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And They Wonder Why We Don’t Trust Them by Sandy Gottstein

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The New England Journal of Medicine just published a shoddy piece, innocently titled “The Age-Old Struggle against the Antivaccinationists”, in which they make a multitude of outrageous, unsubstantiated claims.  Here is my response to many of them.

Labeling people who want their concerns about vaccinations to be taken seriously “anti-vaccinationists” is an age-old, shameless tactic.  Some are; most aren’t.  Regardless, dismissive and pejorative labeling does nothing to address the real question:  do the benefits of vaccines really (far) outweigh their risks?

 “Countries that dropped routine pertussis vaccination in the 1970s and 1980s then suffered 10 to 100 times the pertussis incidence of countries that maintained high immunization rates; ultimately, the countries that had eliminated their pertussis vaccination programs reinstated them.” 

And the result of the rise in pertussis cases?  This is a classic mistake (ploy?) made by those who unquestioningly promote vaccinations:  equating incidence of disease with adverse disease outcomes.  The number of people getting a disease is not useful information in and of itself. The only meaningful question is, “what are the long-term consequences of a disease and what are the long-term consequences of the vaccine designed to prevent that disease”. 

Equating incidence with outcome is at best an example of sloppy thinking.  At worst?  By the way, Dr. Gordon Stewart published many articles about what actually happened in England when the pertussis vaccine went out of favor.  You might want to familiarize yourself with him and them (1,2,3).

Note, also, that vaccination against pertussis is by no means a guarantee that whooping cough will be averted. (1, 2)  Outbreaks continue to occur in highly vaccinated populations. (3)

Moreover, do you even care about the possible risks from the vaccine?  For instance, Dr. William C. Torch found that “These data show that DPT vaccination may be a generally unrecognized major cause of sudden infant and early childhood death, and that the risks of immunization may outweigh its potential benefits. A need for reevaluation and possible modification of current vaccination procedures is indicated by this study.” What if he was right?  Don’t you even wonder about it?  What of the at least* 1,808 deaths associated with vaccines containing the pertussis component, 923 of which were attributed to a vaccine containing the acellular pertussis component, and reported to VAERS over the years?  The at least* 7,901 hospitalizations  (4,483 acellular related)?  Do you care about any of them?  Shouldn’t they be included in any evaluation of the risks vs. the benefits of a vaccine?  Shouldn’t they be understood? 

What number should we multiply the VAERS reports by to account for under-reporting?* Should we multiply 1,808 by 10 to arrive at 18, 080 deaths? By 100 to arrive at 180,800?  Something else?  Aren’t you in the least disturbed by the fact that we don’t know the answer to this critical question?

Or are only children harmed by disease important enough to properly count?

What about SIDS?  Parents are probably vastly under-reporting SIDS deaths that might be vaccine-caused since they have been told SIDS can’t possibly be related to vaccination, even in the case of a recently administered one.  In spite of that fact, there have been 1,090 vaccine-associated SIDS deaths reported so far, including 960 that have been associated with vaccines containing a pertussis component (That’s almost 90% of them!), including 437 with the acellular one.  We know that deaths are occurring shortly after vaccination, even within one day.  SIDS is a disease of unknown cause.  Until its cause is known, shouldn’t an obviously temporally- related intervention at least be considered a possible culprit?  Why isn’t it?  And how many of them are there really?

“The 1998 publication of an article, recently retracted by the Lancet, by Wakefield et al. created a worldwide controversy over the measles–mumps–rubella (MMR) vaccine by claiming that it played a causative role in autism.” 

Did you even read the paper?  Here is what it ACTUALLY said: “We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described. Virological studies are underway that may help to resolve this issue… We have identified a chronic enterocolitis in children that may be related to neuropsychiatric dysfunction. In most cases, onset of symptoms was after measles, mumps, and rubella immunisation. Further investigations are needed to examine this syndrome and its possible relation to this vaccine.”

“This claim led to decreased use of MMR vaccine in Britain, Ireland, the United States, and other countries. Ireland, in particular, experienced measles outbreaks in which there were more than 300 cases, 100 hospitalizations, and 3 deaths.”  

