friends and family any power is the widespread desire for vaccination to be the cure-all for diseases of all kinds. Essentially, most people are walking around wearing a big sign that says “Lie to Me! PLEASE!”

And there are plenty of people who will tell them what they want to hear. Some have financial motivations, but most, in my opinion are motivated by fear. Fear that maybe vaccination is actually more harmful than they have been told. Fear that it isn’t very effective and that their child could contract what they view as a deathly illness. I think the greatest fear is that the people we trust most with our health- doctors, public health agencies and and pharmaceutical companies- are either ignorant or dishonest. It means losing our heroes as we find out that some vaccine pioneers like Jonas Salk and Louis Pasteur were not as selfless as we thought, but rather people who had interests and egos like the average person or business. When I was first questioning vaccines, this was the thing I was most afraid of.  It’s painful to find out that the people you looked up to were not as altruistic as you thought. It’s kind of like finding out Santa Claus doesn’t exist.

We can talk about legislation to protect our rights against mandatory vaccination. We can blame “Big Pharma”. But really it’s all of us wearing the big sign that says “Lie to Me! PLEASE!” that are to blame. These entities would have no power if the public actually wanted the truth. Their power comes because people desperately want a lie. The change will never come from the top down. It will come from the bottom up as more people take off that big sign.

How To Argue With Under-informed “Science” Magazines and Their Well-Intentioned Writers: A Guide

“What are we supposed to do? We’ve already funded our own research center!”- Lucky Strike Tobacco executive in “Smoke Gets In Your Eyes”, Mad Men, Episode 1, Season 1

Popular Science is an interesting name for a magazine. My understanding has always been that popularity and science don’t necessarily always go hand-in-hand. After all, some of the greatest scientific discoveries and theories have been the most unpopular (like Ignaz Semmelweiss’ research on hand washing, the heliocentric model of the solar system and the theory of evolution). So perhaps you can understand why I raise an eyebrow at a magazine that touts itself as being both scientific and popular. Indeed, it forces a choice on said publication as to where their loyalties lie. Is this publication more interested in being popular or being scientific?

The 2013 article from Popular Science seems to be much more grounded in the “popular” part of its name than the “science”. Written by Francie Diep and titled “How to Argue With The Anti-Vaccine Crazies: A Guide”, this smug little article claims to be a fact-based guide preparing people to refute common anti-vaccine questions and claims. Unfortunately, it looks at popular arguments rather than examining larger issues backed up by credible research. Quotes from the article will appear in italics. You can read the full text (which is far shorter than my analysis here) at the link above. For those of you who remember the infamous Kristen Bell post, this is another one to strap in for as I have gone to great pains to be very thorough in my research and explanation. And as always, I see new connections every time I do one of these grand dissections. I think that is what I love most about writing this blog. So here we go…

CLAIM: Historically, recommended vaccines have been shown to harm children. Why would today’s recommendations be any different?

Yes, some older vaccines had severer side effects than current ones do. I’ll look at two examples, polio and pertussis, which is commonly known as whooping cough.

No one has gotten polio from the newer polio vaccine. Before 2000, pediatricians in the U.S. routinely gave kids a polio vaccine that contained live, attenuated polio virus. Now, American kids get a vaccine with an “inactivated,” or killed, virus. Very rarely, the live virus in the older vaccine could actually revert to its natural state and cause paralysis, a tragic consequence.

Some people in the world still deal with this risk. Live, attenuated polio vaccines are used in some regions where polio is endemic because those who get the live, attenuated vaccine are able to pass on their immunity to others around them, which helps spread immunity more quickly. People are also able to take the live, attenuated vaccine by mouth, instead of in a shot, so it’s quicker and easier to get to people in regions where there are few doctors and nurses. Different countries must judge the risks and benefits of the oral polio vaccine differently; even the U.S. had once judged the live, attenuated vaccine worth the risk, when there was nothing better available.

No one has gotten polio from the newer polio vaccine.

Before the 1990s, kids in the U.S. got a pertussis vaccine with severe potential side effects ranging from fever to fainting fits. Some parents sued vaccine manufacturers, claiming that the shot caused brain damage. Scientists have since determined that the parents’ claim is unproven. U.S. doctors now use a new pertussis vaccine with milder side effects.

Of course, it’s up to everyone to decide individually whether the risks of a medicine outweigh its benefits. Consider the numbers around vaccines, though. Often, something like 1 in 1,000 kids experience moderate side effects such as prolonged crying. For more severe side effects, such as seizures or that rotavirus-caused bowel blockage, the odds go down to one in tens of thousands.

Among children who contract measles, one in 1,000 get encephalitis, an acute brain infection, and one or two in 1,000 die. In 2011, among the 18,000 Americans who got whooping cough that year, more than 1 in 2,000 died, all of them babies.

Alright, let’s get started with polio. I think we can safely assume that Diep is referring to the issue of the live virus oral poliovirus vaccine (OPV) versus inactivated poliovirus vaccine (IPV), though this article fails to actually use such precise terminology. The OPV was indeed discontinued in the US in 2000 because of vaccine acquired paralytic polio (VAPP). Diet’s assertion is  “No one has gotten polio from the newer polio vaccine.” This is an oversimplification of a much more complex issue. (First of all, the OPV and IPV were developed in a very close time frame, pretty much simultaneously, so to say that the IPV is “newer” is inaccurate.)  Provocative poliomyelitis is a medically documented condition in which polio is brought on by a surgery, intramuscular injection or other medical procedure. It was well documented to be associated with the DTP vaccination, but any type of intramuscular injection can induce provocative polio. Because of this, some countries like India actually advocate for the usage of the OPV because they feel it is safer than the risks of the provocative polio from the IPV.

Provocative polio has been well-documented to follow intramuscular injection, for further information I recommend taking a look at the 1949 J.K. Martin study titled Local Paralysis in Children After Injections,  the 1998 study by Drs. Matthias Gromeier and  Eckard Wimmer which found that injury to tissue to during certain types of injections allowed the polio virus easy access to nerve channels, thereby increasing the likelihood of paralysis and the more recent HV Wyatt study from 2003 which found that three-quarters of children with paralytic polio receive injections just before the onset of paralysis. And really, if we are going to get technical, the Salk vaccine has been documented to cause polio as in the case of the 1955 Cutter Incident. Though the general public has received a highly simplified (and not entirely accurate) account where an entirely selfless Jonas Salk eradicated polio, the controversy about which is more effective and safe, the Salk IPV or Sabin OPV has continued to be debated amongst scientists.

Live, attenuated polio vaccines are used in some regions where polio is endemic because those who get the live, attenuated vaccine are able to pass on their immunity to others around them, which helps spread immunity more quickly. Ah, the fanciful thinking of vaccine proponents attributing all sorts of powers to vaccines that don’t actually exist. It seems Ms. Diep needs a refresher in how vaccines are supposed to work. Vaccines don’t contain “immunity” and they don’t allow people to “pass immunity” to one another- that would defeat the point of mass vaccination and herd immunity which she claims to believe in later in her article. Vaccines contain live or weakened viruses or bacteria that when introduced to the body are supposed to “train” the immune system to recognize and reject the pathogens, supposedly allowing the vaccine recipient to gain immunity without actually suffering the illness. However, while you can’t “pass immunity” through the OPV, the OPV can give an immunodeficient recipient the poliovirus which they may excrete for several years, passing it to others. This is a significant issue with the worldwide eradication of polio, especially in countries with a a high number of HIV infected individuals.

You can still develop paralysis from enteroviruses other than polio. Since polio is said to be eliminated from the United States, these types of enteroviruses are called non-polio enteroviruses. The CDC states that these viruses (often manifesting as cold-like illnesses in the summer and fall) often produce no symptoms or mild symptoms, but can cause serious infection and paralysis.  Curiously enough, despite the fact that so-called non-polio enteroviruses can potentially cause the same serious effects as polio, there is no vaccine for them and in fact the CDC recommends hand washing and good hygiene to prevent transmission. The United States has started seeing an increase in children with paralysis from enteroviruses as well.

