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The price exacted by the anti-vaccine movement

As 2009 ended and 2010 began, I made a vow to myself to try to diversify the topics covered on this blog. Part of that vow was to try to avoid writing about vaccines and the anti-vaccine movement for more than a couple of days in a row. Unfortunately, even in the middle its very first full week, 2010 has already conspired to make a mockery of any “plans” I thought I might have for the blog, with a flurry of vaccine-related news items relevant to the pseudoscience that is the anti-vaccine movement coming fast and furious. Oh, well. I might as well just go with the flow and do what I do best–at least for now.

When I wrote the other day about the libel suit brought by the grand dame of the anti-vaccine movement, Barbara Loe Fisher, against the man whom they view as the Dark Lord of Vaccination or even Satan himself, Dr. Paul Offit, I mentioned that lawsuits against prominent defenders of vaccines could be a strategy to intimidate them into silence. Including the reporter who quoted Dr. Offit (Amy Wallace) and the publisher of the magazine in which the article appeared (Condé Nast, publisher of WIRED) also struck me as a rather transparent attempt to discourage reporters and publishers from writing about the anti-vaccine movement.

The reason I made this latter conclusion is that 2009 was in general a great year for the media’s waking up and examining the anti-vaccine movement in a much less positive light. Whether it was Amy Wallace’s article that provoked Barbara Loe Fisher’s lawsuit, Brian Deer’s expose of Andrew Wakefield’s scientific fraud, or Trine Tsouderos’ expose of Mark and David Geier, Dr. Mayer Eisenstein, and the autism/a> biomed movement, 2009 marked the year that the mainstream press started to realize that the harm the anti-vaccine movement is doing to public health is actually the story, not scorned parents bucking the system in a Lorenzo’s Oil frenzy of crushing existing paradigms no matter what science and medicine think about the issue of whether vaccines cause autism. This is a very good thing indeed.

And the anti-vaccine movement does not like it at all.

Another excellent example of such journalism appeared in, of all places, USA Today, yesterday, starting this way:

Brendalee Flint did everything she could to keep her baby safe. She nourished her with breast milk; she gave her all the routine vaccines. But Flint never realized how much her daughter’s health would depend on the actions of her friends, neighbors and even strangers.

By 15 months old, Flint’s daughter, Julieanna Metcalf, was walking, exploring and even saying her first few words. Then one day in the bath, while fighting what seemed like an ordinary stomach bug, Julieanna became so weak and floppy that she couldn’t hold up her head.

“She couldn’t say ‘Help me,’ but her eyes were begging me to do something,” says Flint, 35.

It turns out that Julieanna had severe Haemophilus influenzae type b meningitis. She was one of the victims of the recent Hib outbreak in Minnesota, which was linked to pockets of unvaccinated children. She still has serious sequalae from her bout of meningitis that will likely be with her for the rest of her life. Because Julieanna has a rare immune deficiency, vaccines don’t work in her; she depends on herd immunity:

That worries moms such as Flint, who learned that her daughter has a rare immune deficiency only after she contracted Hib. Because Julieanna doesn’t respond to vaccines, she depends on other parents to keep germs out of circulation by vaccinating their kids, a phenomenon called “herd immunity.”

Then there was this mother, whose daughter died of invasive pneumococcal disease:

The most shocking part of this video is that the dead girl’s doctor didn’t believe much in vaccinations and in fact encouraged her parents not to vaccinate. My recommendation: Sue the doctor for malpractice. Given that I’m one of the “tribe” and have just as intense a loathing for malpractice attorneys and malpractice suits as any other physician, you can be sure that if I say that about another doctor I really mean it and really consider the offense to be egregious. Any pediatrician who discourages recommended vaccines is very likely committing malpractice. In this case, a girl died as a result; so there is demonstrable injury as a result of this physician’s negligence. Sue his ass. Maybe if more parents started doing this when their children suffer or die from vaccine-preventable illness because their doctors discouraged vaccination fewer doctors would be so cavalier about such advice not to vaccinate.

Worse, the rationale for not vaccinating can border on seriously burning stupid:

Parents such as Rebecca Estepp of San Diego decided not to vaccinate her younger son after his older brother was diagnosed with autism. When measles broke out in Southern California in 2008, “I had to decide, ‘Would I rather have him get the measles or risk having him get autism like his brother did?’ ” says Estepp, national policy manager for Talk About Curing Autism. “My husband and I decided we’d rather he get measles.”

