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.

Scientautism: A bad week gets worse for Jenny McCarthy and Jim Carrey

February 12, 2010

A week ago, America’s top vaccine schmexperts, Jenny McCarthy and Jim Carrey, denounced the General Medical Council in England. The Council  reprimanded Dr. Andrew Wakefield over the way he conducted his experiments on children for a paper, published in the Lancet in 1998, which can be credited with launching the idea that vaccines cause autism into mainstream public consciousness. The Lancet retracted the paper.

JennyJim described the Council as a “kangaroo” court in hock to BigPharma;  the Council described Wakefield’s research as “misleading” “dishonest” and “irresponsible.” Ten of the 13 authors had already disavowed the study.

As proof of the vital work Dr. Wakefield was doing on autism, JennyJim hailed a new paper he co-authored -

“…along with eight other distinguished scientists from institutions like the University of Pittsburgh, the University of Kentucky, and the University of Washington, of a set of studies that explore the topic of vaccinated versus unvaccinated neurological outcomes using monkeys.

The first phase of this monkey study was published three months ago in the prestigious medical journal Neurotoxicology, and focused on the first two weeks of life when the vaccinated monkeys received a single vaccine for Hepatitis B, mimicking the U.S. vaccine schedule. The results, which you can read for yourself HERE, were disturbing. Vaccinated monkeys, unlike their unvaccinated peers, suffered the loss of many reflexes that are critical for survival.”

The paper, which was published online last October, has now been withdrawn “at the request of the editor” of NeuroToxicology.

In a further agonistic development, a new case-control study to be published in the May edition of the Pediatric Infant Disease Journal failed to find an association between the MMR vaccine and autism; in fact, “for children vaccinated before diagnosis, autism risk was lower in children vaccinated with MMR than in the nonvaccinated.” (hat tip – Ben Goldacre)

Study finds lower incidence of autism in vaccinated kids

January 4, 2010

Reuters reports on a remarkable Polish study which found that children who were given the MMR vaccine had lower rates of autism than those who did not get vaccinated:

When the researchers looked only at children who had been vaccinated before their autism diagnosis, they found that children who had received the MMR vaccine had an 83 percent lower risk of autism than unvaccinated children. Similarly, the measles-only vaccine was associated with a 56 percent lower risk.

When the researchers looked at children who had been vaccinated before showing any symptoms of autism, MMR vaccination was again linked to a lower risk of the disorder. The measles-only vaccine showed no effect on autism risk.

This raises the intriguing question of what accounts for the appearance of a protective effect. Reuters reports that one theory may be that children who were in the early stages of exhibiting autistic behavior were not given the vaccine.

Kudos for Reuters leading the piece with a forthright assertion of the lack of evidence for a link between the MMR vaccine and autism.

The CDC diagnoses swine flu by telephone

October 22, 2009

Every flu season doctors note that many people mistake having a bad cold for the flu, but that their symptoms, even if flu- like, do not mean they have the flu. So what do you think happened when the Centers for Disease Control called 10,000 people by phone and asked them if they had flu-like symptoms? Well, golly gosh, it turns out that one in five kids had “flu-like” symptoms in the past month (you know, the month when kids returned to school to give each other their germs).  The CDC claims that most of the kids probably had swine flu, which, naturally, led some people in medialand — The Los Angeles Times, MSNBC and several others who appear to have toned down their headlines during the day– to claim that they actually had swine flu.

But – cough – how could anyone possibly make an accurate diagnosis of swine flu over the phone, when so many people commonly refer to “cold-like” symptoms as having the flu? We have privileged access to our thoughts and feelings, and can tell a telephone interviewer with 100 percent accuracy whether we are happy or sad; but we cannot, alas, discern between viruses when we’re sick; we just know we’re sick with something.

Aside from the limits of self-diagnosis, a telephone survey of this kind is also prey to other kinds of bias, such as whether people were more inclined to affirm that they had flu-like symptons (rather than claim a mere cold) due to the proliferation of swine flu stories in the media.

