June 7, 2009

this won't hurt a bit

6/7/09

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
Comments
Posted by: ms four at June 8, 2009 3:48 AM

The whooping cough already is back in America. (I heard it on NPR so it must be true!)

The saddest part of all of this is the herd immunity protects our most vulnerable members. Right now the latest whooping cough fatalities are infants who are too young to get vaccinated. In the past, herd immunity prevented babies from getting it.

Maybe parents need to stop letting unvacc'd kids play with their kids... I don't see that happening, but we can't blame celebrities only for this.

Posted by: Neva at June 8, 2009 3:50 AM

THANK YOU! You got it exactly right - please keep this up as I always feel that people don't believe me when I make these points because I'm part of the "vast medical conspiracy". We need brilliant, non-medical, people like you to take this on!
Great job.

Posted by: LFMD at June 8, 2009 4:50 AM

I don't know. . . I have seen Jenny and Jim on many a talk show, and I think that they make sense.

Part of Jenny's argument is that kids are being given too many vaccines all at once at too early an age. I agree.

Another of Jenny's arguments is that the vaccines are being pushed on all of us too soon without being properly tested. Such as the rotovirus vaccine back in 1999 or so, and the HPV vaccine. I agree.

I would not be too quick to shot down Jenny and Jim. They are not against vaccines, as they told Larry King. They are questioning the cycle at which they are administered.

Posted by: Joanna at June 8, 2009 5:00 AM

Whooping cough is already all over Chapel Hill. Ironically, entire classes of children were not permitted to return to public school without taking a z-pak because a fellow student was permitted to attend school without the pertussis vaccine, and subsequently carried the virus. And we were thrilled to get a note from the health dept. that it's already been at our swimming pool.

Posted by: christi at June 8, 2009 5:10 AM

I'm with Joanna - my kindergartner in was in a class that was exposed to whooping cough in carrboro and he was required to take the z-pack or he had to be out of school for 3-weeks. He is vaccinated. . .

When my kids were babies and I talked to the dr. about vaccines and my concerns, he looked at me seriously and simply said "I don't have any other way to protect your kids from these terrible diseases." He's old enough that he saw these go around before we could stop them.

I'm all for vaccine safety, but relying on the herd immunity just drives me crazy. Free riders?

Posted by: The Other Lee at June 8, 2009 5:13 AM

if not for this one point you made, "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 I would be all for the people who don't want vaccines to not get them and let natural selection take it's course. The herd needs to be thinned once in a while but unfortunately these people are not just self selecting themselves but every around them.

Posted by: The Other Lee at June 8, 2009 5:14 AM

oops, I forgot to end the quotation, but I'm sure everyone can figure it out.

Posted by: asd at June 8, 2009 5:27 AM

I would like to ask a question to LFMD
you said

"kids are being given too many vaccines all at once at too early an age. I agree. "

"vaccines are being pushed on all of us too soon without being properly tested. Such as the rotovirus vaccine back in 1999 or so, and the HPV vaccine. I agree."

Youo agree? Based on what?
At what age should children be vaccinated?
how many should they be able to get at a time?
How many people shoudl they test the HPV vaccine on before it is allowed to come to market?

Please do tell!

Posted by: emma at June 8, 2009 5:30 AM

Don't even get me started. Jenny was on Larry King about a year ago and the counterpoint guest was Dave Tayloe, MD President of the american pediatric association, I think. He is the one you need to listen to, not Jenny McCarthy. There is no link between these immunizations and autism.

Posted by: kent at June 8, 2009 5:44 AM

Anyone considering not vaccinating their kids based on something Jim Carrey and Jenny McCarthy said should say this to themselves out loud: "I'm taking medical advice from Jim Carrey and Jenny McCarthy" preferably in a room full of parents and pediatricians.

Posted by: Joanna at June 8, 2009 5:54 AM

Christi, Neva, do we pass each other at Weaver St? Hang out without knowing it at Wilson Park?