Because of fear of a vaccine that is, by any measure, incredibly safe, Estepp decided that she’d put her her son at extreme risk of contracting measles, which, contrary to the misconception, is not a benign disease. Worse, she did it because she believed in a myth, a lie promulgated by the anti-vaccine movement, namely that the MMR vaccine causes autism. It is not a choice of “measles versus autism.” It is a choice of preventing measles at a very low risk versus the risk of getting the measles and its potential complications.

The USA Today article then goes on to describe how pockets of low vaccine uptake are placing us at risk for outbreaks of vaccine-preventable diseases. Certainly, they are, and, unlike in the past, when areas of low vaccination rates tended to be associated more with poverty and poor access to health care, these days pockets of low vaccine uptake tend to be more associated with upper middle classed “worried” parents who have never seen the ravages that vaccine-preventable infectious disease can cause. Protected by herd immunity, they see only risks and no benefits from vaccines, and these risks are exaggerated by the anti-vaccine movement to the level where even rational parents might take pause. But what if herd immunity fails?

The USA Today article is, I hope, a continuation of the trend begun in the mainstream media in 2009, namely telling it like it is when it comes to the anti-vaccine movement and pointing out how (1) it is not based on any science and (2) its adherents are frightening parents into not vaccinating, a decision that can result in death.

I can only hope that, in April (which is Autism Awareness Month, a month I’ve come to dread every year now) dim and dimmer Jenny McCarthy and Jim Carrey start showing up on Larry King Live to hawk the latest propaganda angle of pseudostudy from Generation Rescue, when vaccine “skeptics” such as Dr. Jay Gordon or Dr. Bob Sears start repeating the brainless “too many too soon” mantra, when J.B. Handley slimes his way onto various TV shows to trumpet his usual nonsense, there will be real skeptical journalists there instead of lapdogs to challenge them on the facts.

Your children’s health is at stake.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

252 replies on “The price exacted by the anti-vaccine movement”

Orac, you may have exceptionally rough going avoiding the vaccine nonsense. Just this morning AoA had to run Barbara Loe Fisher’s latest nonsense, “2010 Needs A Fearless Conversation About Vaccination.”

kwombles @2
2010 does need “A Fearless Conversation About Vaccination” – It needs a conversation about vaccination without the irrational fear of vaccination causing autism.

Thanks for mentioning this article. I’ve added a bit to antiantivax about the anti-vax question “Why worry if I don’t vaccinate my kids?” This article is linked as an example of why it’s important.

Sue his ass. Maybe if more parents started doing this when their children suffer or die from vaccine-preventable illness because their doctors discouraged vaccination fewer doctors would be so cavalier about such advice not to vaccinate.

As an objective onlooker to this debate, can you please explain to me why a person that suffers from infectious disease is more important than one that suffers from vaccine injury? Doctors that suggest vaccinating a gestationally immature baby should also be sued, but you see, this can’t happen. There is no consistency among those defending the universal application of the current recommended schedule.

People advocating for a safer schedule for their very young child (who very well may be predisposed to injury) are ones who have been previously harmed. When they read stuff like that, they cannot understand why you value the life of a child that suffered from infectious disease more than you value the life on a child that participated and tried to protect that child. If you continue to discount that they contributed to herd immunity, and suffered a price for it while making those that suffer from disease more important, you will continue to have vaccine refusal.

Because of fear of a vaccine that is, by any measure, incredibly safe

A passive reporting system hardly demonstrates safety. Vaccine trials performed on healthy people, do not demonstrate safety or the real world. These are the legitimate arguments being made.

Orac,

Dr Bob’s “The Autism Book – What Every Parent Needs to Know About Early Detection, Treatment, Recovery, and Prevention” is scheduled to come out April 2, 2010, that should keep everyone busy for the month.

@anon

If a doctor uses a vaccine off-label (i.e., contrary to what is included in the insert/labeling), particularly in an instance where the labeling clearly says it should not be used, and harm results, then the doctor should be sued. The doctor should have known, with a reasonable degree of certainty, of the increased risk of injury. And example of this would be administering a flu vaccine to a child when the doctor knows that the child has severe egg allergies.

