White, well-educated and wealthy parents spread measles risk

March 22, 2010

A new and fascinating study in the journal Pediatrics examines what happened when an intentionally unvaccinated seven-year old boy caught measles on a trip to Switzerland in January 2008 and brought it back to San Diego. Despite the city having a 95 percent  immunization rate, clusters of intentional under-vaccination, particularly in upper income and private school enclaves, led to the largest outbreak of measles in the city since 1991. 839 people were exposed to the disease, which sickened 11 other children, 8 of whom were unvaccinated, apparently due to parental fears of adverse vaccine effects or the misguided belief that “natural lifestyles” would confer protection (the other three were too young to have been vaccinated). As MedPage Today reports (only an abstract of the study is available free online), the primary infected or “index” child,

“directly infected his two siblings, two classmates, and four children who were treated at the same clinic. The index patient’s sister then infected two of her classmates. One of the index patient’s classmates infected his brother, bringing the total number of cases to 12.”

What the study call’s “a vigorous outbreak response” by city health officials prevented further transmission, but it came at a cost of $176,000 or $10,000 per case, which included the cost of quarantining infants too young to be vaccinated. Unsurprisingly, MedPage Today reports a sense of alarm among doctors over the possibility that misguided fears over vaccine risks and unrealistic expectations about “natural lifestyles” will increase the size and number of unvaccinated clusters and that herd immunity will not prove a bulwark against the transmission of disease, especially to infants who haven’t yet received their vaccinations.  What is most troubling is that such clusters were most likely to occur among white, well-educated, and well-to-do parents.


Should you delay your child’s vaccination schedule?

August 10, 2009

Dr. John Snyder, Chief of the Section of General Pediatrics and Medical Director of Pediatric Ambulatory Care at Saint Vincent’s Hospital in New York City, takes on one of the most vexing issues facing the parents of a new baby: should they follow the vaccination schedule recommended by the American Academy of Pediatrics and the CDC’s Advisory Committee on Immunization Practices, or should they follow an alternative vaccination schedule just to be on the safe side?

As Dr. Synder observes in a gripping post on Science-Based Medicine, this alternative schedule is largely the work of Dr. Robert Sears, a celebrity pediatrician, and author of The Vaccine Book: Making the Right Decision for your Child.  Essentially, the message is that there is a safer way to vaccinate your child, but that most doctors don’t know enough about the science of vaccination to offer this advice to parents; however, help is at hand if you are willing to part with the money for Dr. Sears’ book, the fruit of his self-taught expertise in vaccination.

The history of science – and medicine in particular – comes to us as a steep learning curve, where one moment’s conventional wisdom turns into nonsense the next.  But while the accrual of scientific knowledge is now a vast daily enterprise, it is less likely, given the refinements of critical method and the extensive formal and informal peer review given to new theories and treatments, for the lone scientist to stand athwart a field and declare that all its practitioners are deluded and mistaken.

So when Synder notes that Dr.  Sears is a), selling a book; b), is self-taught in the field he is writing about;  and c), offers a completely different view of that field to its established authorities, one should d), be skeptical. Authors, whether scientists or doctors, tend to challenge their fields from within, and by peer-reviewed publication, before taking their message to the general book-buying public. Unfortunately, the public has become so primed to view official expertise with suspicion that the messianic expert (“only I can lead you on the path to truth that no others can see”) is given a free pass, a fat book advance, and an endless revenue stream from sales. It’s an extraordinary social phenomenon, no doubt driven by society’s ever increasing preoccupation with risk combined with  limited scientific literacy.