Posted by: Kelly in NC at June 8, 2009 5:55 AM

Holy cow. If you think politics is a touchy subject just wait till you see the comments you get on this one.

I have 2 sons with autism and I agree with everything you said with one exception. I don't think the increase in the numbers is soley because of better diagnosis. Surely that has played a role but based on what I've read, that doesn't explain it all. (I'm sorry, I don't have time right now to link to any studies.)

But this is a minor quibble.

That said, the vaccine talk has prompted me to spread out my kids booster vaccines a bit. Like LFMD, I think (and this is purely my gut) that it's better not to bombard little bodies all at once. I've done this with a doctor's approval and have had blood drawn to ensure that their titer levels are high enough to maintain protection.

My 2 boys are part of a set of triplets. Their sister has no issues. No does their singleton sister or anyone else in the family that we're aware of. I hope one day scientists will figure out this genetic puzzle.

Gotta run - off to 1st grade "graduation"!

Posted by: CM at June 8, 2009 7:30 AM

Well, girls are 1/3 less likely to be autistic than boys, from what I've read. I wonder what *is* the reason for the increase? Maybe older women having kids is part of it, but not all of it. As someone who hopes to someday have a kid (and who's of what they call Advanced Maternal Age), I'll be reading a lot about this debate...

Posted by: Dr. W at June 8, 2009 7:41 AM

As a medical professional, I'd like to refute what LFMD says:

"Part of Jenny's argument is that kids are being given too many vaccines all at once at too early an age. I agree."

While your immune system is not fully mature when you are 6 mo of age, it is at its most plastic. Your body is processing millions of antigens a day, and adding one or two more is not a burden. Immunologists place the number of vaccines an infant could handle at about 100,000 in ONE DAY. (source: http://pediatrics.aappublications.org/cgi/content/full/109/1/124 and other research by Offit PA)

"Another of Jenny's arguments is that the vaccines are being pushed on all of us too soon without being properly tested. Such as the rotovirus vaccine back in 1999 or so, and the HPV vaccine. I agree."

There is debate about being an "early adopter" for vaccines which I can respect; however, this will not affect aforementioned "herd immunity." The "herd" of protected has not been accumulated. This should in no way prevent a parent from getting the full host of vaccines that have been in existence for many years.

PLEASE don't get your medical advice from Jenni McCarthy or, worse yet, Oprah (Dr. Oz does speak the truth, but will not correct other very misguided guests).


Posted by: LFMD at June 8, 2009 8:55 AM

I don't claim to have all the facts, and I was just sharing my opinion. I have one child . . . who is very healthy (and for that I am thankful). My daughter has been in a day care/school environment since she was 10 weeks old, and we were state-mandated to get all of the required shots on time so that she could enroll in day care/school. My husband and I never gave it a second thought to vaccinate her. Good citizens abide by state mandates and we are good citizens, by God!

Since my time as a parent of an infant (my daughter is 10 now), I have been interested in the viewpoints of people like Jenny. I admire her efforts to advocate for her son and to question authority. Truth be told, so much occurs behind the scenes between Big Pharma and Government, that perhaps the recommended vaccination schedule is overkill. Newsflash: Big Pharma is not really interested in your well being as much as it is interested in making money off of vaccines and getting states to mandate the vaccination. If I were pregnant now, especially if I were to have a little boy, I would at least question whether particular vaccines, or the wisdom of the timing of the recommended schedule, was necessary. Frankly, I am embarrassed that I so blithely and without question agreed to vaccine my daughter the first time. It never occurred to me to question the vaccines.

Some states are mandating the relately new HPV vaccination in young girls age 13. I do not agree with this, but I don't have the time or energy to pull up the info, so feel free to dismiss me. RE: the rotovirus vaccine, we were about to give our baby the vaccine, but our pediatrician told us that it was new and recalled a week earlier. Apparently, it was causing intestinal blockages in infants! The fact that we were so close to giving her a vaccine that was not properly tested and ran the risk of causing more damage that the diahhrea it was intended to prevent gave me pause.