If the doctor uses a vaccine on-label, and harm results, the doctor should not be sued, as the doctor could not have known, with a reasonable degree of certainty, that the child would suffer a rare injury.

If a doctor encourages patients to refuse vaccines, the doctor is knowingly advocating a behavior which puts the patient (and those around them) at risk and is operating outside the standard of care. In a legal sense, any reasonable person with the doctor’s knowledge and experience should have known better, and is therefore being negligent.

A passive reporting system hardly demonstrates safety.

That’s why we have clinical trials to establish safety and efficacy before the product is marketed, and post-marketing surveillance studies and programs after it is marketed.

Vaccine trials performed on healthy people, do not demonstrate safety or the real world.

Which is why Phase III clinical trials are typically large, randomized, controlled trials to ensure as much as possible that the populations in the treatment and control arms are representative of the real world, as much as is possible, rather than only conducting trials in “healthy” people. This is also why we have a rather robust vaccine surveillance program to monitor new vaccines that have either just reached the market or have only been around for a couple years.

@ anon

Premature babies are in particular need of vaccinations (especially against all bugs that go to the lungs), since they will have little or no maternal immunity.

anon said:

can you please explain to me why a person that suffers from infectious disease is more important than one that suffers from vaccine injury?

I will leave it to others to tackle the rest of your argument, but I just want to address this one question, which is a strawman through-and-through. Nobody is arguing that one patient is more important than the other — the argument is about whether the doctor’s recommendation was sufficiently irrational that it put the patient at unnecessary risk.

To take it out of the medical realm… if person A tells their children, “Always wear your seatbelt,” and person B tells their children, “Seatbelts are for squares!”, then I would argue that person B is an asshole. This does not imply that the incredibly rare victim who gets trapped in a burning vehicle as a result of a stuck seatbelt is “less important” than any one of the thousands of people whose lives are saved each year by seatbelts. Both potential victims are just as important — it’s just that one piece of advice is far more likely to save your life, while the other piece of advice is far more likely to end your life.

If you want to make an argument that vaccinating is a poor cost-benefit tradeoff, I’ll let others tear that one apart. But please, the appeal-to-emotion strawman I quoted above — that’s just embarrassing.

[email protected]

“Vaccine Injuries” aren’t contagious. People who suffer adverse reactions to vaccines are not a danger to other people, as opposed to untreated disease carriers.

As an objective onlooker to this debate, can you please explain to me why a person that suffers from infectious disease is more important than one that suffers from vaccine injury?

Amazing how anti-vaxxers are able to lie with every breath.

This isn’t about importance, this is about risk versus benefit. Nutbars like you think that a one-in-a-million risk, alongside an infinite number of imaginary risks born from the greedy imaginations of lawyers to your children are more important than the deaths of hundreds of others.

You think your tinfoil hat paranoia is more important than the lives of many, many others. You would have us shoulder a very real risk so that you can be safe from imaginary and absurdly unlikely ones.

Chance of encephalitis from a measles shot: 1 in 1,000,000.
Chance of death from getting the measles: 1 in 2,000.

You think that we should stare death in the face so that your paranoid mind can sleep a few nights before inventing more imaginary risks. You think that you are superior to us mere mortals.

Why Todd, if I didn’t know any better, I’d think you were kinda being reasonable about some of our concerns. “If a doctor uses a vaccines off-label… and harm results, then he should be sued. Bravo!

Orac you’re a little late to the fear-mongering party. USA Today and Left Brain/Right Brain had this propaganda yesterday. PKIDS must not realize what a useful tool you are and can be. Anyway I’ll repost what I said yesterday since lb/rb has no readership.

Tragic story. It’s sad to see the medical establishment using it to push more vaccine. Anyway it looks like the “younger” doctor is off the hook since:

it is recommended that Prevnar not be routinely given to children over five years old. The risk of invasive infection with the pneumococcus bacteria is much less in children over age five.

I wonder what made this child so vulnerable to such a rare occurrence? And should I have my child vaccinated if he or she doesn’t share those vulnerabilities? Unfortunately these videos, full of fear and forebodence, are always short on detail.

PS

You really need to show the one on the killer chikenpox

@jen

I’m not expressing any view I have not expressed before, first of all. Second, a doctor being negligent does not impact whether or not a vaccine is safe when used as directed.