Moving on to DTP vs DTaP… (Again, Diep has not specified which vaccines she is referring to, but judging by the context, it is reasonable to infer that she is referring to the whole-cell live virus diphtheria-tetanus-pertussis shot (DTP) and the inactivated virus diphtheria-tetanus-acellular pertussis shot (DTaP).) “Some parents sued vaccine manufacturers, claiming that the shot caused brain damage. Scientists have since determined that the parents’ claim is unproven. U.S. doctors now use a new pertussis vaccine with milder side effects.” 

It sounds like what Diep is referring to hear is the 1980’s controversy over SIDS and DTP, though her account glosses over some pertinent facts. During the 1970’s and 1980’s there were many complaints of death and injury regarding the DTP shot as well as the influenza vaccine and OPV. In 1980, the Office of Technology Assessment was asked by the House Interstate and Foreign Commerce Committee to put together a memorandum on the possibility of a federally funded vaccine injury compensation program. This is a very interesting read and highly informative. The full memorandum can be found here.

From the OTA:

“As there is no one ‘at fault’ for these reactions, the injured vaccinee would not be able to successfully sue the manufacturer, doctor, or other defendant in a lawsuit based on negligence; e.g., faulty manufacturing of the vaccine such that it was contaminated, or faulty vaccination such that a nerve was damaged by the injection. However, the courts have developed a legal basis for a potentially successful lawsuit in the doctrines of ‘informed consent’ and (1) the ‘duty to warn.’ l)a person about to be vaccinated should be given a clear explanation of the benefits of vaccination and of the potential side-effects that might occur; and (2) someone in the chain from manufacturer to purchaser (such as a state or federal health agency) to the person who administers the vaccine bears the responsibility to give that explanation.

There has been considerable difficulty in determining what constitutes an adequate warning and whether or not a truly informed decision had been made to be vaccinated (the ultimate test of whether the condition had been satisfied takes place by hindsight in a lawsuit, when the injury has already occurred and the answer is crucial to the success or failure of the lawsuit). Furthermore, ‘informed consent’ and the ‘duty to warn’ imply that the potential vaccinee can refuse the vaccination, but almost all states require that children receive certain vaccinations as a condition of attending school.”

So there are legal grounds for suits that can apply to vaccines because people may not be fully informed of the actual benefits and risks associated with vaccines and because in many cases people are legally required to receive vaccines- and more states are limiting options to refuse for things like school or employment. Along with these legal grounds for suit, people can and have successfully sued in court for vaccine injury.

From the OTA:

“The report noted that in three major cases in the past 11 years, plaintiffs have won large judgments against vaccine manufacturers for injuries caused by non-defective and properly administered vaccines. The resulting uncertainty for manufacturers has affected their willingness to produce and supply vaccines.” Note that the vaccines didn’t necessarily have to be defective or improperly administered to cause a serious injury- which implies that some aspect of vaccines or the process of vaccination is inherently risky. However, the belief that vaccines were an essential part of maintaining public health overrules any questions about whether we should be implementing mass vaccination programs.

In the late 1980’s, the US government instituted the Vaccine Injury Compensation Program administered through the Health Resources and Services Administration, a federal public health agency. In the HRSA’s own words, the purpose of the VICP is as follows:

“The National Childhood Vaccine Injury Act of 1986 (PDF), as amended, created the National Vaccine Injury Compensation Program (VICP), a no-fault alternative to the traditional tort system. It provides compensation to people found to be injured by certain vaccines. Even in cases in which such a finding is not made, petitioners may receive compensation through a settlement.

The VICP was established after lawsuits against vaccine manufacturers and healthcare providers threatened to cause vaccine shortages and reduce vaccination rates. The Program began accepting petitions (also called claims) in 1988.”

Now back to DTP specifically. As of 1988, 3,982 petitions have been filed about the DTP vaccine. 3,286 petitions were for injury and 696 were for deaths. 1,273 were compensated and 2,706 were dismissed. Compensation does not mean an admission of guilt that the vaccine caused the injury, often it can mean simply that a negotiated settlement was reached, often with a desire to avoid the cost and expense of litigating a case. The government just pays people to make the problem of vaccine lawsuits go away and is doing it now more than ever. DTP still holds the VICP record for most claims filed, though influenza vaccines are catching up and slightly more compensations have been made for influenza vaccines than DTP at this point.

On to the issue that scientists have now proven parents’ claims of death and injury to be unproven. In the late 1980’s several studies started coming out in response to claims that DTP caused SIDS. Dr. James Cherry of UCLA was at the forefront of the movement to discredit a relationship between the two and has since participated in many other studies and works advocating the further need for use and continued to development of the pertussis vaccine. There is one possible problem with Dr. Cherry though. He has a substantial conflict of interest because he has served as a consultant for GlaxoKlineSmith Biologicals and Sanofi Pasteur for pertussis vaccines. Another article he worked on contains this financial disclosure: “Dr. Cherry has given talks in programs supported directly and through program grants by Sanofipasteur and GlaxoSmithKline. Dr Cherry has consulted about pertussis vaccines with Sanofipasteur and GlaxoSmithKline.” Interestingly enough, Andrew Wakefield has been roundly condemned for conflicts of interest, though that argument has not been seen as a legitimate reason for questioning the research of scientists like Dr. Cherry. As for the infants who die from pertussis, the numbers are not in dispute, but the ability of the pertussis vaccine to actually prevent the spread of the disease is highly debatable and will be addressed later on herein.

On to measles. Measles has become kind of a “boogeyman” that lurks in the closet. The reality is that before the measles vaccine was introduced, people were probably less afraid of it than they are now and that we have far more deadly threats than measles in the 21st century that don’t get nearly as much media attention. The 1953 report from the office of Vital Statistics shows that measles deaths were approximately 13 per 100,000 in 1918 for an estimated population of 103, 208,000. But by by 1950, measles deaths had fallen far below 1 in 100,000. This report states that while infectious diseases like diphtheria, measles and whooping cough were responsible for 242.6 per 100,000 deaths in children under 15 in the early twentieth century, by 1950 these diseases combined accounted for only 5 deaths per 100,000 for children under 15. Take note that the measles vaccine was not introduced until 1963. (MMR became available in 1971  and the DTP vaccine started mass usage in 1948.) Ironically enough, this report is glowing with optimism about the state of health in America, while we perceive this to be a time of rampant disease and death.

The CDC’s official statement on measles reads: “In the United States, measles caused 450 reported deaths and 4,000 cases of encephalitis annually before measles vaccine became available in the mid-1960s.” So by the CDC’s standard, 450 deaths and 4,000 cases of an illness is a serious public health impact. How does this compare with other causes of death today? According to the American Cancer Society, an estimated 15,780 children will be diagnosed with cancer this year and 1,960 children will die from cancer. Most of these childhood cancer cases will be leukemia, brain and nervous system cancers, and lymphoma. Much has been said about the great burden and cost that fighting measles would entail if the disease was to become endemic, but cancer is already far more common and far more costly to treat. Here’s another example. According to the CDC, in 2013 2 million people developed antibiotic resistant bacterial infections and 23,000 died as a result of an antibiotic resistant bacterial infection.   That’s far in excess of the numbers the CDC cites for measles death before the vaccine was introduced!

While we praise the lower rates of measles cases today (which can be disputed as well, we’ll get to that in a minute), the actual death rate from measles has actually increased since the mid-twentieth century. In 1912, the case fatality rate for measles in the United States was 25 per 1,000 and 30-40 per 1,000 in Scotland at the beginning of the 20th century. Those numbers declined to approximately 1 per 1,000 in the United States and the United Kingdom by the mid 20th century. Today the mortality rate for measles in approximately 3 per 1,000. The authors state: “This increase is most likely due to more complete reporting of measles as a cause of death, HIV infections, and a higher proportion of cases among preschool-aged children and adults.”

Better reporting could be debatable (again we’ll get to non-classical measles in a minute), though the emergence of HIV certainly added a new variable to the measles equation that had not been seen before. The other interesting thing is the higher proportion of cases among children under 5 and adults. If you check out Table 2 of this study, it will show you the rates of complications for measles cases between 1987 and 2000 by age group. As you can see, school age children (the group most likely to get measles before routine measles vaccination) are actually the least likely to suffer complications. However, children under 5 and adults have a greater risk for complications, with adults over 30 having the greatest risk for severe complications like encephalitis and death. In our haste to prevent the spread of measles in our schools, we have overlooked the fact that school age children as a group have the fewest complications for measles and if they do contract the virus they gain lifelong immunity. Instead, when the measles vaccination does grant temporary immunity to children, it can leave them open to measles as adults when they are more prone to serious complications.

