Left is right and up is down: An actual pro-vaccine article on The Huffington Post?

ResearchBlogging.orgWhen it comes to science, I’ve always detested The Huffington Post.

Nearly four years ago, when Arianna Huffington’s vanity group political blog went live, I was the first one to notice a most disturbing trend about it. As far as I knew at the time (or know now), I was the only one to have noticed that The Huffington Post had become a hotbed of antivaccine propaganda a mere three weeks after its launch. It was home to David Kirby, author of that paean to the mercury militia Evidence of Harm: Mercury in Vaccines and the Autism Epidemic, A Medical Controversy and now antivaccine blogger on both The Huffington Post and Age of Autism; Robert F. Kennedy, Jr., antivaccine über-crank supreme; and Dr. Jay Gordon, antivaccine pediatrician to the stars known to show up on television and who is ever so offended whenever it is pointed out to him that he is an apologist for the antivaccine fringe and so deluded that he thinks himself to be “not antivaccine but pro-safe vaccine.” Since then, with only occasional exceptions, HuffPo has remained staunchly antivaccine, adding Deirdre Imus and even Kim Stagliano, also of Age of Autism. Even Rachel Sklar, Media & Special Projects Editor of The Huffington Post, is a total antivaccine crank. Indeed, HuffPo is so bad that I ruthlessly mocked the very idea of its starting a science section, given that it has done so well with its pseudoscience section, including not just antivaccinationists but woo-philes like Deepak Chopra.

That’s why, on those rare occasions when HuffPo allows a voice of science and reason a chance to write, it’s an amazing event. It’s even more amazing when that voice of science and reason is Dr. Paul Offit, the man whom the antivaccine fringe considers the Darth Vader of vaccines, the Mouth of Sauron, and the pharma shill to destroy all pharma shills. Even more amazing is when actual peer-reviewed science is cited by said Darth Vader, peer reviewed science like this study in the December issue of the American Journal of Epidemiology entitled Geographic Clustering of Nonmedical Exemptions to School Immunization Requirements and Associations With Geographic Clustering of Pertussis.

I wonder if Rachel Sklar’s head will explode.

Dr. Offit’s article, entitled Don’t Risk Going Unvaccinated, gets right to the point:

This past year the United States witnessed a measles epidemic that was the largest in more than a decade. About 135 people, mostly children, were infected with measles; some of those children were hospitalized with severe dehydration and others with pneumonia caused by the virus.

Why did this happen? The answer can be found in a study published in December 2008 in the American Journal of Epidemiology that received little attention from the media. The authors, epidemiologists from Johns Hopkins Bloomberg School of Public Health, examined school children in Michigan whose parents had chosen not to vaccinate them. They compared clusters of unvaccinated children with clusters of documented whooping cough (pertussis) outbreaks. Not surprisingly, the clusters overlapped. The authors concluded: “Geographic pockets of vaccine exemptors pose a risk to the whole community.”

This is exactly what had happened during the measles epidemic in 2008. Almost all of the children who caught and transmitted measles were unvaccinated. The authors of this study had provided an insight into the obvious. If parents choose not to vaccinate their children, not only do they put their own children at risk, they put others at risk. Because no vaccine is 100 percent effective, some vaccinated children can still get pertussis. Others at even greater risk include children who haven’t completed the entire series of pertussis vaccines or those who can’t get vaccines because they are receiving steroids for asthma or chemotherapy for cancer.

The study itself is worth looking at in more detail. Here’s its hypothesis:

…pockets of high exemption rates occur within states (5, 6). These pockets could produce the critical mass of susceptible persons required to maintain transmission of vaccine-preventable diseases, even when overall state-level vaccination coverage is high (5, 6). In a Colorado study (7), the incidence of measles and pertussis among vaccinated children in a county was associated with the frequency of exemptions in that county. In addition, at least 11% of nonexempt children who acquired measles were infected through contact with an exempt child with measles. School-based outbreaks have been associated with high exemption rates, and in a recent survey of schools, substantial intrastate variability in implementation of exemptions was reported (7, 8).

We evaluated the spatial clustering of nonmedical exemptions in Michigan and tested the hypothesis that there is a higher likelihood of pertussis cases’ occurring in areas with high rates of nonmedical exemptions, as measured by geographic overlap between exemptions clusters and clusters of reported pertussis cases.

This study tested just that. Depressingly, the investigators tested my home state for these reasons:

We chose Michigan because it has had relatively high overall exemption rates and has easy administrative requirements for obtaining exemptions in comparison with other states (9). According to the Michigan Department of Education, there were 4,500 schools in the state in the fall of 2005. The Michigan Department of Education has not retained records for previous years. In recent years, the number of schools reporting exemption information has been very close to the number of schools on record with the Michigan Department of Education, giving us confidence that the school-level exemption data used for this analysis were reasonably complete.

Bummer that my home state has high overall exemption rates and easy administrative requirements for exemptions. I hate to think that Michigan is so easy that vaccine investigators from Baltimore found it to be a perfect subject for studying the relationship between clusters of unvaccinated children and clusters of pertussis outbreaks. So what did the investigators find?

Surprise, surprise! There was evidence of increased exemption rates and strong evidence of spacial and temporal clustering of pertussis outbreaks related to areas with the highest levels of of unvaccinated children. In other words, areas of pertussis outbreaks correlated both in location and in time with areas of increased percentages of children who remained unvaccinated. No doubt antivaccine advocates will point out that correlation does not necessarily equal causation. True enough. I’ve said as much many times myself when arguing against the “science” that antivaccinationists routinely cite in support of their cause.. However, correlation can be strongly suggestive of causation when appropriate studies are done.