No need for sarcasm.

@Anon

Just how would you define “objective observer”? I can’t wait for Orac’s response.

@ James Sweet; @ Bronze Dog: I agree; however,people are notoriously bad at understanding risk and probability,a fact which has contributed endless material for psychological studies and guaranteed profit for the casino/lottery industry.When anti-vax drama queens constantly dispense their *bon mots*,worried parents re-evaluate their (probably) already over-estimated risk from vaccines while the facts and figures remain unchanged- which might provide a hint how to instruct parents about risk of vaccines vs. illness.

The Chicago Tribune articles were absolutely terrific, but Patricia Callahan also deserves a mention, along with the aforementioned Trine Tsouderos, as they generally shared the byline for each article.

As an objective onlooker

Q. How can you tell when an anti-vaxer is lying?

A. Their lips move.

Boom-Tish! Thanks folks, I’ll be here all week…

These are the legitimate arguments being made.

Seriously, if the anti-vax movement was genuinely interested in making legitimate arguments, it would start by nixing the vast amount of blatantly illegitimate ones it peddles every day. Getting its own house in order before attacking others’ would go a considerable way to dragging its credibility out of the giant hole it’s dug itself into.

Alas, the anti-vax movement seems far less interested in having the correct answers than having the only answers. Says volumes about what’s really driving them.

“Chance of encephalitis from a measles shot: 1 in 1,000,000.
Chance of death from getting the measles: 1 in 2,000.”

Cases of measles in the US in 2008: 140. Deaths from measles, statistically: 0.07.

Children born in the US in 2007: 4,315,000. Assuming a 95% vaccination rate, and a one in a million chance of encephalitis (the actual rate is far higher, but Big Pharma hushes it up): four children crippled.

4/0.07 = the MMR vaccine is 57.1 times more likely to cripple or kill a child than measles are.

And we inject these destructive toxins into the bodies of innocent children?!??

/statistics ftw

Over age 5 they can get pneumovax instead of prevnar, right? My kids got their pneumovax this year, but they’re jr. high students. I don’t know what the recommendations are for kids in between 5 and 12.

My kids also got their H1N1 shots, and their newly requred DTaP boosters, etc. I got an MMR, DTap, and pneumovax because I went back to school.

We all seem to be in fine health so far…no need for a multi-Generation(al) Rescue here.

Nice how the wolves descend when opposition rears its head. If nothing else, it is entertaining.

Todd @7:If the doctor uses a vaccine on-label, and harm results, the doctor should not be sued, as the doctor could not have known, with a reasonable degree of certainty, that the child would suffer a rare injury.

Do on-label directives address predisposition? Or is there denial that predisposition is a factor?

This is also why we have a rather robust vaccine surveillance program to monitor new vaccines that have either just reached the market or have only been around for a couple years.

I don’t know how you can say that with a straight face.

Catherina @8:Premature babies are in particular need of vaccinations (especially against all bugs that go to the lungs), since they will have little or no maternal immunity.

Are there sufficient data that suggests it’s safe? Immune challenges in animals of this age are not all that favorable.

James Sweet @10: I just want to address this one question, which is a strawman through-and-through. Nobody is arguing that one patient is more important than the other –

I’ll concede the strawman, for debating purposes. I didn’t say it to debate it. I said it, because the tone of the statement is highly suggestive that the doctor was negligent for not recommending vaccines – and when those that do result in harmed children, the outpour of sympathy is… well, you’ll never see it here.

appeal-to-emotion strawman I quoted above — that’s just embarrassing.

Emotion? That’s rich. The only emotion here is calling people assholes (yeah you Pablo) for having concerns over ANOTHER one of their children being harmed by doing what’s best for the public.

Dave Robison @11:”Vaccine Injuries” aren’t contagious. People who suffer adverse reactions to vaccines are not a danger to other people, as opposed to untreated disease carriers.

As if vaccination status is the singular action that determines the overall capability to spread disease? C’mon, really? If we are going to measure immunity by when we stop showing symptoms, how the hell do you know who is or isn’t spreading disease? The one showing symptoms will always get the prize.

Bronze Dog @12:Amazing how anti-vaxxers are able to lie with every breath.

Ad hominem. Or is it defamation per se?