CLAIM: It is dangerous for little babies to get so many vaccines at one time. The immune system can get overwhelmed.

Babies really do get a lot of vaccines at once. Their first round alone includes six shots. And the list of recommended childhood vaccines has grown in recent decades, as researchers have developed more and more immunizations.

States with lenient policies about immunization exemptions had 90 percent more whooping cough cases than stricter states.However, numerous studieshave found no link between getting the recommended schedule of vaccines and getting other diseases later in childhood. There’s no credible scientific evidence that vaccines are able to “overload” babies’ immune systems. Though immature, babies’ systems are prepared to handle vaccines. They already handle numerous viruses and bacteria all around them in everyday life.

The U.S. Centers for Disease Control and Prevention recommend vaccines at very young ages because that’s when kids are the most vulnerable, as some of the natural immunization they got from breastfeeding fades.

“States with lenient policies about immunization exemptions had 90 percent more whooping cough cases than stricter states.” Now this is an interesting claim since the pertussis vaccine has had a number of problems with efficacy.

• It is a medically documented fact that individuals who have been vaccinated for pertussis and contract the disease often don’t display any symptoms. So all of those strict policy states may have higher rates of pertussis vaccination and fewer diagnosed pertussis cases, but that doesn’t actually mean that pertussis is less prevalent in these states since many people who have been vaccinated for pertussis can be carrying the disease and be asymptomatic. The only way you could find that out for certain what the actual pertussis rates are would be to test everyone in the state on a frequent and regular basis, whether vaccinated or not and whether they are presenting with symptoms or not.
• On the CDC’s website there is a dispatch describing cases of pertussis in fully vaccinated Israeli children which resulted in the death of one vaccinated infant. The report examined 46 fully vaccinated children, five of whom tested positive for pertussis, though only two of those children met the World Health Organization’s diagnostic criteria for pertussis. The study concluded that even vaccinated, asymptomatic children can be carriers of pertussis.
•  In Lithuania 53 children tested positive for pertussis in 2001. 32 of the 53 were fully vaccinated with DTP.
• The outbreak of pertussis in San Diego showed that many vaccinated individuals can still contract pertussis and pass it to babies too young to receive vaccines. Of the 1,000 adults and children who tested positive for pertussis in 2010, over half had been vaccinated.
• A survey of nine other counties in California showed that between 44 and 83 percent of individuals with pertussis had been immunized. Researchers from Amsterdam said they had found that the pertussis virus had mutated two decades ago. Currently, pertussis vaccines do not confer immunity against the mutated form. Vaccine makers have said that testing for the mutation wasn’t necessary.
• In 2002, vaccine proponent Arthur Allen wrote an article titled Bucking the Herd about the importance of vaccination to prevent the outbreak of disease. In his article, Mr. Allen stated that pertussis has become endemic in Boulder, Colorado and blames it on the high number of unvaccinated children there. He undermines his own argument, though, when he states “Although unvaccinated children are six times as likely as vaccinated children to get whooping cough during an outbreak, about half the cases in Colorado have involved vaccinated children…”  If half the children in Colorado with pertussis have been vaccinated, then obviously they are not six times less likely to contract the disease. If vaccines actually are as effective as public health and medical authorities claim they are, then herd immunity shouldn’t make a difference in protecting vaccinated individuals. If vaccination rates drop, then vaccinated individuals should still be protected against the disease while unvaccinated individuals succumb to it. If vaccines can only work in a “sterile” environment where the pathogen is no longer  present, then vaccines would be incapable of eradicating diseases.

However, numerous studieshave found no link between getting the recommended schedule of vaccines and getting other diseases later in childhood. There’s no credible scientific evidence that vaccines are able to “overload” babies’ immune systems.

Now there were a couple of interesting things here. The study about how there are no cognitive delays in fully vaccinated versus children who do not meet the definition of fully vaccinated has a couple of questionable things about it. First of all is the financial disclosure : “Drs Smith and Woods are or have been unfunded subinvestigators for cross-coverage purposes on vaccine clinical trials for which their colleagues receive funding from Wyeth, Sanofi Pasteur, GSK, MedImmune, and Novartis; and Dr Woods has received honoraria for speaking engagements from Merck, Sanofi Pasteur, Pfizer, and MedImmune and has received research funding from Wyeth and Sanofi Pasteur.” So again, it’s something to consider. If we’re uncomfortable accepting research about autism and vaccination from someone who has financial conflicts of interest, in the nature of scientific inquiry, we should be willing to apply a similar standard to research that supports vaccination.

Another potential problem with this study is what is referred to as “confounding” in statistics. If you read the full text of the study, it states: “Children with later vaccine receipt had lower family household incomes in both analyses, although all groups averaged well above the poverty level. They also had lower percentages of mothers with college degrees. Finally, there were greater proportions of male children and single-parent households in the less timely groups. These differences did not reach statistical significance in the primary analyses of timely versus untimely receipt but did in the secondary analyses of most timely versus least timely receipt.” (Quick note: the term “statistical significance” means that after doing a set of calculations you can determine whether or not a particular result is due to chance or “fluke”. If something is determined to be “statistically significant”, it means that the result is not due to chance. If a result does not reach statistical significance, it means that the result could be due to chance. This is a simplified version of the definition that doesn’t get into things like p values and the value of alpha, but for the purposes of understanding a study, it’s sufficient.)

So when the researchers in this study say their results did not reach statistical significance the first time, it means that the results did not indicate a strong correlation between vaccination status and cognitive function in their first analysis. But they ran a second analysis and say their results did show a strong correlation. (Which would certainly be fortunate for their interests in performing this study and getting the desired outcome.) If you take a look at Table 2, you can see that the sample sizes (value denoted as n) are different on the primary vs. secondary analysis. In the secondary analysis, the researchers compared only children classified as “most timely” and those classified as “least timely”. In certain parts of the study, the authors state that they did control for factors such as maternal education and IQ, computer experience, etc. , the multivariable analysis, but when comparing the most and least timely, there could be problems with confounding since the researchers acknowledge that there were more children in the least timely category who came from single parent homes with mothers who had lower education levels and lower incomes while more children in the most timely category had higher incomes and two parent homes with better educated parents, so if they really did just compare the most and least timely, socioeconomic factors could be responsible for the outcome in the secondary analysis. Thus, the term confounding.

Furthermore, since this study was published new vaccines and doses have been added to the American vaccine schedule so the results are less relevant with the current schedule. I wouldn’t take this study as conclusive proof that vaccination will affect your child’s cognitive abilities one way or the other. There may have been some “massaging” of the data that in my mind makes it less reliable as a source. Now that I’ve flogged that one to death, let’s take on just one more of the safety studies cited in this article…

The 2001 study by Destefano, Mullooly, Okoro, et. al. in Pediatrics concerns the timing of vaccine as a possible risk factor for developing type 1 diabetes mellitus (formerly known as juvenile diabetes). The article links off to an abstract of this study, but with a little digging, you can find the full text. The authors claim to be looking at the hepatitis B and Haemophilus influenzae B vaccines specifically, though the study gives results for several other vaccines including whole cell and acellular pertussis vaccines, MMR and varicella. There are a couple of interesting things going on with this study. One has to do with cases and controls. This is a case-control study, meaning that the study compares people with the disease or outcome (cases) with those who do not have the disease or outcome (controls or referent). This study is a little hazy about what they actually qualify as a control. In the case of Hepatitis B vaccination, those who had never been vaccinated for Hepatitis B were used as the referent. (We can assume that all the children had received at least some vaccines as the study later states that all the cases and controls had received the MMR vaccine.) The referent switches on the data for Hib vaccination to children who had received 3 doses by 8 months plus 1 dose at 12–18 months. Referents are not specified for either of the pertussis vaccines, MMR or varicella. (It seems it would be difficult to come up with a referent for MMR since all the children in this study had received the shot.) A big weakness that I see in this study is that half of the cases were born between 1988 and 1990, meaning that they were on a vaccine schedule with fewer vaccines than the children in the study who were born between 1991-1997.

CLAIM: Vaccines have dangerous ingredients in them.