Which is whyDr. Synder’s expose is a truly jaw-dropping read.  Consider the following extract:

Measles

Dr. Sears’ discussion of measles consists of a series of downplayed statements. He describes the rash as one that “can look similar to rashes…of other diseases, so its not easy for a doctor, much less a parent, to recognize.” And he states that the disease is “transmitted like the common cold”. The clinical presentation of measles is striking and very difficult to mistake for any other illness. As I was taught during my residency, there’s no such thing as a mild case of measles. Every child with the disease is very ill appearing. And, while it is transmitted by respiratory droplets like the common cold, it seems the sole reason for making this statement is, again, to liken it to other, less dangerous viral infections. In answer to his self-posed question “Is measles serious?”, Dr. Sears replies,

Usually not. Most cases, especially in children, pass within a week or so without any trouble. However, approximately 1 in 1000 cases is fatal…Now that measles is rare, many years go by without any fatalities.

He then makes the astoundingly misleading statement,

The possible complications of measles, mumps, or rubella are very similar to the side effect of the vaccines themselves.

Because I can’t fathom he is that ignorant of the facts, I am inclined to believe that Dr. Sears is simply being deceitful. Here are the facts about the complications of measles:

  • One in 1000 cases of measles results in encephalitis, with a high rate of permanent neurological complications in those who survive.
  • Approximately five percent develop pneumonia.
  • The fatality rate is between one and three per 1000 cases.
  • Contrary to Dr. Sears’ statement, death is most commonly seen in infants with measles.
  • Subacute sclerosing panencephalitis (SSPE) is a rare complication of measles infection that occurs years after the illness in approximately 10 of every 100,000 cases.

Here are the facts about complications of the measles vaccine:

  • It causes fever and a mild rash in 5-15% of recipients.
  • 0.03% will have a febrile seizure – likely not a result of the vaccine itself, but simply a child’s individual predisposition to febrile seizures.
  • One in 10,000 children will have a more serious event following the vaccine, such as a change in alertness, a drop in blood pressure, or a severe allergic reaction.
  • Approximately 1 in 25,000 cases is associated with an asymptomatic drop in the blood platelet count, which quickly returns to normal without any consequences.

Dr. Sears uses reactions listed in the vaccine package insert as if they are true vaccine side effects. This is analogous to using VAERS data to draw conclusions about vaccine reactions, since there is no evidence that any of these are causally related. Most side effects listed in package inserts occur at the same rate as background or placebo rates.

And this is only one in a list of substantive criticisms which subjects each of Dr. Sears claims to the critical scientific consensus. Almost as valuable are the comments, many from other doctors.  One particular one, by Wilbert Mason MD, reinforces why measles is far from being a trivial disease:

“Let me share with you our experience with measles at Childrens Hospital Los Angeles during the measles epidemic in 1990. We diagnosed 440 cases between January 1st and June 30th. Of these cases 195 (44%) had to be admitted for one or more complications of measles. We documented the complications in all 440 cases and they included 63% with ear infections, 45% with diarrhea, 39% with dehydration, 36% with pneumonia, 19% with croup, and about 3% with other bacterial infections. Three children died all of pneumonia. Measles is not a trivial infection as you inferred. We would not be having a debate about vaccines at all if people realized the tremendous costs in suffering and human life we incurred before vaccines became available.”

As Dr. Synder notes, by claiming that he wants to avoid indulging in the kind of vaccination hysteria that has done so much to confuse and scare parents, Dr. Sears actually engages in a “more subtle” kind of fear mongering:  he adopts the journalistic rhetoric of giving  “a straight, unbiased story,” but then repeats and reinforces “common parental fears and anti-vaccine myths.”  (hat tip – Shaw’s Eco-logic)


Scientists need to speak out more quickly on bad science says Financial Times

January 19, 2009

In honor of the 200-year anniversary of the birth of Charles Darwin, and the 150-year anniversary of the publication of the Origin of the Species, the Financial Times took a swipe at a) burgeoning scientific illiteracy, b) the mass media, and c) scientists.

