this won't hurt a bit
Look, I've always thought Jenny McCarthy was a hoot, fairly self-deprecating for someone who has shown their vulva to North America. And Jim Carrey gets a lot of props for "Ace Ventura" and "Spotless Mind", even as he slowly went mad for the last decade or so. But they have GOT to COOL IT on the vaccine talk, because pretty soon, some impressionable Americans are going to start believing them.
I thought with the coming of Barack Obama, we were coming back into the Age of Enlightenment, when people actually started listening to scientists again, not just rejecting them out of hand when they didn't agree with Creationist fantasies. It's once again au courant to take scientific studies seriously, but that doesn't seem to be stopping the Anti-Vaccine groups, and the prideful quack doctors that enable them.
I'll leave it to Neva or Caitlin or any of the other brilliant medical minds to tell me if I'm wrong, but here's my take on the "vaccine/autism" research as it stands now: there is no direct connection between the two. It is possible that some children inherit an autism gene (or a combination of genes) that can get "switched on" by a vaccine, as a sort of environmental damage - or a vaccine can intensify a child's pre-existing condition (like mitochondrial issues) but they're just as likely to have the same thing happen from another element in the environment (sickness, air quality, bad food, etc.)
The reason autism rates appear to be going up is because diagnosis is much more inclusive, and parents/teachers are finally paying attention to their kids. Anecdotally, I could tell you about many kids in my grade school class who would have ended up on the autism spectrum if anyone had been noticing. Hell, I'd probably have dipped my toe into the spectrum, and one of my brothers as well.
The preservative in old vaccines was once labeled as a potential problem, but thimerosal has not been used for a long time. When presented with that information, the anti-vax crowd will mention aluminum, or some other element in vaccines they mistakenly call a "toxin". In short, it starts to get very ugly and evangelical the farther you go into the anti-vaccine movement.
All of which would be fine, except they are beginning to put your kids and my kids at risk for some truly ugly diseases like polio, measles, rubella and diptheria. Those sound antiquated and cute? Well, like Megan McArdle writes on her brilliant blog at the Atlantic Monthly, "The vaccines scare us because the diseases don't. And they don't because of the vaccines."
The non-vaccinated are kept safe because of herd immunity - when everyone else shoulders the responsibility of vaccination, they benefit. But only for so long. If their numbers increase, pretty soon they start giving diseases to each other, and since some vaccines have only 90% efficacy, they can give it to your kids too.
And THAT is where I start getting EVANGELICAL RIGHT BACK. If you want to place your own child on the polio roulette wheel and not get the shots, I can't stop you... but you better be living on an Antarctic island or inside a latex bubble, because your kid shouldn't be near any of us, or any of our friends. You're practicing a lazy, dangerous science, more or less in the realm of magical thinking, and if you bring the whooping cough back to America, you will have started the fire that burns down the town.
I'm all for making pharmaceutical companies sweat; they're all corporations, and corporations could give a fuck about human life, especially if it interfered with their cashflow. But disregarding every independent study, and putting us a step closer to a pandemic? You're making us lefty, paranoid, conspiracy theorists look bad.
Posted by Ian Williams at June 7, 2009 11:08 PM
Ian, thank you for this, my favorite of your many wonderful rants. This issue drives me completely, totally insane. There are mountains of well-done studies that refute any connection between vaccines and autism (nor is there any evidence for the "trigger" hypothesis you mention), but the public apparently gives equal weight to excellent, rigorous medical epidemiology and the speculative opinions of grade B Hollywood celebs. I consider Jenny McCarthy and her ilk dangerous disease-mongers.
The idea that kids get "too many vaccines too soon" and that vaccines can overwhelm the "immature immune system", while perhaps intuitively appealing, has _no basis_ in fact. The infant immune system is bombarded with thousands of exposures to viruses, bacteria, you name it, and handles it with aplomb, from the very moment of birth onward. Vaccines represent the tiniest portion of these exposures.
Morever, the overall number of antigens (the fragments of pathogens in vaccines that induce immunity) children are exposed to in vaccines has actually gone _down_ markedly since the elimination of smallpox from the vaccine schedule after smallpox was eradicated in 1977.
I believe in evidence and not anecdotes, but here are a few that are seared into my memory:
- I've had whooping cough that made stay up all night coughing so hard I vomited repeatedly and broke two ribs
- I've seen a child die with measles encephalitis
- I've cared for an unvaccinated woman with tetanus who we had to keep on a ventilator (via a trach cut in her throat), paralyzed and sedated for weeks to keep her from having the most intense muscle spasm that you've ever seen course through her entire body and stop her diaphragm from moving. She recovered but it took her months to learn to walk again.
- I've taken care of so many people with cirrhosis caused by vaccine-preventable Hep B -- jaundiced til they are dark yellow, confused, reeking of death, hospitalized until they eventually succumb to sepsis and die, comatose and bleeding.