One of McCarthy’s–and other vaccine opponents’–most popular claims is that thimerosal, a mercury-based preservative once common in vaccines, causes autism. There’s so much evidence showing thimerosal doesn’t cause autism.

Nevertheless, thimerosal no longer appears in any vaccines except influenza because an infant receiving the recommended schedule of old vaccines would get a higher-than-recommended dose of mercury, which is toxic in high levels.

The Children’s Hospital of Philadelphia has more information on the ingredients in vaccines. They are not dangerous.

Thimerosal may be dubious. Personally, I think it’s possible that the symptoms described by many parents like Jenny McCarthy might be due to encephalitis- which is a legitimately acknowledged side effect of live virus vaccines. The Merck Manual Home Edition states that autoimmune encephalitis can be caused when “A virus or vaccine triggers a reaction that makes the immune system attack brain tissue (an autoimmune reaction).”  (I consider the Merck Manual to be a reliable source of information, do you?) If you would like a second opinion, the Mayo Clinic’s website states: “Secondary encephalitis often occurs two to three weeks after the initial infection. Rarely, secondary encephalitis occurs as a complication of a live virus vaccination.”

Now getting into the actual link cited here, the page was written by Dr. Paul Offit. He is one of the developers of the Rotateq vaccine and has gotten a great deal of media attention lately from news articles applauding his hard line stance against parents who want to selective/delay vaccinate or not vaccinate at all and from his involvement with the PBS documentary “The War on Vaccines”. Despite his claims that alternative medicine and figures like Dr. Sears take advantage of parents’ feelings and media attention, Dr. Offit receives the same kind of attention and it has made him (and the Rotateq vaccine) more and more prominent. Frankly, I don’t find him a credible authority on vaccines because of the following:

• A tendency to overdramatize- For a sampling of Dr. Offit’s tactics, take a look at this interview PBS did with him for the ever so diplomatically named documentary, “The War on Vaccines”. You will actually read him calling not vaccinating for measles as playing Russian roulette. We’re talking about a disease with a fraction of the morbidity and mortality of cancer in the United States. For comparison, recall that the CDC states that  “In the United States, measles caused 450 reported deaths and 4,000 cases of encephalitis annually before measles vaccine became available in the mid-1960s.” Here are the estimates of numbers for cancer in the United States for 2016 from the American Cancer Society:

  “About 1,685,210 new cancer cases are expected to be diagnosed in 2016 and… about 595,690 Americans are expected to die of cancer in 2016, which translates to about 1,630 people per day.” (And by the way, heart disease causes even more deaths in the United States annually than cancer does.) And here is Dr. Offit trying to convince us that measles will be a serious health impact?! But remember it’s extremely important for his Rotateq vaccine and his position as vaccine developer and expert that parents and pediatricians not question the current vaccine schedule and believe that death and destruction will  follow from not vaccinating. If parents start questioning which vaccines are necessary, rotavirus will probably be one of the first on the chopping block because it’s extremely rare for a child in a developed country to actually die from the disease and all of us grew up just fine without it. And if we start questioning that, then we start asking about why we need to vaccinate for chickenpox (which was a mild illness when we were growing up and not a cause for concern), and then we’ll start questioning measles and mumps (which were considered mild illnesses when our parents were growing up and not a cause for concern). Pretty soon, the entire vaccine industry would be losing a lot of money. So yes, characterizing measles as “Russian roulette” is not an accurate representation and instead sells parents and healthcare providers an inaccurate picture of risks that favors Dr. Offit’s interests.

  Bigotry- If you’re on the right side of the debate (the side that believes vaccines are the answer and the more the better), you are rational and well-informed and without any competing interests. If you don’t vaccinate or selective/delay vaccinate or support such decisions, you are selfish, ignorant and have ulterior motives, based on attention or profit. He claims it doesn’t matter that he has a profit interest in vaccines, because his vaccine works. Dr. Offit claims in his interview that a study comparing parents who vaccinate and don’t vaccinate would be fundamentally flawed because parents who vaccinate and those don’t are so fundamentally different. Parent who don’t vaccinate, he claims would be less likely to think their child has a problem because they think that not vaccinating will prevent developmental problems and other health problems. He does not think that parents who vaccinate could be subject to the same prejudice in reverse. PBS should be ashamed to be disseminating such bigotry, but they don’t seem to be able to pull their heads out and see this sort of “snow job” for the prejudice it is, they’re simply too set in the mindset that we must vaccinate or die to see anything else. But remember folks, when people were protesting on the steps of Little Rock High School about integration, they weren’t doing it because they considered themselves ignorant, prejudiced, bigoted, uninformed or hateful. They were doing it because they believed integration to be a genuine threat to their children’s health and safety and could point to research showing that people from other ethnicities were inferior to back up their stance. That’s the great thing about bigotry. It’s easy to see it in other decades and places, but not in our time and place.

  Can he even get his facts straight? I was not impressed with his scare story of a pertussis outbreak in Delaware and I’m a little suspicious of whether he is even presenting accurate facts on this incident. He says that in 2006 there was an outbreak of pertussis in Delaware that was reported in the CDC’s Morbidity and Mortality Weekly Report and that most of the incidents of pertussis were in school age children ages 5-9. I have not been able to find a MMWR bulletin that meets this particular description. However, I did find one that detailed a pertussis outbreak in Kent County, Delaware in an Amish community during September 2004 through February 2005. This was published on August 4, 2006. This report details that most of the cases were preschool age children. (And in fact the charts published with this report showed that the breakdown by age group of pertussis cases in the Amish community differs substantially from the United States as a whole. The majority of the pertussis cases in the United States actually occur in adults with children ages 11-14 second. If this is the outbreak of pertussis he was referring to, there is something very ironic about it. Of the 123 patients ages 6 months to 5 years in the interviewed Amish households, almost one in four (24%) had records of receiving three or more doses of DTP or DTaP. (And another 5% had records of receiving 1 or 2 doses of DTP or DTaP.) The rate of vaccination for the interviewed households where clinical pertussis had been discovered was 45% not vaccinating any children, 42% vaccinating at least some children and 14% declined to give information about vaccination status. So out of the 40 households with at least one clinical pertussis case reporting at least some level of vaccination, 35 cases of pertussis were present. And out of 43 households with at least one pertussis case reporting no vaccination, 88 cases were present. But then of course, this may not account for vaccinated cases that do not meet the clinical definition, as noted above.

  And the things he won’t tell you about his Rotateq vaccine from the Clinical Microbiology Reviews…

Rotateq: “Diarrhea and vomiting occurred more frequently among vaccine recipients than among placebo recipients. The efficacy of RotaTeq was evaluated in two phase III trials (10, 85). In these trials, the efficacy of RotaTeq against rotavirus gastroenteritis of any severity after completion of a three-dose regimen was 74%, and that against severe rotavirus gastroenteritis was 98%. RotaTeq also proved to be strongly efficacious in preventing rotavirus gastroenteritis of any severity caused by the predominant G1 serotype (75% efficacy) and the G2 serotype (63% efficacy). There was a trend toward efficacy for the remaining serotypes, but patient numbers were too small to show statistical significance (83% efficacy for G3, 48% efficacy for G4, and 65% efficacy for G9). The efficacy of RotaTeq in reducing the number of office visits for rotavirus gastroenteritis and in reducing the number of emergency department visits and hospitalizations for rotavirus gastroenteritis was evaluated in a large study. (85). The efficacy of RotaTeq in reducing the number of office visits for rotavirus gastroenteritis among 5,673 subjects and in reducing the number of emergency department visits and hospitalizations for rotavirus gastroenteritis among 68,038 subjects over the first 2 years of life was evaluated. RotaTeq reduced the incidence of office visits by 86%, emergency department visits by 94%, and hospitalizations for rotavirus gastroenteritis by 96%. Efficacy against all gastroenteritis hospitalizations of any etiology was 59%. The efficacy of RotaTeq in the second rotavirus season after immunization was 63% against rotavirus gastroenteritis of any severity and 88% against severe rotavirus gastroenteritis.”