Darwin, the paper noted, is not merely worth remembering for the sustained attack on evolution over the past decade, but as a symbol of the systematic degradation of evidence in public debate over science-based policies. This starts with general ignorance or faulty data or methods, is spread by the mass media, and is not stopped by the scientific community:

The campaign against the MMR vaccine, which has cost many lives by delaying the elimination of measles from Europe, demonstrates the harm that can come from ignoring overwhelming scientific evidence. A faulty study suggesting a possible link between MMR and autism was quickly picked up by anti-vaccine campaigners and amplified by the media. Scientists could have limited the damage with a quick response, pointing out the defects in the study and the evidence for the safety of MMR – but, as so often happens, they reacted slowly and reluctantly.

Mavericks are occasionally right: the few who warned in the 1980s that mad cow disease might affect humans come to mind. But any extraordinary claim must receive extraordinary scrutiny – and be weighed against all the evidence.

We need far more scientists than are available today to speak out quickly and firmly when reason is under attack. And in the long run we need a scientifically literate population, better educated about what constitutes valid evidence to support a particular viewpoint.”

It would surely surprise many journalists to know just how much contempt there is for the press among scientists in all fields. In one university department in a field of absolute critical value to public health, only one of the faculty will speak to the press, and then only on the condition that they can review their quotes in the final piece.  Another leading expert in a particular field said he didn’t bother to correct a New York Times reporter, even though that reporter totally misrepresented what he said, because he didn’t want to lose access. A leading cardiologist pronounced the media’s reporting of statistics in medicine “disgraceful” – these are just a handful of anecdotes STATS has heard in the past couple of years. What they all have in common is this: scientists will criticize the media for ripping their work and other people’s work out of context and to fit a narrative that simply doesn’t reflect the weight of evidence.  But instead of doing something about it, they just complain to each other.

Scientists will also call out their colleagues bad research at the drop of a hat: it’s not a surprise to find (or that difficult to find out) that some of the scientists whose names routinely appear in certain publications have little credibility with their peers; but don’t expect this criticism to ever make it on the record. Nobody wants to rock the boat or do something that could jeopardize their career.

Cardiologist Steve Nissen, who drove Congressional hearings on the safety of diabetes drug Avandia, has been torn apart by biostatisticians and endocrinologists across the U.S. for producing a study which didn’t and couldn’t say what he claimed it did; but the criticism was coded in the language of statistics: it was virtually uninterpretable to journalists covering the controversy (who do an excellent job of appearing  to know nothing about statistics to begin with), and so the public never got the message. Instead they heard Nissen declare that the toll from Avandia worse than 9/11. That’s the message they got, not that his math and methodology didn’t add up.

And so, when the Food and Drug Administration voted against giving Avandia a black box warning, the decision, instead of reassuring the public, suggested that the FDA was incapable of regulating dangerous drugs.

Unfortunately, the mass media is unlikely to get better at covering science anytime soon; in fact, it’s much more likely to get worse, as experienced journalists retire or are forced to produce news with ever decreasing amounts of reporting, and young journalists, pressured by time, effectively take dictation from press releases and activists. The loudest person shouting in a public event is often a crank, and it’s no different with science and public policy. Problem is they make news – and they make great news stories if they also happen to have a Ph.D.

This  journalistic principle that what’s new is news usually takes precedence over what, in fact, is true.  As long as  someone is found to give a “balancing” quote, the story is journalistically kosher for publication. This is *not* how science determines what is true. A new study with a dramatic finding has to be replicated before it gains credence, which is why scientific truth always leans on the existing weight of evidence and gives that precedence. In other words, the scientific narrative is always disposed to what is old and replicable, not to what is new and not yet replicated. This means that journalism and science are often opposed; their respective narratives look at new information in distinctly different ways. A scientist is unlikely to change his or her view based on one new study; but a journalist is far more likely to report what is new and treat the narrative in a way that gives precedence to the new rather than the existing body of research. Meanwhile, the public, fed new findings each day, reads only that this is what “science says” or scientists “say.”

And this is why scientists, or more aptly, the bodies that represent science – the National Academies, the Institute of Medicine, the National Institutes of Health -  need to not only,  as the Financial Times put it, ” speak out quickly and firmly when reason is under attack,” but to explain the reasoning behind good and bad science.