First, rightly or wrongly, Wakefield called for the use of single vaccines, not an end to measles vaccinations.  Thus, a strong case can be made that any decline in measles vaccine uptake in the UK was due not to Wakefield et al’s paper, or his personal recommendation, but to the fact that single vaccines, shortly after he made the recommendation, stopped being made available in the UK.  As far as any declines in the US are concerned, at least according to this report, the decline was short-lived. 

It also isn’t clear that Wakefield’s paper led to an increase in measles cases, as demonstrated in the excellent, recent paper by Dr. F. Edward Yazbak, “Measles in the United Kingdom - The ‘Wakefield Factor’”.  According to Dr. Yazbak, and well-substantiated in his paper, at first the number of measles cases in England and Wales actually declined and didn’t increase until almost 10 years later.  At that point, an increase in measles cases was occurring even in highly vaccinated countries.  Why would you make such a bold claim in the face of official evidence to the contrary?  

But, regardless of any putative decline in MMR vaccine coverage and increase in measles cases, compared to what?  There have been at least* 194 vaccine-associated MMR deaths reported to VAERS, just in the United States alone.   There have been at least* 3,185 hospitalizations.  Are you even interested in whether or not these events might be causally related to the vaccine?  Or what these numbers represent?  What adjustments to the numbers should be made given the widely acknowledged problems with any passive reporting system, which is what VAERS is?  Should we multiply the number by 2, by 50, by 100?  Where’s your concern about the fact that we have no idea how many deaths and hospitalizations might be attributable to the MMR vaccine?  Or to any others?

“Today, the spectrum of antivaccinationists ranges from people who are simply ignorant about science (or “innumerate” — unable to understand and incorporate concepts of risk and probability into science-grounded decision making) “to a radical fringe element who use deliberate mistruths, intimidation, falsified data, and threats of violence in efforts to prevent the use of vaccines and to silence critics.” 

WOW, you mean there is no one with any credentials or understanding of science who questions the sacred cow of vaccination? 

What about the aforementioned Dr. Gordon Stewart, emeritus Professor of Public Health at the University of Glasgow, who at one time even worked for WHO?  Or how about UCLA’s Dr. John Menkes, who authored a textbook on pediatric neurology (later co-authoring an updated version of it) and who organized the  “ Workshop on Neurologic Complications of Pertussis and Pertussis Vaccination” with Dr. Marcel Kinsbourne, another lightweight?  Then there is Dr. Eugene Robin of Stanford who wrote a book called “Matters of Life and Death: Risks vs. Benefits of Medical Care” and testified to the IOM about his concerns.  I could go on and on.  By pretending that only weak-minded, poorly educated or even crazy people question the status quo on vaccines, you simply make yourself look bad.  So thank you for that.

“The H1N1 influenza pandemic of 2009 and 2010 revealed a strong public fear of vaccination, stoked by antivaccinationists. In the United States, 70 million doses of vaccine were wasted, although there was no evidence of harm from vaccination.” 

Or was it the absence of a genuine threat that led to the refusal to use the H1N1 vaccine?  Apparently the CDC and the public learned different lessons from the 1976 swine flu vaccine “fiasco”.  The CDC evidently learned this lesson: “When lives are at stake, it is better to err on the side of overreaction than underreaction. Because of the unpredictability of influenza, responsible public health leaders must be willing to take risks on behalf of the public. This requires personal courage and a reasonable level of understanding by the politicians to whom these public health leaders are accountable. All policy decisions entail risks and benefits: risks or benefits to the decision maker; risks or benefits to those affected by the decision. In 1976, the federal government wisely opted to put protection of the public first.”  The public largely seems to have learned something different, deciding not “to err on the side of overreaction”.  Instead they made their own assessment of H1N1 risk, and having decided the risk was reasonably low, rejected the vaccine.  Given the nature of the epidemic so far, it looks like it may have been prudent to “waste” it. 