In other words:

• Children who receive the Rotateq vaccine may be sick with diarrhea and vomiting more frequently than those who do not.
• Success rate for Rotateq is largely concerned with reducing office and emergency visits, not necessarily preventing actual rotavirus infections.
• The Rotateq vaccine protects against particular strains of rotavirus. Its efficacy against other strains has not been determined with certainty.
• Efficacy of Rotateq against all rotavirus infections of any severity is below 80%- nowhere near enough to establish herd immunity- a concept that Dr. Offit actively promotes.
• The efficacy of Rotateq diminishes over time.

So, no, I’m not too confident in anything Dr. Offit has to say about vaccination.

Aside from Dr. Offit, I personally think there are some interesting issues with vaccine excipients that still are worth studying beyond thimerosal.  For example:

• Potassium dibasic phosphate is an excipient in MMR Pro Quad. PDP is known to cause tumors and damage to the kidneys. (From the cited study: “We have also recently demonstrated the promoting effect of PDP on early-stage renal carcinogenesis…”) Children receive two doses of the MMR vaccine during the first five years of their life, the same time frame that most cases of Wilms tumor occur.
• From studying provocative polio, scientists know that vaccination can allow viruses and bacteria easy access to nerve channels.
• Many vaccines contain chemicals like beta propiolactone (Which has been found to cause tumors in test animals when injected beneath the skin), formaldehyde, a known carcinogen, and calcium chloride which is known to cause both genetic mutations and tumors. For a full list of vaccines with these and other excipients, visit the CDC’s list here.
• Simian Virus 40 has been found in bone and brain tumors. (Please see Figure 2 of this cited page for mention of bone tumors and the second to last paragraph under “History of SV-40” for mention of an increased incidence in brain tumors of children whose mothers received the inactivated polio virus while pregnant. This should give pregnant women pause before getting a flu vaccine.) Since the polio vaccine was and continues to be cultured in African Green Monkey tissues, it has been cited as the most likely culprit for the spread of the virus.  In fact, the CDC has acknowledged other animal viruses are present in vaccines, like pig viruses in the rotavirus vaccines. They just say that these viruses are not known to cause any disease in humans.
• Most vaccines are administered through intramuscular injection and contain carcinogens. This should be investigated as a contributing factor to rhabdomysarcoma. Rhabdomysarcoma is cancer of the skeletal muscles, where most vaccinations are administered.
• Aluminum hydroxide is in some Hep B shots and research has shown that it may affect the blood, bones and liver, all of which are common areas of the body for children’s cancer.
• Pertussis shots contain 2-phenoxyethanol, chemical which is known to depress the central nervous system. Could this be linked to cancers of the nervous system like neuroblastoma?
• Lymphoma is a cancer of the immune system. Is it simply coincidence that children receive several shots containing carcinogenic chemicals and animal viruses meant to supposedly stimulate their immune systems and then develop cancer of the immune system?

Adjuvants are the other chemicals frequently found in vaccines.

FAQ’s from the CDC about vaccine safety say that adjuvants are put in vaccines “to enhance the immune response of vaccinated individuals”. However, if you dig around in immunology literature, you’ll find a few more interesting details about adjuvants.

Let’s start with immunologist Charles Janeway. Janeway did a significant amount of research into what he called “the immunologist’s dirty little secret”– that the presence of foreign antigens alone are often not enough to elicit a response from the immune system. In fact, it has been well known amongst immunologists for a long time that the presence of bacteria and viruses is often not enough to induce a response from the immune system. This is why scientists routinely add substances like mineral oil, bovine serum albumin and mineral salts like aluminum hydroxide to their experiments to get a reaction from the immune system.

So while we’ve been told that vaccines work by imitating an infection which then leaves the body with T- and B-lymphoctes which tell it how to fight the infection in the future, it’s not the bacteria or viruses that are causing the immune reaction, it’s the adjuvants.

Adjuvants are responsible for many of the reactions to vaccines. Table 5 from Edelman’s section on adjuvants in Vaccine Adjuvants: Preparation Methods and Research Protocols details the “Real and Theoretical Risks of Vaccine Adjuvants” which include:

• Local or acute chronic inflammation with formation of painful abcesses, persistent nodules or draining lymphadenopathy (enlargement of the lymph nodes typically associated with cancer or infection).
• Flu-like illness with fever
• Anaphylaxis (a whole body allergic reaction)
• Chemical toxicity to tissues or organs
• autoimmune arthritis, amyloidosis, (a condition in which abnormal protein buildup is deposited in an organ of the body) anterior uveitis (inflammation of the eye which can ultimately cause blindness).
• Cross reactions with human tissue antigens causing glomurelonephritis (inflammation of the filters in the kidneys) or meningoencephalitis (inflammation of the brian and meninges that can result in speech and motor impairment, epilepsy and intellectual deficits; ironically, vaccination is often recommended as a way to prevent encephalitis and meningoencephalitis.)
• Immune suppression (Aren’t vaccines supposed to enhance, the immune system, not compromise it? If they’re suppressing the immune system, then what’s the point?)
• Carcinogenesis (See my post on cancer and vaccines.)
• Teratogenesis (causes birth defects) or abortogenesis (causes abortion or miscarriage).
• Spread of a live vectored vaccine to the environment.

Edelman doesn’t care to explicitly state which of these risks are “real” and which are “theoretical”.

CLAIM: It’s not like a parent’s decision not to vaccinate his child harms other kids.

Vaccinated kids generally won’t get sick from the preventable diseases that they’ve been inoculated against. However, if a non-vaccinated kid gets sick with a preventable disease, there are still several people he may infect beyond non-vaccinated classmates.

What do you consider “generally won’t get sick”? Is this what you consider “generally won’t get sick”?

• The above cited pertussis outbreaks in vaccinated individuals.
• The above cited performance of the rotavirus vaccine Rotateq.
• The International Journal of Epidemiology records a case of measles vaccine failure in Hungary, where the majority of measles cases struck those who had been vaccinated.
• A case study from India documents a measles outbreak in a slum. Almost one-third of the children who contracted measles were vaccinated for the disease.
• The 1988-1989 outbreak of polio in the African country of Oman found that “a substantial proportion of fully vaccinated children had been involved in the chain of transmission.”
•  India was certified polio-free, but it has some of the highest rates of AFP in the world now. AFP can cause paralysis which requires an oxygen tank (rather than an old iron lung).
• Even in the 20th century, problems with smallpox persisted despite high rates of immunization for the eradication program instituted by the World Health Organization. A quote from a paper on the history of smallpox reads: “The concept of mass immunization, originally proposed to include 80% of the population in each country to achieve herd immunity proved ineffective as herd immunity did not cease and smallpox persisted in such immunized or ostensibly over-immunized populations.” (pg.491 of document.)  So while smallpox vaccination rates were high, the disease continued to persist. This does not constitute eradication.
• The CDC has released a statement saying that the 2014 flu vaccine was only about 14% effective. They say it is usually more like 50-60% effective. Even at normal strength, how do they expect to achieve herd immunity, which requires 80% or more of a population to be effectively vaccinated and immune to a disease?

Which one of these examples do you feel fits the description of “generally won’t get sick”?

He may infect babies that haven’t yet been scheduled to receive their vaccines. He may also infect the small percentage of kids for whom their immunizations don’t work, as immunizations aren’t 100 percent effective. The measles vaccine, for example, is more than 95 percent effective—very good, but not perfect.

Well, the CDC tells a very different story than respected vaccinologist Dr. Gregory Poland. To quote the article referenced: “Dr. Poland is no vaccine denier. Not only is he among the harshest and most outspoken critics of the ‘irrationality of the antivaccinationists,’ he is also one of the strongest proponents for vaccines and the good that they can do. As Professor of Medicine and founder and leader of Mayo Clinic’s Vaccine Research Group, one of the world’s largest vaccine research organizations; as editor-in-chief of the peer-reviewed scientific journal, Vaccine; as recipient of numerous awards; as chair of vaccine data monitoring committees for pharmaceutical giant Merck; as patent holder in various vaccines processes; as someone who enjoys special employee status with the Centers for Disease Control and the U.S. Department of Defense and as someone who has sat on every federal committee that has dealt with vaccines, no one can accuse him of seeing vaccines from a narrow perspective.”