Nutbars like you think that a one-in-a-million risk,

Accurately reported in VAERS.

You think your tinfoil hat paranoia is more important than the lives of many, many others. You would have us shoulder a very real risk so that you can be safe from imaginary and absurdly unlikely ones.

Well the conspiracy card is pretty original. You’re not shouldering anything for me. Demonstrate that your vaccination status is keeping me safe, because we all know it’s the singular mechanism that determines whether or not you’ll respond accordingly if challenged. Right? Sell that to someone else, I’m not buying.

Chance of encephalitis from a measles shot: 1 in 1,000,000.
Chance of death from getting the measles: 1 in 2,000.

OOOOhhh… Scary stuff. Based on what? Not like scaring the shit out of the public with the world wide pig flu pandemic, declared “National Emergency” isn’t going to send every yahoo to the doctor to get diagnosed for it thereby increasing morbidity. Plus, it’s pretty easy not find signs of injury if you’ll only look at them in Vaccine Court.

You think that we should stare death in the face so that your paranoid mind can sleep a few nights before inventing more imaginary risks. You think that you are superior to us mere mortals.

Holy sensationalism. If you’re staring death in the face from measles, it’s very likely that you’ve got some co-morbidities that aren’t cooperating in your response. Or you’ve got someone shoving tylenol down your throat. Measles virus doesn’t seem to do very well in high temperatures or in the environment in general, so it makes perfect sense to keep that fever in check.

No Dog, I’m not superior. I just think that the promotion of discrimination has no place in a civilized society. I guess that’s because we’ve yet to create one.

If you can look aside your “anti-vax” rhetoric long enough to realize that the people that are now asking if there is a safer way to vaccinate are people that HAVE VACCINATED, you might be on to something. I know it’s not as entertaining as talking smack about the illuminati or the NWO, and it sure helps to character assassinate when you bring that nonsense up… can’t always be fun and games.

@ mts

Germany 2006: 1700 cases of measles, 2 children dead, one girl looses her speech after encephalitis – 2009 one more girl who got measles in that outbreak comes down with SSPE – so all it needs is about 2000 cases of measles in the US to break even with your calculated risk of universal MMR vaccination. Anti-vaccine liars are pretending that the low rate of measles infections is some kind of “natural order”, where in fact it is the consequence of 2xMMR for nearly every child. If vaccination rates drop just a little bit, we are so going to see deaths and disability return.

Janet Camp @17:Just how would you define “objective observer”? I can’t wait for Orac’s response.

An objective observer is someone that doesn’t have anything to gain from being on either side of the issue. One that reads information posted by the skeptical community, then goes to verify that they’ve reported unbiasedly. I read here quite a bit, post less than I read. Sometimes I get irritated enough to speak my mind. Today is one of those days.

Orac will tell you that I’m certainly anti-vaccine and I’m couching my views in emotional sentiment without providing evidence for an alternative. If you don’t know that, you’ve not been reading here long enough.

You can get Prevnar if you’re over five. I believe it is approved up to nine. It just isn’t recommended because the risk is much lower in the over five group. It hard to keep up with the convoluted and ever changing sched.

As to Pneumovax:

Pneumovax® and Pnu-Immune® are 23-valent polysaccharide vaccines (PPV23) (recently renamed PPSV) that are currently recommended for use in all adults who are older than 65 years of age and for persons who are 2 years and older and at high risk for disease (e.g., sickle cell disease, HIV infection, or other immunocompromising conditions.)

Here’s a good link that covers them all
http://www.cdc.gov/vaccines/vpd-vac/pneumo/default.htm

mad the swine, that is the most idiotic use of illogical math I have ever seen. The only reason the risk of getting measles is so low is due to high vaccine coverage. If we had it your way and stopped using the MMR, measles and mumps will return. Which has happened in the UK, Switzerland, Japan and elsewhere.

You also neglect to factor that several of those who got measles in 2008 were hospitalized.

The overweight is harmful for the health, because it can affect our organism, like the heart, increases the pressure sanguineous, to cause diabetes, drop, artrosis, arterial hypertension, etc. The best way to lower of weight is to eat a good healthy diet and to make exercises indicated findrxonline in article; When making exercises burn more calories.

mad the swine, your numbers only hold if the measles infection rate doesn’t increase without vaccination… I believe that Phil Plait knocked that assumption on its head pretty vigorously.