It's hard to watch parents walk away from the greatest gift of modern medicine, one that has done more to prevent suffering and death than any other. I wish I could understand why refusing vaccines has become so trendy in certain circles.
If you are interested in reading thorough debunking of anti-vaccine advocacy, Orac's blog 'Respectful Insolence' is worth a read. I particularly enjoy his take-downs of Jenny McCarthy's LA anti-vaccine pediatrician, Jay Gordon:
LFMD, your comments worry me because you represent a huge group of people that are becoming skeptical about vaccines. You are a thoughtful, well-educated parent who wants what is best for your child. And you have become concerned that vaccines may be dangerous, that there are too many in the schedule, and that the profit motive and a Big Pharma - Government behind-the-scenes agreement has led to 'overkill' in the vaccine schedule. All the concerns that are encouraged by people like Jenny McCarthy.
If reasonable people like you have come to these conclusions, we in infectious diseases and public health are in deep trouble.
I wanted to point out a few things: that producing vaccines is not, in fact, a hugely profitable enterprise for Pharma companies -- they make way more money on cholesterol treaments, antidepressants, Viagra, etc, things that require chronic treatment for years, than on one-time vaccines. There are only a few or sometimes even only one company making each vaccine, and any problem with manufacturing can mean a big shortage, as happened with the HiB vaccine this winter.
Second, the original rotavirus vaccine you mentioned was thoroughly and properly studied in many large groups of children prior to approval. However, the complication of bowel obstruction is so extraordinarily rare that this adverse effect was only detected after the vaccine was in use. The fact that it was detected and the vaccine was pulled from the market is testament to the vigilance and effectiveness of the vaccine safety program, not evidence of lax oversight.
On HPV, you can bet my daughter is getting the vaccine -- I keep thinking about this woman I saw in the ER a few years ago, in her early 30s, who came in confused and in kidney failure because of the giant fungating cervical cancer I found when I examined her. You hate to use the words "palliative care" when caring for someone that young. Now admittedly that is an extreme case and has a lot to do with her lack of access to health care (another topic worthy of ranting), but still, without HPV she'd be alive.
Though I agree that it should be optional, not mandatory, until it's been out for a few years. If I had a son he'd be getting it too, since 1) men spread HPV to women, and I'd hate for a child of mine to give anyone the virus that causes cervical cancer and 2) HPV-associated anal and rectal cancer is a big problem in men who have sex with men, and the studies are underway that will likely show the vaccine protects men as well.
Neva, I admire you for working with your vaccine-skeptical patients, I don't think I'd have the patience to have that kind of lengthy respectful dialogue over and over again. It's interesting that you are no longer practicing (at all? or not peds?), I am also leaving clinical medicine to go into public health this year.
I'm almost scared to post - LOL - and frankly, I'm actually a little surprised that I'm only the second to chime in with Laurie because I would have put money on at least seeing more delayed vaxers in this pretty select group.
Let me go ahead and tell you that I vax, so the herd is not in any danger from me. Both boys are up-to-date. That said, I was much more thoughtful, and yes, reluctant as far as scheduling goes, with my second.
With Connor, I just did what the doctor told me to do.
Then I joined my local mommies group, which is based online and has well over 3,000 members from every walk of life. And there are four discussions that are guaranteed to get our board in an uproar Every Single Time a newbie brings them up: breastfeeding vs. formula feeding, SAHM vs. WOHM, circ'ing vs. not circ'ing, and vaxing vs not vaxing. You'd be amazed how passionate women can get over these topics.
On top of that, one of the forums we have within the site is dedicated to Natural Living/Attachment Parenting lifestyles (I'm more AP than NL, but I do pick my battles in NL, like eating organic when I can), and that's where you'll find most of the women who either don't vax or do so selectively. There are entire threads devoted to research/anecdotes, ways of talking with your doctor about your vax plan, doctors in the community who are on board with delaying/not vaxing, pharmacies who will work with you to obtain the separate elements of the MMR, etc, etc.
So while pregnant with my second, I started taking it all in, reading what I could online, and really thinking about how I wanted to proceed, knowing full well that my beloved ped and the group practice as a whole were not going to be very receptive to anything other than the status quo. I had a copy of Dr. Sears' Vaccine Book and my plan was to follow his delayed schedule.
I declined the first Hep B shot in the hospital - the plan was to get it later on down the road. The nurse respectfully made the note in my chart and that was that. But then the ped on call from my practice came to check on Graham and once he realized I had declined it, decided to berate and patronize me. Let me tell you, the only thing that kept my postpartum self from completely going off on him was that my mother raised me better...that, and I was still sore and groggy from a complicated c-section. I still remember him asking me as if I were nothing more than a silly, uneducated child, "do you have any medical training?" In hindsight I have a million better, snarkier replies, but the only one I had at that moment was, "no...but I can read."
Still, that was the beginning of the end.