Dr. Poland has stated that the MMR shot is not effective at preventing measles on a wide scale. He says that the MMR vaccine is far less effective than anticipated and that immunity from it quickly wanes. To quote again: “During the 1989-1991 U.S. outbreaks, 20 per cent to 40 per cent of those affected had received one to two doses. In a 2011 outbreak in Canada, “over 50 per cent of the 98 individuals had received two doses of measles vaccine… People’s failure to get vaccinated is deplorable, Dr. Poland often stresses. But the more fundamental problem stems from the vaccine being less effective in real life than predicted, with a too-high failure rate — between 2 per cent and 10 per cent don’t develop expected antibodies after receiving the recommended two shots. Because different people have different genetic makeups, the vaccine is simply a dud in many, failing to provide the protection they think they’ve acquired. To make matters worse, even when the vaccine takes, the protection quickly wanes, making it unrealistic to achieve the 95 per cent-plus level of immunity in the general population thought necessary to protect public health. For example, 9 per cent of children having two doses of the vaccine, as public health authorities now recommend, will have lost their immunity after just seven and a half years. As more time passes, more lose their immunity. ‘This leads to a paradoxical situation whereby measles in highly immunized societies occurs primarily among those previously immunized,’ Dr. Poland stated.”

And just like pertussis, vaccinated individuals can contract measles and not present with classical measles symptoms and may not be detected by tests for typical wild measles cases. And this isn’t coming from some “natural news” site, it’s coming from the 2009 Journal of Infectious Diseases. It contains an article about nonclassical measles in two fully vaccinated physicians which can be found here. It discusses a number of aspects of the disease eradication program and the role of vaccination. Little is really known about the full impact of modified/nonclassical measles because it is rarely given any consideration as a diagnosis and remains a little researched subject.  “To complicate matters, nonclassic cases of measles in vaccinated persons may be identified, which must be investigated. Often the symptoms are mild and resolve rapidly and, outside of the context of an outbreak or known exposure to a measles case patient, the nonclassic presentation might not raise suspicion of measles.” Also discusses the role of the lack of wild measles virus on the disease: “… the rate of nonclassic infection is likely to increase as measles control improves in a population, because boosting from exposure to wild-type measles virus will be rare. ” (In other words, the wild virus primes the immune system and if eliminated will not be present to “remind” the immune system of what it is supposed to be fighting.) Also discusses difficulties with detecting cases of nonclassical measles in vaccinated individuals because the usual IgM method used for measles diagnosis confirmation is unreliable in nonclassical cases.

Since the publication of that article in 2009, a 2011 outbreak of measles in New York was traced to a woman who was fully vaccinated. So while the media, the healthcare profession and this “science” magazine are implicating non-vaccinated individuals as ignorant specimens of humanity passing around horrendous diseases, we know that fully vaccinated individuals can contract non-typical forms of so-called “vaccine preventable diseases” and pass them on to others. Unfortunately, we don’t know the full public health impact of it because it isn’t being studied widely and most of the time individuals aren’t being tested for these diseases if they are up to date on their vaccines.

CLAIM: There’s nothing wrong with spacing out my child’s vaccines, if I want to.

Delaying a vaccine just means there’s that much longer a window for an unimmunized child to get sick. Limiting the number of doctor’s visits children need to get all their shots also helps more families stick to the recommended schedule and reduces the costs of vaccination.

“A longer window for an unimmunized child to get sick.” Well let’s talk about long windows for getting sick and the consequences. If you take above cited statistics on the measles, for example, the highest rates of morbidity and mortality are not in children, but adults- which is why developing the measles as a school age child and then having life long immunity could actually be more ideal from a health perspective. We actually do things backwards where we are immunizing school age children and then leaving them open to future infection as adults when the stakes are actually higher. The same actually goes for many other diseases like rubella and chicken pox (pregnancy complications) and mumps (infection to testicles in adolescent boys). A better strategy might actually be to forego vaccinating children for these diseases and vaccinate adults and teens who do not have demonstrated immunity through blood titers test.

How about the flu? What window of time applies to flu vaccination? Recently the flu mist vaccine was found to be almost completely ineffective against influenza after being the recommended choice for children for several years and after several studies from the manufacturer which pointed to it being highly effective. (The manufacturer stands by its studies even though real world observations have proven otherwise, prompting its downgrade from preferred method for children). And even when flu vaccines do work against the strains contained in them, they don’t work against other strains.

And side note: This article claims that vaccines just aren’t profitable for pharmaceutical companies to research and produce.  Let’s just take a quick look at that. Bringing up our dear friend Dr. Offit, he wrote an article in 2005 saying that vaccines aren’t profitable and predicting dire consequences from a lack of vaccine development, and in the past eleven years several new vaccines have some how made it into the regular rotation for children, adults of all ages and pregnant women. And while there are plenty of news articles out claiming otherwise, there are other voices from the medical and pharmaceutical fields saying the opposite:

“But the economics of this landscape are changing. The once low-margin vaccine market now includes blockbuster and megablockbuster products. Optimism over new candidates — including some for cancers, human immunodeficiency virus (HIV), and adult influenza — has led to expectations of healthy growth. Economists at the World Health Organization (WHO) report that the market has been growing at 10–15% annually, compared with 5–7% growth for other pharmaceutical segments, since 2000. That growth is expected to continue at 8% or better through 2018, reaching almost US$100 billion by 2025 (2, 3). And some signs indicate that vaccine players may be narrowing their focus to a few areas (e.g., biosimilars) to reduce competition. Thus, an examination of the industry value chains reveals significant bottom-line potential.”- BioProcess International

“One of the new vaccines Gavi is tasked with introducing is the pneumonia vaccine (PCV), which aims to combat a major childhood killer in developing countries. A dramatic 37 per cent (or US$2.8 billion) of the total amount raised for Gavi last week from taxpayers and private foundations will go to pay for just this one high-priced vaccine, which today is produced by only two pharmaceutical giants: GlaxoSmithKline and Pfizer. The two companies have made more than US$19 billion in sales off of the vaccine since its launch, yet still charge developing countries unaffordable and unsustainable prices. It’s important to point out that this vaccine was initially developed for children in wealthy countries, and its research and development costs have long been recovered.” –Stephen Cornish, Executive Director of Doctors Without Borders, Huffington Post Canada

One of my personal favorites though was actress Kristen Bell’s Huffington Post article in which she claimed that vaccines weren’t profitable and used a link to an article in The Atlantic titled “Vaccines Are Profitable. So What?” to support her claim. (Bless her heart, I do believe that Ms. Bell has the best of intentions and cares very much about making the world a better place. And yes, I enjoyed Frozen just as much as the next person.)

Going further into the flu, is it really the flu that kills or other accompanying complications? Take for example NBC’s account of a previously healthy teen athlete who supposedly died from the flu within days with no prior history of health problems. There is something very subtle going on with this article if you take a good look at it. They keep focusing you over and over again on the flu and the flu vaccine, but they mention that the boy had been diagnosed with a MRSA (methicillin resisitant staphylococcus aureus) infection and that he went into organ failure. MRSA is a nasty bacterial infection that can and does cause death by infecting the bloodstream (MRSA sepsis) and organs like the lung and heart. And it often seems like the flu at first. According to the Mayo Clinic, athletes who play contact sports are at an increased risk of contracting MRSA.

So while this boy did have influenza and he did die very suddenly and his family has focused on his story for flu shot awareness, clinically speaking, there is a very good possibility that MRSA contributed substantially to his death- even though the article keeps deflecting the issue. (For another account of a previously healthy teenage boy who contracted MRSA through contact sports and then started experiencing flu-like symptoms, see this article here from the University of Maryland Medical Center. Fortunately, this boy’s condition was found to be MRSA infection in enough time to save him, though he spent 59 days in pediatric intensive care fighting organ failure.) The family’s reaction is completely understandable. They have experienced a living nightmare and are trying to find a way to put their lives together after a tragedy. But unfortunately, there is no flu shot that can protect against MRSA. And for a further investigation into how flu deaths are even being tallied, see my flu post here. So whether you choose to get the flu shot or not, you’re not looking at some sort window of protection.

How about Hepatitis B? Does the window of infection for that one really start at birth for babies whose mothers are negative for the disease? Because statitiscally speaking, the chances of a baby contracting hepatitis B from a low-risk mother are negligible. For a more in-depth explanation of Hepatitis B risks, see my post here.