Moreover, no evidence of harm?  First, there have been at least* 4,344 H1N1 vaccine-associated reports to VAERS that fall in the following categories:  death, life threatening, permanent disability, hospitalized, hospitalized prolonged, emergency room.  (Don’t forget that passive reporting is notoriously low.  Feel free to multiply those adverse vaccine-associated reactions by as much as 100*.)  Second, there have been accounts in the news of serious adverse reactions, like the fact that 80 people were reported to have suffered narcolepsy and many reports of H1N1 vaccine-associated miscarriage.  Note that pregnant women were specifically advised to have the vaccine.

Besides, there are plenty of just plain good reasons to avoid the vaccine, perhaps none expressed so convincingly than by Dr. Marc Girard, consultant in drug monitoring and pharmacoepidemiology expert,  in his superb paper “Swine Flu: to Vaccinate or Not?

“Antivaccinationists tend toward complete mistrust of government and manufacturers, conspiratorial thinking, denialism, low cognitive complexity in thinking patterns, reasoning flaws, and a habit of substituting emotional anecdotes for data.”

Pray tell, where does “data” come from, if not anecdotes, i.e., observation of events.  To determine if anecdotes are representative of genuine phenomena, they must be scrutinized.  The now over 325,000, likely way under-reported, vaccine-associated reactions so far recorded at VAERS are not even examined, let alone investigated and studied.  How do I know that?  As I documented in “VAERS: Is the Joke On Us?”, and most recently confirmed here, in over 30% of the cases it is unknown whether or not the person even recovered from their symptoms.  Clearly, there is no effort to follow-up on, let alone understand, this “anecdotal” evidence. 

Furthermore, labeling the anecdotes “emotional” does nothing to cast light on their veracity, although it does cast light on your intentions.

“In the face of such a legacy, what can we do to hasten the funeral of antivaccination campaigns? First, we must continue to fund and publish high-quality studies to investigate concerns about vaccine safety.” 

Therein lies the rub.  We disagree about the quality.  Where, for instance is an actual control group, the never-vaccinated, in any of your studies? 

And funeral?  My, my.

“Second, we must maintain, if not improve, monitoring programs, such as the Vaccine Adverse Events Reporting System (VAERS) and the Clinical Immunization Safety Assessment Network, to ensure coverage of real but rare adverse events that may be related to vaccination, and we should expand the VAERS to make compensation available to anyone, regardless of age, who is legitimately injured by a vaccine.” 

How about also treating the VAERS reports as worth your while?  How about not dismissing virtually all of them out of hand?

“Third, we must teach health care professionals, parents, and patients how to counter antivaccinationists' false and injurious claims.” 

How about fairly addressing the many legitimate ones?  How about genuinely addressing the injuries vaccines seem to be inflicting?

“Fourth, we must enhance public education and public persuasion. Patients and parents are seeking to balance risks and benefits. This process must start with increasing scientific literacy at all levels of education. In addition, public–private partnerships of scientists and physicians could be developed to make accurate vaccine information accessible to the public in multiple languages, on a range of reading levels, and through various media.” 

Accurate, of course, being defined as anything that supports the use of vaccination.

“The diseases that we now seek to prevent with vaccination pose far less risk to antivaccinationists than smallpox did through the early 1900s.”  

Yes, we would agree.  Had you stuck to the really serious diseases, perhaps we might not be questioning your assessment of the vaccine risk/benefit ratio.

“on the other hand, the reality that none of the antivaccinationists' claims of widespread injury from vaccines have withstood the tests of time and science.”  

How do you know that?  You don’t even know what the baseline health status of the never-vaccinated is.  

And your “science”?  The best that money can buy.

*I say “at least” because if they weren’t specifically coded as a death or hospitalization, regardless of whether the death or hospitalization was noted in the “symptom_text”, it would not have been counted.  Note also that passive reporting is notoriously low.  David Kessler, a former FDA commissioner stated that only about 1% of serious events are reported to the FDA, according to one study.

Sandy Gottstein

Date: 1-18-2011

“Eternal vigilance is the price of liberty.” – Wendell Phillips (1811-1884), paraphrasing John Philpot Curran