The false certainty created by ‘guessurveying’ the  incidence of swine flu may well be designed to encourage parents to get their children vaccinated, but laudable ends are rarely well served by such obviously lame means.  It just makes the CDC look unscientific. And that’s the kind of development that can metastasize into full-blown lack of credibility, when, eventually, some news organization starts to ask awkward questions.

And despite the prevalence of stenography in the press, the CDC’s “guessurvey” comes a day after an  investigation by CBS News  found that the Centers told states to stop doing real testing for H1N1 in July — and to stop counting actual cases, decisions which the network reported left some public health experts perplexed. On top of that, CBS’s analysis of state data shows that H1N1 was less prevalent over the summer than expected  and that claims based on apparent symptoms and not actual testing — such as the alleged outbreak of swine flu at Georgetown University — were more likely to over-estimate the  incidence of disease.

Anti-vaccination – a left wing disease?

October 20, 2009

Wired has published a dazzling and timely story on the rising toll of childhood diseases in the U.S. due to the increasing numbers of parents who refuse to vaccinate their children. Author, Amy Wallace, correctly notes that this issue has bridged those on both sides of the political spectrum (we’ve observed vaccination being framed on the far right as some sort of tool of one-world health care, a division of one-world government); but the inescapable fact is that the anti-vaccination movement’s ringleaders are firmly on the liberal-left-Hollywood side of politics, which is a disaster for public health. Here’s how her article begins:

“To hear his enemies talk, you might think Paul Offit is the most hated man in America. A pediatrician in Philadelphia, he is the coinventor of a rotavirus vaccine that could save tens of thousands of lives every year. Yet environmental activist Robert F. Kennedy Jr. slams Offit as a ‘biostitute’ who whores for the pharmaceutical industry. Actor Jim Carrey calls him a profiteer and distills the doctor’s attitude toward childhood vaccination down to this chilling mantra: ‘Grab ‘em and stab ‘em.’ Recently, Carrey and his girlfriend, Jenny McCarthy, went on CNN’s Larry King Live and singled out Offit’s vaccine, RotaTeq, as one of many unnecessary vaccines, all administered, they said, for just one reason: ‘Greed.'”

It doesn’t matter that RotaTeq protects children against the Rotavirus, whose symptoms of severe diarrhoea lead to some half-a-million deaths per year, there is simply no reasoning against the anti-vax movement’s belief that big pharma is evil. So while many Democratic politicians would be appalled if asked to denounce evolution as a tool of “big science,” they appear happy to minister to the idea that vaccination is not scientific. As Wallace notes:

“There are anti-vaccine Web sites, Facebook groups, email alerts, and lobbying organizations. Politicians ignore the movement at their peril, and, unlike in the debates over creationism and global warming, Democrats have proved just as likely as Republicans to share misinformation and fuel anxiety.

US senators John Kerry of Massachusetts and Chris Dodd of Connecticut have both curried favor with constituents by trumpeting the notion that vaccines cause autism. And Robert F. Kennedy Jr., a scion of the most famous Democratic family of all, authored a deeply flawed 2005 Rolling Stone piece called “Deadly Immunity.” In it, he accused the government of protecting drug companies from litigation by concealing evidence that mercury in vaccines may have caused autism in thousands of kids. The article was roundly discredited for, among other things, overestimating the amount of mercury in childhood vaccines by more than 100-fold, causing Rolling Stone to issue not one but a prolonged series of corrections and clarifications. But that did little to unring the bell.”

Wallace and Wired, by contrast, have produced a model of science journalism – the article needs to be read for one of the best descriptions of how virulent measles is once one person is infected, and for how elegantly and economically it manages to dispel so much patent nonsense put out by the anti-vax loons. We can only hope this article gets the National Magazine Award it so richly deserves, that it shames Arianna Huffington and her friends (who have turned the Huffington Post into a venue for all manner of anti-vax vapidity), and that those on the liberal left stop patting themselves on the head for not being creationists, and realize that left-liberal irrationality might actually do more harm than Bush’s war on science ever did.