P.S.: I also diligently gave my beagle all the proper vaccines, on time, and per state-mandated schedule.

Posted by: Caitlin at June 8, 2009 8:59 AM

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:
http://scienceblogs.com/insolence/

Posted by: Ehren at June 8, 2009 9:46 AM

I wouldn't even take acting advice from Carey or McCarthy, and that is ostensibly their area of expertise.

I agree with this, Ian. 100%. The high level of health in our society is the biggest piece of evidence in favor of power and reliability of modern medicine. Say what you will about Big Pharma and the problems of monetizing health care (and what's going on in Africa with AIDS drugs is just one example of the nightmare), but our current system, flawed as it is, has kept humanity's biggest enemies at bay for decades. Take a look through an old cemetery and see how often little children were buried to get an idea just how successful modern medicine has become.

Posted by: Neva at June 8, 2009 10:36 AM

Thanks Caitlin - you made the point I wanted to make about the number of antigens in the vaccines actually going down. I think that is the biggest comeback against this "too many vaccines" argument. And, your patient stories or horrible. I too, got pertussis during residency (while watching an infant almost die from it) and it was AWFUL and I was relatively well the whole time.

LFMD - I respect your point of view I really do, and I get where it is coming from. I actually partly blame the medical community for creating this monster. If we hadn't jumped on the big pharma bandwagon, accepting every free meal and trip that was thrown at us and actually asked for good evidence and well done studies supporting drugs and new vaccines instead of just taking the free pens we might be in a different place with the better educated parents in this world. Right now, I think a lot of otherwise fairly reasonable people are, rightfully so at times, questioning the safety of things that are quickly and without discussion forced upon them. And, some of what we recommend might not make sense at times. Does it really make sense to give Hep B vaccination at such an early age? Most people are not going to be at risk for Hep B until they have sex or exposure to needles. Early infancy is when we have the best access to kids though and we have to rely on good parents to vaccinate older kids which doesn't happen so well anymore. If a parent wanted to put hep B off or put off the HPV vaccine (I for one am not going to give that to my daughter at age 9 and am going to wait until more studies come out because I have the benefit of time. If she were older, I would do it though).

There is a difference between getting your MMR to prevent measles or your DTP to prevent pertussis in early childhood and getting an HPV vaccine. I think parental choice of an alternative vaccine schedule is fine but to do it safely and smartly requires educating/talking/listening to parents and treating them respectfully. This is something that I think is sorely lacking in most doctor/patient relationships these days. Not to beat a dead horse but until we do something about our horrendous medical system with 5 minute well child visits we'll never be able to address this well. I saw lots of your more "granola" types in my practice. We had a lot of discussions about vaccines and the great majority of the parents came around to getting most of the vaccinations after having a respectful discussion about them. I, however, am no longer practicing because if I had to spend that amount of time with each patient/parent I would not be able to pay the 2 billers , 2 receptionists and 2 medical assistants it took to make sure I got the $60 I'd get paid for that visit.

Sorry for the rant, but I had to go there..

Posted by: Neva at June 8, 2009 10:42 AM

Joanna,
We may well cross paths. I don't get over to Carrboro as much as I used to - we live near Timberlyne and are more likely to see you at Cup a Joe, or Trader Joe's for that matter. We just joined the Exchange Pool though. That's on your side..

Posted by: christi at June 8, 2009 11:06 AM

Joanna and Neva - It sounds like wee do cross paths. I too am at the exchange pool, cup a joe, and trader joes of course...live not far from fosters.

Posted by: LFMD at June 8, 2009 11:21 AM

Neva - I hear you.