 

Beyond that, however, there’s little evidence about which alternative schedules of vaccinations is best and whether alternative schedules are better or worse than the standard schedule. The standard schedule has been studied because the vast majority of U.S. kids get it, but alternative schedules are pretty new and several different alternatives exist, so they are difficult to study. The Institute of Medicine is trying to figure out whether a study of alternative schedules is feasible.

Some delayed schedules celebrities (and celebrity doctors) have endorsed leave out some vaccinations altogether, which leave kids vulnerable to those diseases.

Well it’s not like the APA’s schedule is the gold standard either, for that matter. Many other countries follow different schedules and we don’t label these countries as a whole to be “anti-vaccine”. They all have reasons with research for the type of schedule they employ. And for that matter, adding more vaccines isn’t proof positive of lower childhood mortality either.

You can take a look at vaccine schedules from other countries like  Iceland, Singapore, Great Britain and even our neighbor to the north Canada and see that they don’t give as many vaccines as we do. For example, Great Britain does not routinely give a varicella, hepatitis A or rotavirus vaccine, nor does Singapore. Iceland doesn’t routinely give out vaccines for hepatitis A or B, rotavirus, varicella or Human Papilloma Virus. In Canada, the vaccination schedules vary from province to province and in some provinces the rotavirus vaccine is not publicly funded. And guess what? Children are still very healthy in these nations. For a quick measuring stick, let’s take under 1 year infant mortality rates from the CIA fact book: the US ranks 167th for infant mortality, the UK 187th, Singapore is 221st, and Iceland ranks 223rd. (Lower is better, it means there are fewer deaths in a given year per 1,000 live births, e.g. Iceland has 2.06 deaths per 1,000 live births and the US has 5.87 deaths per 1,000 live births. This isn’t a perfect indicator since it includes deaths due to birthing practices. It gives an indicator of the overall state of health of children under 1 year. However, a great many vaccines are administered to children under 1 year because this is when they are supposed to be the most susceptible to many diseases- which is the argument against delayed vaccination schedules.)

CLAIM: Every medicine has side effects, and I want to protect my kids.

It’s always important to know about side effects before deciding to give your kid a vaccine or another medicine.

Most of the side effects of vaccines are mild compared to the illnesses they prevent. Different vaccines may cause temporary fussiness, swelling, prolonged crying and other effects. Some babies get mild vomiting and diarrhea after the DTaP and rotavirus vaccines. (We fully acknowledge that what doctors call “mild vomiting and diarrhea” is not fun to have to take care of.)

Very rarely, kids may be severely allergic to a vaccine. Allergic reactions generally occur within hours of getting a shot. The reaction may be bad enough that a kid can’t get the rest of the shots in that series, which means he or she will have to rely on other kids being vaccinated to protect him from that disease.

1 in 20,000 to 1 in 100,000 babies who get the rotavirus vaccine get a serious bowel blockage for which they have to visit the hospital. Some will need surgery.

This isn’t an exhaustive list of the potential side effects of different vaccines, though I’ve tried to cover the most severe ones. You can find out more from the Centers for Disease Control and Prevention.

Well, we’re in the home stretch here folks. Let’s talk about side effects. We’re used to hearing extravagantly large numbers for vaccine side effects 1 in 4,000,000 and the like. The thing is, these rates are typically based on two variables: the number of doses of vaccines manufactured and the number of incidents reported as vaccine reactions. Let’s talk about the first variable, the number of doses manufactured. Not every dose of vaccine that is manufactured is actually administered. Obviously a vaccine can’t cause a reaction unless it is administered, so counting doses manufactured doesn’t give an accurate picture. In 1980, the Office of Technology Assessment was asked by the House Interstate and Foreign Commerce Committee to put together a memorandum on the possibility of a vaccine injury compensation program. This is a very interesting read and highly informative. The full memorandum can be found here.

From the OTA: “Estimating the number of serious adverse vaccine reactions that occur annually in the United States cannot be accomplished with absolute certainty. There are conflicting incidence estimates for the various adverse reactions, and no one really knows how many doses of vaccine are actually administered (versus distributed) annually, particularly by private physicians. An often-used conservative rule of thumb is to estimte one-fourth wastage.” Current (last updated July 1, 2016) charts from the VICP simply use the number of doses administered between January 1, 2006 and December 31, 2014 simply use the number of doses distributed according to the CDC.

The second variable is how many incidents are actually attributed to vaccine reactions. I think it is entirely possible that there is a bias on the part of physicians. They have heard that vaccine reactions, especially disabling ones or death are so incredibly rare that it is extremely unlikely that they would ever see one. So, I think it is possible that many vaccine reactions are misdiagnosed as other conditions with similar symptoms. For example, encephalitis is a known side effect of live virus vaccines, though the symptoms of disability resulting from encephalitis can be very similar to those of autism. In another example, Guillain-Barre Syndrome could be mistaken for multiple sclerosis. The above cited article on autoimmune encephalitis says that the condition often looks very much like multiple sclerosis.

Underreporting is a possibility. An interesting letter from a New York pediatrician to the British Medical Journal brought up the possibility of underreporting with an example of Kawasaki Disease and Rotateq (which I did not plan): “During the 18-year period from 1990 through 2007 just 88 cases of Kawasaki Disease in children under 5 were reported to VAERS. During the same period about 88 million U.S. children passed through the 0-5 age group; consequently the incidence rate reported to VAERS was 0.10 KD cases per 100,000 person-years. (Pediatr Infect Dis J 28:943, 2009) From 1988 to 2006 the published KD incidence for U.S. children under 5 rose from 11.0 to 20.8 per 100,000 person-years. (Pediatrics 111:448, 2003. Pediatrics 112:495, 2003. Pediatr Infect Dis J 29:483, 2010) Even for infants 3-6 months old, when suspicion for vaccine adverse effects should be especially high, KD incidence as reported to VAERS was 0.11 while published background rates were 23.1 (2000) and 24.6 (2006); fewer than 1 in 200 KD cases were reported to VAERS. It is bewildering, therefore, to learn that FDA and CDC officials used VAERS data to dismiss a placebo-controlled trial that found a 5-fold KD risk associated with RotaTeq–RR=4.9; 95% CI 0.6, 239. (Pediatr Infect Dis J 28:943, 2009. 6/15/07.) If confirmed by a larger trial, the KD risk associated with RotaTeq would translate to an extra 4000 U.S. cases annually in young children.” So there could be misrepresentations with the calculation of vaccine adverse events.

But for an interesting experiment, let’s say that in some cases physicians encounter a vaccine adverse event and mistake it for some other similar condition. So let’s estimate that 1% of incidents of the following conditions are actually vaccine reactions. Sudden Unexpected Infant Deaths (not caused by accidental suffocation or strangulation in the bed area= 2,625 total, 1%=26). Autism spectrum disorder. (Finding an actual number of diagnoses per year- not a prevalence or percentage- is extremely difficult, so I’m left to my own devices. So we’ll take 73.6 million children ages 0-17 in 2015. Since autism case prevalence is computed based on 3-17 year olds, we’ll take half of the number of children ages 0-5 which is 23.7 million– 23.7 million/2= 11,850,000, so we’ll estimate that the number of children in the United States ages 3-17 is 73,600,000-11,850,000= 61,750,000. Autism prevalence for children ages 3-17 is placed at 2.24%, so 2.24% of 61,750,000 is 1,389,375. 1% of 1,389,375 is 13,893.75, we’ll round up to 13,894.) Multiple sclerosis (an estimated 10,000 new cases diagnosed every year in the US, 1% of 10,000 is 100) and Shaken Baby Syndrome (according to the New York State Department of Health is 1,000-3,000, so we’ll estimate 1,500 and 1% of that is 15- which may be extremely generous considering that SBS is a highly suspect diagnosis that may be attributed to vaccine adverse events very frequently.) So 26+13,894+100+15= 14,035. In 1980, the OTA placed their estimate of disabling vaccine reactions at 100-250 a year, but based on estimates such as mine above it could actually be much higher.

But for a moment let’s take all that off the table and say that the OTA’s estimate in their memorandum is completely accurate. We know that vaccines frequently have a very high failure rate and that herd immunity is more wishful thinking than actual fact. So parents have to decide whether they feel like it is worth the possibility of their child suffering a disabling condition to receive a medical procedure that can’t actually provide high level of protection for themselves or others.