Our favorite surgeon blogger comments here

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:


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)

A pox on pox parties

January 12, 2009

Once upon a time, pox parties – where children were introduced to other children infected with chickenpox – were a logical way of trying to stimulate immunity to the virus in the absence of a vaccine. As epidemiologist Tara C. Smith noted on her blog Aetiology, “Chickenpox ‘parties’ were deemed a better alternative to potentially encountering the disease as an adult–when the frequency of serious complications is higher. Today, however, that just ain’t so.”

But the prevalence of “vaccineophobia” among many parents,  due to all manner of concerns, has spread to the chickenpox vaccine. And now, according to the New York Post’s Page Six magazine , “A growing number of New York parents are scheduling chicken pox playdates where kids share lollipops and trade germy pajamas to spread the disease and avoid vaccinations.”

The Post asks whether this is “an ill-advised idea?” But it’s attempt at providing balance between the anti-vaccine parents’ perspective and the “mainstream” medical perspective illustrates a thorny problem for journalists: how do you report on a contentious health issue affecting children that appears to pit increasing numbers of parents against the medical community?

The problem with reporting both sides and leaving it up to the reader to decide what to make of their respective claims is that clear distinctions between testable scientific proof and non-scientific or pseudoscientific opinion can be blurred in the interests of fairness.  The parents all get to say why they think vaccination is wrong; the doctors all say the parents are wrong; and the journalist steps back from the fray as if both perspectives were equally right. The problem is that they’re not equally scientific. A parent who has done research on the internet isn’t speaking the same language as  someone who has been through medical school, knows how to think through statistical data, or has done years of research in a laboratory. Take the following paragraph from the Post story:

“In the last two decades, rising rates of autism have been loosely linked to vaccines and over the past few years, more and more parents have turned into anti-vaccine public crusaders. Boldfacers like Robert Kennedy Jr. and actress Jenny McCarthy (whose son, Evan, 6, was diagnosed with autism) warn against possible dangers of vaccinations, although the mainstream medical community insists there is no link to autism.”

What, to the reader who doesn’t have a background in statistics or science, does “loosely linked” mean? It suggests that there might be a link even though any correlation between rising autism rates and vaccination can’t demonstrate causation, and has, in fact, been shown to be a product of changes in the way autism has been diagnosed and reported.

Meanwhile, public statements by Jenny McCarthy suggest that she doesn’t understand basic textbook science, and that Robert Kennedy Jr.’s investigation into the suppression of data on the risks of the MMR vaccine demonstrated that he could neither report accurately or fairly nor understand basic science either.

The Post, on the other hand, says mainstream medicine “insists” that there is no link to autism. Actually, it has demonstrated that there is no link to autism through a series of  rigorous studies. Again, the subtle  inflection suggests that there are two bodies of commensurable knowledge in conflict and that the reporter cannot take sides in interpreting one to be superior to the other. False equivalence is even more exaggerated in the following extract:

Upstater Ingrid Johanns, 34, is the former CEO of Affinity Neighborhoods, a real estate investment company. After extensive research, she has decided not to give her  ½-year-old son any vaccines. She, like a number of parents, is convinced there must be a link between vaccines and autism and has shared this belief on an NYC Craigslist forum.

“In the past, we only gave kids a few shots [for deadly diseases like mumps and measles]. Now [doctors] recommend so many. Most children’s bodies can handle that much toxicity, but for others, it does damage—possibly permanent damage,” Ingrid explains. (Although the main worry among parents like Ingrid is autism, critics have blamed vaccines for everything from ADHD to asthma.) “I would rather take the risk of my child contracting measles than autism. The fact that chicken pox has been added to the list of recommended vaccines required truly astounds me.”