I still don't understand the hate towards Jenny and Jim. Jenny has spent years advocating for her son and trying to draw him out of autism (which she claims to have done successfully)-- and, while you may find her thoughts misguided, she is trying to HELP PEOPLE. I doubt people are taking their medical advise from Jenny. Rather, she is challenging people (like me) to think about their childrens' health and giving them something to talk to the pediatrician about. She is encouraging parents not to act like lemmings and to advocate for their children.

As for Jim, he is in love with Jenny, parents her son, and supports her as a loving partner should. What is wrong with that? We should all be so lucky to have a Jim.

Posted by: LFMD at June 8, 2009 11:27 AM

Oh, and I truly do not believe Ian's generalization that today's parents are finally paying attention to their kids, hence the explosion of the autism diagnosis. You dismiss the parenting of our parents' generation in one fell swoop, ignoring the fact that autism has been a recognized medical condition FOR YEARS and it is ON THE RISE.

I don't know the reason for this, but it is real and it is very serious.

Posted by: Caitlin at June 8, 2009 11:59 AM

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.

Posted by: Ian at June 8, 2009 12:06 PM

I don't pretend to know the despondency of autism (although I'd love if Kelly in NC wanted to guest-blog) but let's be honest about Jenny and Jim's autism treatment: they have access to the country's best psychological and developmental program at UCLA for autistic kids, and they have the money to send him there full time. Jenny claims it is diet-related and all that, but that's disingenuous to the extreme.

LFMD, you know I love ya, but your last comment doesn't track. I never said autism was never diagnosed (similar observations were noted in the late nineteenth century), but the codification and interest in infant wellness has gone from one book (Dr. Spock) to a whole cottage industry over the last 50 years. Kids who were once thought to be shy, slow or "retarded" are now tested and often labeled with some sort of autism.

There might well be a rise in autistic children. But there are more chemicals and "toxins" in a Happy Meal - or in the air over Houston - than can be found in a million DPT vaccines put together, and we're blaming the vaccines?

Posted by: julie at June 8, 2009 12:19 PM

My question is, and I have wondered about this a lot lately since a "once-upon-a-time" friend had to leave our daycare due to not vaccinating her children, what happens when they go to elmentary school? I know there are religious exemptions, but is that the only exemption that is used?

I admit that I am wholly on Ian's side here and have a few heated discussions with said friend and even my SIL (who decided upon further talk w/pediatrician to space out the vaccinations). But now that my kids are entering school, I really wonder how prevalent it is here (I have read that the west coast has a higher incidence rate of non-vaccinated children than here on the east coast but have absolutely no firm data).

Posted by: Joanna at June 8, 2009 12:41 PM

Neva and Christi, Now that Ian limits his Chapel Hill visits to 3 hours for a Tar Heel game, we should organize our own xtcian get together. We are not at the Exchange Pool, but I've actually heard that's the place to be. We're at Heritage Hills, the pool with pertussis!

Posted by: jje at June 8, 2009 1:54 PM

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!

Posted by: lurker at June 8, 2009 2:02 PM

LMFD, you wrote:

"If I were pregnant now, especially if I were to have a little boy, I would at least question whether particular vaccines, or the wisdom of the timing of the recommended schedule, was necessary. Frankly, I am embarrassed that I so blithely and without question agreed to vaccine my daughter the first time. It never occurred to me to question the vaccines."

Don't be too hard on yourself. You did exactly what most of us do. You (and we) trusted our pedatrician, who is an EXPERT on the subject.

That's the point of today's blog entry, it seems to me.

Posted by: lurker at June 8, 2009 2:08 PM

jje, you wrote:

"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."

Again, yours is a very thoughtful comment and apparently a well thought out position. I just don't understand the tears! Despite the characterization as a "jedi mind trick", you took the advice of a TRUSTED PEDIATRICIAN, over your "gut feeling".

YOU DID THE RIGHT THING!!

Posted by: CM at June 8, 2009 2:10 PM

oops, correcting what i said above, girls are about 1/3 AS likely...