Another frequent refrain from the antivaccine fringe is the question: If vaccines are so effective, why do the vaccinated worry about catching pertussis from the unvaccinated? That one’s easy. Although very effective, accines are not 100% effective. No medical intervention or preventative measure is. That is why herd immunity is so important. Herd immunity is the observation that epidemics or outbreaks cannot get a foothold in a population if more than a certain percentage of that population is vaccinated. For most diseases and vaccines, a good rule of thumb is that greater than 90% of the population needs to be vaccinated. When the percentage of vaccinated people falls below that threshold, outbreaks become much more likely, often fed by a reservoir of the infectious agent among the unvaccinated population. Indeed, this very thing has happened in the U.K., thanks to the activities of one Andrew Wakefield in promoting pseudoscience claiming that the MMR vaccine causes autism. In a few short years, the U.K. went from having the measles under control to having declared it now endemic again.

Basically, this study is pretty strong support for an obvious hypothesis, namely, that ease of getting nonmedical exemptions to vaccination leads to higher numbers of unvaccinated children, which leads to outbreaks of vaccine-preventable infectious diseases. Vaccines have prevented more disease and suffering than any medical advance in history, but their effectiveness is compromised if resistance to vaccination leads to large pockets where vaccination rates fall below the level required for herd immunity. That’s exactly what we’re seeing now, thanks to the likes of antivaccine advocates like Andrew Wakefield, Jenny McCarthy, J. B. Handley, Barbara Loe Fisher, and all the other antivaccine activists, aided and abetted by useful idiots like Dr. Jay “don’t call me antivaccine” Gordon. On its own, this study might not be that worrisome. However, taken in context with other studies and evidence, this study represents simply one more piece of confirmatory evidence of how easy it is for even mildly decreased vaccination levels to lead to outbreaks of vaccine-preventable diseases. That’s not so hard to understand, nor is it surprising. High levels of vaccination provide the herd immunity that makes it much less unlikely that infectious diseases can take hold well enough to spread. It protects the vaccinated and unvaccinated alike.

One thing that was depressing to read was the comments after Dr. Offit’s post. They included the usual collection of antivaccine talking points, but they also revealed another recent addition to the lineup of HuffPo Antivax All-Stars, Anne Dunev, a naturopath:

Shooting a newborn or infant full of bacteria straight into their blood, 23 different kinds on a “recommended” vaccination program is nothing short of insane. It is most certainly NOT good medicine. Developing immune systems should not be subjected to this kind of assault and there are no studies that prove this is safe. But there is plenty of Autism and other disorders that indicate this is a very bad idea.

The stupid, it burns. My neurons cry out in pain from the stupidity waves emanating from Anne Dunev, clueless wonder. Really, she’s that dumb. Fortunately, there is a vaccine against such stupidity, and it’s called science and critical thinking, neither of which Dunev seems to have taken advantage of. She stands in marked contrast to the cleverer antivaccinationists, who can at least come up with reasons to fear vaccines that aren’t so clearly based on idiocy, reasons that at least to people without a sound understanding of the scientific method, sound somewhat plausible. The part about “shooting a newborn or infant full of bacteria straight into their blood” betrays such a profound ignorance of how vaccines are made and is so brain-meltingly dumb that it could only come from a naturopath. Point one: Vaccines against bacterial pathogens are made of either the killed bacteria, carefully cleaned up, or of bacterial proteins made using recombinant DNA technology. Vaccination is not, as is clearly implied by Dunev’s rant, the equivalent of injecting live bacteria into children. Point two: These killed bacteria or recombinant bacterial proteins are not injected “straight into the blood.” They are injected intramuscularly, where the components of the vaccine remain, some of which are slowly absorbed into the bloodstream to provoke an immune response. Injecting them “straight into the blood” would be useless and unlikely to provoke a significant immune response.

Using such emotionally loaded language designed to provoke fear is the mark of a true antivaccine nut. Even J.B. Handley doesn’t use such idiotic terminology, and that’s saying a lot. Heck, I’m not even sure that Jenny McCarthy sinks to such levels of the hell of burning stupid. Here’s a hint, Anne: When Jenny McCarthy seems reasonable in comparison to you, you have a serious, serious problem. Get help. Learn something other than on the University of Google, NaturalNews.com, and Whale.to.

Seeing Paul Offit in the pages of HuffPo is a start of HuffPo wants to shed its image as a bastion of vaccine and autism pseudoscience and quackery. It’s heartening to see him there. However, given the readership of that scientifically misbegotten excuse for a weblog and the pseudoscience fervently believed by its commenters, I seriously doubt that even the stalwart Paul Offit will ultimately have the patience or stomach to stick around very long. Like Arthur Allen before him, he’ll probably tire of the nonsense there and move on to less irrational pastures. More’s the pity.

REFERENCE:

S. B. Omer, K. S. Enger, L. H. Moulton, N. A. Halsey, S. Stokley, D. A. Salmon (2008). Geographic Clustering of Nonmedical Exemptions to School Immunization Requirements and Associations With Geographic Clustering of Pertussis American Journal of Epidemiology, 168 (12), 1389-1396 DOI: 10.1093/aje/kwn263