Before MMR came out, measles rates in the US averaged ~400,000/yr; that changes your estimation significantly, in that you’re looking at 200 dead kids every year in comparison with only 4… even granting your “one in a million” number, which I’m not certain I should.

By my reckoning, that makes MMR 50 times safer than going without.

— Steve

@anon:

“As an objective onlooker to this debate,”

More often than not, when someone says they don’t have an opinion on something, it usually means they really do, but deny it so they can maintain the appearance of impartial objectivity.

When someone prefaces a comment by stating what they are not, or what they don’t believe, or what they’re not sure of, it tends to be followed by a statement that shows they do have an underlying true belief and their preface was dishonest BS.

To the two proceeding statements, I guess I must now add the following: When someone prefaces a comment with a claim to be an impartial or objective onlooker, please see above.

Of course, anaon’s next comment @21 pretty much proved my point, rendering this comment dunsel.

[email protected]:Before MMR came out, measles rates in the US averaged ~400,000/yr;

The Pink Book, Chapter 11, page 162:

Before 1963, approximately 500,000 cases and 500 deaths were reported annually, with epidemic cycles every 2–3 years. However, the actual number of cases was estimated at 3–4 million annually.

3-4 million changes your estimation significiantly.

Before the measles vaccine CDC estimates 3-4 million cases yearly. If deaths were 500 that gives us one death per 8,000 cases. Since there are risk factors for measles complications, a healthy child living in good conditions would be at little risk. In addition since mortality was falling for many years prior to vaccination why should we assume that the figure of 500 would have remained stagnant?

@anon

Do on-label directives address predisposition? Or is there denial that predisposition is a factor?

What kind of predisposition? You need to be specific. For example, someone with egg allergies is predisposed to injury from a vaccine that uses eggs in production. This is why, for example, flu vaccine inserts have warnings about egg allergies.

If you simply say “a predisposition to vaccine injury”, that’s too vague. Further, even have a predisposition (of whatever kind) must be weighed against the risks of injury from the disease, as well. For example, if someone has a known disorder that would lead them to greater risk of injury from, say, the measles vaccine, the doctor must also consider if there is equal or greater risk of similar injury from measles. If the disease is likely to pose greater potential risk than the vaccine, and doctor opts to give the vaccine, then by a reasonable person standard, the doctor is not being negligent.

The key thing, though, is whether or not the predisposition, whatever it may be, is known to be a risk with the vaccine and whether or not it is known that the child has that predisposition. If it is not known to exist, and the doctor gives it to a child who happens to have that predisposition, there is no way that the doctor could have reasonably known that the child was going to be harmed, thus, no case to file suit. Likewise, if there is a known predisposition, but the doctor does not know that the child has that predisposition (e.g., no diagnostic tests available, negative test results, etc.), gives the vaccine and the child is injured, there is no way the doctor could have reasonably known, and again, no case for suit.

Make sense?

Epidemiology & Prevention of Vaccine-Preventable Diseases – 3rd ed. / 1996 / P92 /

Karl, that’s a fair point. The fact is, I don’t have a stake in vaccinating children that’s why I consider myself objective. The fact that I read here, but don’t always agree confirms my own point (at least in mind).

But I never claimed I didn’t have an opinion, only I didn’t have anything to gain or lose by being on either side.

Orac’s followers will be here shortly to rake me, so I best be going now.

So anon and Stone Deaf Sid, you guys would be good with the return of measles at the pre-vaccine levels of millions per year, and don’t mind that one out of eight thousand get to die. Lovely.

Of course, I bet none of the over 120 people who died about twenty years ago in the USA are missed. Who cares? They were just other people’s children, sisters, brothers and even parents (some were adults). Not that you should care.

Still, your little games with the numbers in no way shows that the MMR vaccine has more risk than measles, mumps or rubella.

[email protected]: Indeed… raising the infection rate by a factor of 8 would, given “mad the swine”‘s calcuation, make MMR 400x safer than non-vaccination instead of a mere 50x.

Which takes the safety difference in the vax vs. no-vax decision to the level of “letting your kid ride inside the car vs. making your kid ride on the roof rack”.

— Steve

@anon

I didn’t have anything to gain or lose by being on either side.