Posted by: jje at June 8, 2009 2:24 PM

Lurker, I get what you're saying...the ped is an expert on his subject, BUT I'm the expert on my children. I think I deserve to have an educated role in all this. And if the ped isn't willing to have these kinds of conversations with me, then well, I guess I'm the crackheaded thorn in her side for that day.

I cried because I was seven days postpartum. And because I love my child to pieces and the thought of taking even an educated risk worries me.

Posted by: jje at June 8, 2009 2:31 PM

Oh, and I was just attempting humor with the Jedi mind trick comment. I really do love our ped but I went in there pretty determined that she wasn't going to change my mind. She spent a long time talking me through things, and yes, I eventually decided to stay on schedule.

Again, let me reiterate, I was never planning on not vaxing - just going a little slower. Two shots at a time max, breaking up the MMR, that kind of thing - and just for Graham. Because Connor has never shown any reactions, I have felt reasonably comfortable leaving him on schedule.

Posted by: wyatt at June 8, 2009 2:49 PM

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.

Posted by: Lurker at June 8, 2009 3:07 PM

I hear you, jje. You absolutely SHOULD be educated about your child's medical care, and any pediatrician (or any doctor) who makes you feel bad about asking questions or challenging them shouldn't be your doctor for long.

I was just trying to point out that your tears (and LMFD's guilt) are more Jenny M's fault than your pediatrician's. (By the way, none of this is intended to minimize postpartum depression. It is serious stuff and should not be ignored. My wife wrestled with it some after our third arrived; thankfully, all is well now.)

Sorry for weighing in so much on this. I have a friend who won't vaccinate her kids. Actually, she's no longer a friend. Honestly; all I can think about when I see her is how selfish she is, on so many levels, and I just haven't been able to get past it.

Posted by: Caitlin at June 8, 2009 3:43 PM

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.

Posted by: LFMD at June 8, 2009 3:58 PM

Thanks for having my back, JJE!

I don't even know what herd immunity, Natural Living/Attachment Parenting, etc. is. I had my baby in the prior millenium (1999), which makes all of my thoughts and concerns outdated. Which may be the point. . . most of the information my mother received from her doctor when she was pregnant in 1968 has subsequently been refuted (it is OK to smoke and drink, don't gain more than 10 lbs. during pregnancy, go ahead and take that thalidomide, let baby sleep on her stomach (or was it the back - what are the docs saying now??), start the rice cereal at 3 weeks). It was "good advice from a medical expert" in 1968, and ludicrous now. Who is to say that the advice of the medical experts in 2009 regarding vaccines will hold water when our children are parents?

I never take any professionals' words as gospel. I am particularly suspect of doctors. What JJE said about being the Expert on her children rings true for me.

Can we talk about the new iPhone tomorrow?

Posted by: Sarah at June 8, 2009 4:07 PM

"I never take any professionals' words as gospel. I am particularly suspect of doctors."

Really, LFMD? So then what is the point of education, if you don't accept the opinion of people who are the premiere experts in their fields?

I don't mean to jump on you, but if this is the case, I'm curious as to whether you will encourage your daughter to pursue a higher degree.

Posted by: LFMD at June 8, 2009 4:54 PM

Hi Sarah, jump away. I don't mind!

I think that the premiere experts in their fields are above all human beings with their own biases and limitations who are working with whatever information is considered to be the best and most factual at the moment. Today's experts are tomorrow's nincompoops in the big scheme of things.

My husband and I are both attorneys (my husband is a judge). Frankly, I hope my daughter gets a college degree . . . based on my prediction that in 2017, when she graduates high school, the college degree will give her the salary-generating power of today's high school diploma. I would hope she gets enough education to be able to support herself, which is not necessarily correlated with higher education. Right now, she wants to be a farmer, so more power to her.

Posted by: Kelly in NC at June 8, 2009 5:05 PM

Ian - I don't know if your invitation to guest blog was serious or not but if so, I'm flattered. But with 4 kids ages 7 and under about to get out of school for the summer I'll be lucky if I have time to change my underwear anytime soon, much less write down a coherent thought.