A Case Study In How Something With Little Substantial Research Can Be Adopted As Fact

“It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.”- Mark Twain

“No one can see a bubble. That’s what makes it a bubble.”– The Big Short

“I cannot give any scientist of any age any better advice than this: The intensity of the conviction that a hypothesis is true has no bearing on whether it is true or not.”- Peter Medawar

If the US government and other prominent health organizations endorse a particular measure, we assume it must be scientifically based and appropriately researched. After all, they can point to research and if that research wasn’t substantial then they wouldn’t endorse it, now would they? Unfortunately, that’s not how the public health world works sometimes.

Now while we’d love to live in a world where all public health recommendations are made solely on the basis of accurate research with the health of the population in mind, and where we could see unicorns at the local zoo, both are impossibilities. The fact is that research is conducted and analyzed by human beings who have their own agendas, desires, egos, and biases, all of which sometimes carry over into the research and into subsequent recommendations based on that research. Sometimes, this means that an idea that isn’t fully substantiated makes its way into health policy. So how does this type of thing happen? Well let’s take a look at our case study: the American Heart Association’s low fat diet.

Earlier in the 20th century, the average American diet consisted of very high fat foods with a great deal of animal protein and/or sugar and very little fruits and vegetables. In some areas- especially the South- food was the accepted indulgence of choice since alcohol was considered a sin. In the 1940’s and 1950’s, research began to show that high levels of cholesterol were correlated with heart disease and some researchers began proposing that overweight Americans should decrease their fat intake. In 1977, the McGovern report instructed that Americans in general should eat more whole grains, less meat, more fruits and vegetables and substitute nonfat dairy products for whole fat ones. From Anne LaBerge’s overview of the history of the low-fat diet:

“A turning point in obesity/heart disease studies came in 1983 with the publication of an article based on the Framingham studies, which cited obesity as an independent risk factor for heart disease.²¹ This finding lent further support to the low-fat approach because scientists believed that the low-fat diet might not only prevent coronary heart disease, but also could promote weight loss, thereby reducing the incidence of obesity. By 1984, the scientific consensus was that the low-fat diet was appropriate not only for high-risk patients, but also as a preventive measure for everyone except babies.²² Low fat carried the day, in spite of continued serious skepticism.²³ The diet-heart hypothesis remained a hypothesis, but, as if already proven, it became enshrined in federal public health policy and was promoted by health-care practitioners and the popular health media. By 1988, the Surgeon General’s report emphasized the health dangers of dietary fat, and in 2000, the federal government’s “Report on Nutrition and Health” labeled fat the unhealthiest part of the American diet. From 1984 through the 1990s, dietary fat was increasingly blamed not only for coronary heart disease but also for overweight and obesity.”²⁴

So here we have a hypothesis and some research on a high-risk population. And for people who were eating primarily meat, dairy and sugar, a diet that focused on whole grains and produce might actually bring about some positive changes. However, instead of doing further research to understand if this is actually a correct thing for every single man, woman and child, health authorities latched on to it and ran with it as if it was fact, promoting it for all. Doctors who were skeptical of the idea that the low fat diet was correct for every person accept infants were roundly criticized.

Harvard Medical School sums up the low fat diet this way: “Once the main strategy for losing weight, low-fat diets were shoved aside by the low-carb frenzy. But healthy fats can actually promote weight loss, and some fats are good for the heart; eliminating them from the diet can cause problems. Since fat contains nine calories per gram while carbohydrates contain four, you could theoretically eat more without taking in more calories by cutting back on fatty foods and eating more that are full of carbohydrates, especially water-rich fruits and vegetables. Still, such a diet tends to be less filling and flavorful than other diets, which lessens its long-term appeal. And if the carbs you eat in place of fat are highly processed and rapidly digested, you may be sabotaging your weight-loss plan.” Again, serious problems with the low fat diet as a long-term, blanket strategy for weight loss and health.

Despite emerging research on the importance of moderate consumption of healthy fats, we can still see the vestiges of the low-fat diet “gospel” in government supported food programs. Children at schools drink low fat or non fat milk. Women and children on WIC can only use their WIC vouchers to purchase whole dairy products under special permission- such as if the woman or child is severely underweight.

And this isn’t the first time an idea has quickly morphed from hypothesis to full blown public health campaign. Take Shaken Baby Syndrome– a diagnosis founded largely on research performed on adult baboons and confessions from people under severe emotional duress. Shaking a baby is still abusive and can seriously injure a baby, but the actual diagnosis of Shaken Baby Syndrome as the only cause of subdural hematoma in an infant has come into question in court cases and rightly so. Interestingly enough, we have a great deal of material on not shaking babies, but very little about other abusive behavior towards infant and children. Shaking is specifically singled out in these campaigns.

Or if we really want a throwback, how about the idea that circumcision of male infants should be routine because it would prevent masturbation and a proposed host of accompanying ills? Robert Darby’s paper on the subject notes the “insularity” of the American medical profession in clinging to a belief in “congenital phimosis” long after it had been debunked in Europe. Indeed, despite a mountain of evidence to the contrary, medical texts continued to promote circumcision as a preventative for masturbation into the 1970’s. Whatever your thoughts on circumcision, the point is that the reasons for its widespread promotion during the twentieth century were not scientifically grounded (but rather derived largely from social and cultural ideas) and were presented as fact long after scientific evidence had proved otherwise.

The list can go on and on of “sacred cows” that are founded largely on a belief that something is to true to be untrue or that we simply don’t want to believe it to be true. The mortgage market could never fall apart, it’s simply too safe. The NFL has a history of presenting flawed research as its proof that football players can not develop serious brain injuries from repeated head trauma. Enron was simply too safe and conservative an investment to fail. Madoff was too trustworthy to screw over the investment world.

Sure, you can go around waving research and credentials in people’s faces saying that it’s proof of what you want to hear. But that doesn’t mean the research was carried out in a systematic and unbiased manner or that its results are being correctly interpreted. Just think about next time someone tells you that the research on the safety and efficacy of vaccines is undeniable.

I’m With Stupid

One of the interesting thing about discussing vaccination with pro-vaccine people is that they often think they more intelligent than a non-vaccinating person simply because they have taken the “right” stance. I can not count the number of college educated people who have said that they are grateful no one dies of mumps or rubella any more because of vaccination, who have no idea what an adjuvant is,  do not know that the smallpox vaccine has caused the most recent cases of diagnosed smallpox, do not know that pertussis in vaccinated individuals is frequently asymptomatic, and have no clue that most countries that declare measles “eradicated” have not actually met the requirements for doing so.

These good people are shocked when they find out that they don’t know as much as much as they thought. They were honestly under the impression that  a few “ra-ra- go team!” stories about Jonas Salk, Edward Jenner and the eradication of smallpox with some slogans from billboards and pediatricians and few buzzwords like herd immunity were all they ever needed to understand vaccination.

I have encountered doctors who tell patients that vaccine failure is impossible despite reports from health agencies which confirm otherwise. Others say that vaccine reactions don’t actually happen (despite the fact that our nation’s public health agencies have set up both a vaccine adverse reaction registry and compensation fund for vaccine adverse events victims). Of course it goes the other way too. I’ve seen a few people who spout vaccination conspiracy theories as their proof for their stance. And whenever either side runs out of ammunition they bring up dying children to bolster their view.

It’s human nature. It’s easier to join with the “right” side and not have to actually become educated- it saves us from having to actually ask uncomfortable questions that may cause us to question our current health practices. Of course, there is a lesson in all this. It’s never enough to be on the “right” side. Once you outsource your decision making process to other people, you put yourself in a position where you are relying on them to be 110% interested in your well-being with no self-interest. And that’s never going to happen. It’s far better to do the uncomfortable work to educate yourself. Don’t be with “stupid” and don’t be with “smart”. Inform yourself.

Tribeca

“It must be very fragile, if a handful of berries can bring it down.”- Katniss, Suzanne Collins’ Catching Fire

At first, I was pretty irritated that the Tribeca Film Festival was canceling their screening of Andrew Wakefield’s documentary about autism and the MMR vaccine. What about free speech?! Isn’t this censorship?! Then my husband reminded me that by pulling this film, there will probably be more attention than there would have been otherwise. Robert De Niro wouldn’t be sharing his own very personal story if this hadn’t happened. Banning things has a history of piquing peoples’ interest.