Unvaccinated children behind worrying measles increase

September 8, 2008

As another new study fails to find any connection between the MMR vaccine and autism, there has been a series of articles warning that the decision not to vaccinate children, for whatever reason, is allowing the disease to spread in the U.S.

Scientific American reports that the number of measles cases in the U.S. for 2008 is more than double that of the annual rate for the previous six years. From January to July 2008, there were 131 cases of measles versus an average of 63 cases per year over the previous six years – all of which were infections caught abroad.  The most recent cases in the States, however, were driven by local transmission among unvaccinated people, mostly children. As WebMD reports:

In Washington, an unvaccinated child likely caught measles at a church conference attended by 3,000 junior high school students, some from foreign nations. That child infected seven other children in her household; they spread measles to 11 other people. Of the 19 cases, 16 were school-age children. Eleven of these kids were homeschooled; none was vaccinated because of their parents’ beliefs.

In Illinois, a teenager who recently returned from Italy — where there are ongoing measles outbreaks — seems to have infected four unvaccinated girls ages 10 to 14. Eventually, 30 people came down with measles. All but one of the cases were children or teens aged 8 months to 17 years. Cases included 25 homeschooled children whose parents held anti-vaccination beliefs.

Vaccination against measles is crucial because the disease is highly contagious; Jane Seward, MB, MPH, deputy director of the CDC’s viral disease division, points out that in a room of 100 unvaccinated people, 90 to 95 could catch the disease from one infected person coughing. Seward tells Scientific American’s blog that “people have forgotten what measles looks like and have forgotten how infectious it is…

Back in the early part of the century, it killed thousands of people a year. The biggest year was 10,000. Over the years, those deaths declined but in the 1960s, right before the vaccine was developed, it killed 400 to 500 children every year out of 500,000 reported cases at that time. Three to four million cases actually occurred, because not all cases get reported.

Of those 500,000 reported cases, there were 4,000 cases of encephalitis a year. That’s brain infection and can have some serious sequellae, like retardation and things like that. Measles can also cause pneumonia…

Some parents think that American medical care is such that it can treat any complication on measles. They’re not right on that. Medical care is the same as the 1960s in terms of encephalitis. There’s very little that can be done to alter that outcome. And there is no treatment for measles as such. There are no antivirals to use.

The latest study by researchers at the Columbia Mailman School of Public Health on the connection between the MMR vaccine and autism compared children with both autism and gastro intestinal (GI) problems  and children with just GI problems. Cells were biopsied to see if they contained genetic sequences of the measles virus. The objective was to

determine whether children with GI disturbances and autism are more likely than children with GI disturbances alone to have MV RNA and/or inflammation in bowel tissues and if autism and/or GI episode onset relate temporally to receipt of MMR.

The results provided strong evidence that there was no connection between the vaccine and autism.


And Yet Another Study Finds No Link Between Autism and the MMR Vaccine

February 5, 2008

A brace of Britain’s top doctors have released the results of a study to see if the Measles, Mumps and Rubella (MMR) vaccine could be linked to autism spectrum disorders (ASD) in children. The conclusion supports

“No difference was detected in the distribution of measles antibody or in measles virus in ASD cases and controls whether the children had received the first, second or both MMR vaccinations. This remained true when the analysis was
restricted to ASD cases with a history of regression. Only one child had symptoms of possible enterocolitis, and this child was in the control group.

This is one of three virological case–control studies that have failed to demonstrate any association between measles vaccination and ASD using well-validated techniques.”

The Guardian newspaper has an excellent history of the controversy over the MMR vaccine today.


Fabricating an MMR Scare

November 9, 2007

Trevor Butterworth

A doctor-journalist re-reports a story in his newpaper and finds none of it – the sourcing, the data – is accurate… more

Originally published August 2, 2007


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