Quickly, I'll just say despondency is one of the many emotions we've gone through since learning our boys are autistic but it hasn't been predominate. Yes, autism has made everything a little bit harder but the successes are so much sweeter.

Posted by: LFMD at June 8, 2009 5:08 PM

Ian Dear, I so hate when I start to ramble and sound like an ass in your xtcian comments. I have spouted so much jackassery today, that I don't remember what my original argument was. I still stand by my comments, just wish that I did not sound like such a jackass.

Anyway, I am going to Chipotle to pick up dinner and then watch my Netflix movie. Good night, all! Hugs!

Posted by: LFMD at June 8, 2009 5:10 PM

Yes! Please have Kelly guest blog! I would be very interested in hearing what she has to say.

Posted by: Suzie at June 8, 2009 8:35 PM

I would like to just add a wee note here that one of the main reasons for spacing the vaccinations out is to be able to tell which (if any) vaccine has caused an adverse reaction. There is a risk of complications with each and every vaccine. Complications range anywhere from soreness in the area to (albeit extremely rare cases) death. I see no reason to rush the process before you find out if your particular child is one of the few who does not process the immunization well. Even though the chances are small, you still want to make sure that the "one in a million" isn't your child.

Posted by: ms four at June 9, 2009 2:04 AM

Despite the fact that I made one of the first pro-vax comments, I didn't jump in blindly. I'm a librarian, and I took at a look at the relevant literature and educated myself when I started to hear some of these concerns.

I also talked to my pediatrician about this. I trust her a bunch--she's one of those docs whose office visits are always at least 20 minutes, something like that. My boys had to start from scratch at older ages because they were adopted from overseas. I asked our ped about spacing out the vaccines, but she told me they'd end up getting something like 20 shots instead of five.

Especially my older one freaks out over every shot, and there was no way I was going to put him through that trauma for my peace of mind.

Pro-vax parents aren't necessarily people who are uneducated or haven't looked into these issues themselves.

I am suspicious of the increase in autism, but I suspect it has something to do with all the plastic and crap in our environment now. Wasn't there some study of late that found that a chemical in jet fuel was a regular component of women's breast milk?

Posted by: wes at June 9, 2009 8:11 AM

There's a very interesting article in the new Time or Newsweek (we get both due to a magazine sale at my daughter's school, and I can't ever remember which one I read something in) about the "medical" information dispensed on Oprah's show. Jenny McCarthy looks like Jonas Salk compared to Suzanne Somers, who really sounds like a nutcase.

Thanks, Ian, for a thoughtful post. I've been a mom for 23 years and have never regretted having my children vaccinated. As the daughter and granddaughter of pediatricians, I may fall into the "trust your doctor" camp to an extreme, but I believe my pediatrician has his patients' best interests at heart. I can't imagine why you'd be a pediatrician otherwise -- it isn't the highest-paying or lowest-stress specialty in medicine.

Posted by: jje at June 10, 2009 11:06 AM

Ha - had to come back and mention that I earned myself a tetnus shot (sigh, and 10 staples and five hours at the ER) yesterday after tripping and slicing open my leg on a metal sign while handing out birthday party favors.

So yay vaccines! Boo lockjaw!

Posted by: Ian at June 10, 2009 1:08 PM

jje, I'm a proud recipient of the tetanus shot last month too, due to the sheet metal incident. Doesn't hurt going in, but sure sucked the next day.

Posted by: jje at June 10, 2009 1:23 PM

Yep, I remember. Totally thought of you. ;-) And I FB'ed the entire five hours I was there. Good times.

Oddly enough, the ER doc who stapled me up acted like it wasn't a big deal if I didn't get the tetanus shot. He shrugged and said there hadn't been a case of it in the US in 10 (or maybe it was 20 - can't remember now) years, which didn't sound quite right to me. I insisted on getting it.


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