I truly believed I could convince my ped (whose dad played with Choo Choo Justice) to support my decision to be on a delayed schedule, because afterall, he'd still be fully vaccinated when all was said and done. But God bless her, she used her Jedi mind tricks and I caved. I bawled the entire first visit because I truly felt I wasn't doing my best for my child. I'm dreading his one year visit coming up. I may still push to delay the MMR for just a little longer, I don't know. My husband thinks I'm being a crunchy circus freak, but my gut feeling is that there is something to both sides of the debate.
I don't hold Jenny and Jim in any particular esteem other than an appreciation that someone is out there asking questions and drawing attention to the subject, but I do pay attention when I have very well educated friends who are choosing to selectively delay. One friend, who might be the smartest person I know - GT and Harvard business school (and in a small world note, also a pal of Dacia Toll) - is selectively delaying because her son suffered multiple seizures after receiving the MMR. In fact, a good chunk of my social circle delays (and I don't really hang with a crunchy crowd - mostly banker and attorney wives here in Charlotte). And the ones who don't are pretty supportive and understanding of the ones that do.
Anyway, I figured I'd chime in so Laurie wasn't shouldering the full brunt of the herd wrath. ;-)
Pardon the typos and thinkos - the boys are definitely distracting me while pounding this out!
Damn. Intolerance and suppression, of a vocal minority with real concerns for their children's welfare, right here on xtcian. Whodathunkit?
If your child is vaccinated, what threat is posed by a non-vaccinated disease carrying classmate? You're good to go, right? What? You don't absolutely believe the vaccines will "protect your kids from these terrible diseases", as the doctor, pharmaceutical company, and government say? Sedition!
You read the fine print in your cell phone contract, you examine the candy bar wrapper for "may contain nuts", but if you wonder out loud about the dozens of needles you have to stick into your healthy child to be welcome in public school, you're an idiot.
And bless your heart, but I demand more rigor from my "medical professionals" than reliance on "studies are underway that will likely show...". I'm also disappointed that a mathematical exercise which suggests a child can handle 100,000 vaccine antigens at once is quoted to dismiss the "too much at once" concern, ignoring the theoretical health risk of the solvents and preservatives in the vaccine dose required to deliver that volume of antigens. It's this sort of medical/scientific/technical/logical sloppiness that leads some "reasonable people" to question the one-size-fits-all immunization schedule pushed by The Man.
"Trusted pediatrician" over my gut feeling? Are you kidding me? Ours pooh-poohed our developmental/autism concerns and cost us over a year of early intervention. So FUCK "trusted pediatrician".
Whether they are a Playboy bunny who writes books about her family or a screenwriter who went to my college and has a very cool blog, I'll take their pediatric medical advice with a grain of salt. An organic, free-range, locally grown grain of salt.
Disclosure: carefully diagnosed "some sort of autism" in the house (and probably in the author); kids legally vaccinated, but not according to a schedule deemed convenient to the pediatric clinic or the school board. I don't think the MMR vaccine causes all autism; I think modern vaccination schemes cause some people great lifetime harm.
Wyatt, you misunderstood what I said. I commented that "studies are underway that will probably show benefit" for the _HPV vaccine in boys_ (particularly those who end up having sex with men when they grow up). Note that HPV vaccine is not recommended for boys at this time.
For all the other vaccines, the ones that are currently in the schedule, there is definite, proven benefit in preventing infectious disease in multiple well-done studies.
The canard that "if your child is vaccinated what do you have to worry about from unvaccinated kids?" bears careful examination. About 90-95% of children develop protective immunity after vaccination, but not all do. Those in whom immunity fails to develop, those too young to be vaccinated, those who have immune deficits like hypogammaglobulinemia, and those who are immunosuppressed from chemotherapy or HIV are all at risk from unvaccinated children in their schools and neighborhoods. And unvaccinated children themselves are at an estimated 22-39 times higher risk of measles and pertussis than vaccinated children. These statistics come from my review of the relevant primary medical literature.
Which 'solvents and preservatives' are you concerned about? There is no longer thimerosal in vaccines, except flu vaccine, and there hasn't been since 2003 -- despite this, autism rates continue to increase. MMR is a live virus with attenuated (weakened) vaccine and has never contained any preservatives. The tiny amount of aluminum in some vaccines is an adjuvant that stimulates the immune response to the vaccine antigen and has been studied; no difference has been found between aluminum containing and aluminum free vaccines.
I have yet to see any evidence that any putative "toxin" in vaccines is more dangerous than the toxins produced by actual infection with vaccine-preventable diseases, such as tetanospasmin, tetanolysin, diphtheria toxin and pertussis toxin.
There is also no scientific, medical, clinical, immunologic, or epidemiologic evidence that there is any benefit to delaying or breaking up vaccines in the schedule. Indeed, doing so increases the pool of children susceptible to infectious diseases at any one time, and increases the risk of outbreaks.