Dr. Gershon assures parents that there has been no credible research linking autism to vaccinations. “But it’s very hard to prove that something doesn’t happen, so that’s why it has continued to be questioned,” she says. Although not even all doctors agree on the chicken pox vaccine, she adds that the varicella vaccine is one of the safest available. And it has a big advantage: While 30 percent of people who get pox naturally have the virus reactivated as shingles, the varicella vaccine lessens the risk of that too. Dr. Gershon says that a lot of the doubt over the vaccine comes from the time when kids were required to get just one dose—in about 15 to 20 percent of cases, the vaccine didn’t take. The Centers for Disease Control and Prevention recommends a first dose after 12 months and the second between ages 4 and 6, so “now we give two shots to everybody,” she says. “The immunity appears to persist.”

Now consider what is being said by the way the quotes have been arranged and framed.  A CEO of a real estate company  has done “extensive research” and determined that children can’t withstand the toxic overload from vaccines, and that it astounds her that doctors recommend children get vaccinated against chickenpox.

Here are the questions the journalist should have considered: what does it mean to tell a reader that someone, who isn’t a medical expert and appears to have no medical or scientific training, has done “extensive research?” Does this mean simply surfing the internet – and if so why should the opinion derived from that “research”  be given equal or greater weight to the knowledge of doctors, research scientists, epidemiologists or biostatisticians?

To be fair, the Post then turns to Dr. Anne Gershon, professor of pediatrics at Columbia University and president of the Infectious Disease Society of America, to put the scientific case. But mainstream medicine is on the defensive – and suddenly has its authority undercut  by the Post  turning to a homeopath:

But Dr. Lauri Grossman, a professor at the American Medical College of Homeopathy, says the varicella vaccine can be skipped. “For eons, people have had chicken pox and survived. The immune system gets stronger by having had the virus and establishing a response to it,” she explains.”

While many people are devotees of homeopathy,   it’s not exactly clear why Dr. Grossman, who treats people for physical complaints and emotional disturbances, should have a special insight on infectious diseases, other than to make the general case for alternative medicine.  She doesn’t appear to have  trained as an actual MD.

The bigger problem is that homeopathy has been extensively studied and found to be no better than a placebo; its claims that water has memory are undemonstrable; and we many of its practitioners  have been exposed as offering really bad advice for basic health risks (A BBC investigation found many homeopaths dispensing deadly recommendations on protecting against malaria to those visiting sub-Saharan Africa). But the biggest problem with Dr. Grossman’s challenge to Dr. Gershon is that doing nothing about chickenpox will, at some point, run up against statistics. While many children can shrug off chickenpox as an unpleasant but not especially bad experience, for some, the virus will prove to be rather more traumatic. As one poster noted in a discussion about chickenpox vaccination on scienceblogs:

As for “a few pox” – the daughter of a friend of mine spent 6 weeks in a hospital with osteomyelitis due to chicken pox, 4 weeks on IV antibiotics. It wasn’t clear whether she would keep her leg (she did, luckily) – the scars were their smallest worry.

The daughter of an acquaintance had a varicella stroke.

The daugther of another friend had literally over 1000 pox *everywhere* (including in her vagina, in her throat, her ear canals, under her eyelids). She could not eat and hardly drink for 2 weeks. Granted, the scars are ugly, too, but compared to the 2 week ordeal, they are no issue.

A playmate of my son spent a week in the hospital due to seizures with chicken pox.

And of course, one child in 50,o00 who develops chickenpox will die from encephalitis (during the 1990s, and before widespread vaccination, there was an average of 145 chickenpox-related deaths in the United States each year).  The Post ended with a comment from one parent – “Angie”  whose child finally managed to acquire the virus through a pox party in New Jersey.

It wasn’t exactly fun watching her be so uncomfortable,” Angie says. “But I just felt hugely relieved we wouldn’t have to get the shot.” Of course, she immediately sent an e-mail to friends and family. This time, the pox party was at her place.”

One might ask how long will it be before the media run a story about a child who dies from attending a pox party; if stories about this practice prompt more parents to take the advice of other parents as being equal to that of  the medical community, it will only be a matter of time.*

*One recent comment posted at the end of the article, in fact, mentions such an occurence.


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