So, you either do not have children/young nieces or nephews, good friends with young family members, family members or good friends with weakened immune systems (due to medical conditions/transplant recipient, or in some other way compromised), elderly family members, good friends with elderly family members or anyone else that would be adversely affected by vaccine-preventable diseases, or you do but just don’t care whether they suffer injury from the diseases. Fair enough. Thanks for letting us know.

To add a bit more evidence against the anti-vaxers, here is an analysis of the rubella outbreak that happened in the Netherlands and spread to Canada in 2004-2005:

http://www.pediatricsupersite.com/view.aspx?rid=43990

* Two intrauterine deaths at 16 and 23 weeks gestation following initial infection at weeks four and five.
* Eleven infants had defects associated with congenital rubella (85% risk rate; 95% CI, 55%-98%), with all experiencing deafness and no reported cases of cataracts or vision loss.
* Disability and/or delayed development in six of the 11 infants with defects reported at follow-up.
* Interventions included cardiac operations in three children and cochlear implants in two children.
* Lab-confirmed maternal rubellavirus infection was evident in the first trimester for the 11 children with defects.

Which takes the safety difference in the vax vs. no-vax decision to the level of “letting your kid ride inside the car vs. making your kid ride on the roof rack”.

With or without seatbelts?

@anon,

Objective: not influenced by personal feelings, interpretations, or prejudice; based on facts; unbiased: an objective opinion.

“The fact is, I don’t have a stake in vaccinating children that’s why I consider myself objective.”

Non sequitor. I don’t see anything in the definition about not having a stake in something.

“The fact that I read here, but don’t always agree confirms my own point (at least in mind).”

Non sequitor. Objectivity doesn’t depend on how often you do or do not agree with others.

“Orac’s followers will be here shortly to rake me, so I best be going now.”

Hey, you’ve indicated that you’ve been reading this blog for a while, so if you don’t like heat, don’t go in the kitchen in the first place.

I’m a little reminded of one of my favorite forum comments of all time:

“And the moral we learn from that last comment, Boys and Girls, is that if you can’t win an argument on its merits, take a shit on the desk and leave.”

-Someone named Jody in a thread on skeptico

@anon,

Objective: not influenced by personal feelings, interpretations, or prejudice; based on facts; unbiased: an objective opinion.

“The fact is, I don’t have a stake in vaccinating children that’s why I consider myself objective.”

Non sequitor. I don’t see anything in the definition about not having a stake in something.

“The fact that I read here, but don’t always agree confirms my own point (at least in mind).”

Non sequitor. Objectivity doesn’t depend on how often you do or do not agree with others.

“Orac’s followers will be here shortly to rake me, so I best be going now.”

Hey, you’ve indicated that you’ve been reading this blog for a while, so if you don’t like heat, don’t go in the kitchen in the first place.

I’m a little reminded of one of my favorite forum comments of all time:

“And the moral we learn from that last comment, Boys and Girls, is that if you can’t win an argument on its merits, take a shit on the desk and leave.”

-Someone named Jody in a thread on skeptico

To erase another anti-vax lie that seems to persist around the internet, vaccine are tested on “unhealthy” children, including premature and HIV positive infants. Here are some examples:

http://linkinghub.elsevier.com/retrieve/pii/S0022347604002823

http://www.journals.uchicago.edu/doi/abs/10.1086/324666

Those are just the top two of a very long list found by a simply google scholaring “DTaP premature”

Here are the top two when googling DTaP HIV:

http://linkinghub.elsevier.com/retrieve/pii/S0091674905013126

http://pediatrics.aappublications.org/cgi/content/abstract/peds.2007-0729v1

“the incredibly rare victim who gets trapped in a burning vehicle as a result of a stuck seatbelt”

As far as I know, there is no evidence that this has EVER happened. I have read comments on this from “urban legends” scholars. A relevant datum is that less than 1 in 200 accidents involve a fire. My own take is that, when a fire does occur, there is likely to be no conclusive evidence of the victim’s situation after the fact!

Lost in the discussion about deaths due to MMR vs. measles is the cost. So maybe the mortality rate of measles was dropping, but what was the outcome for those that were hospitalized and survived? Perhaps more survived, but did more survive with permanent injury or disability? What was the cost of care both in the hospital and afterward for those who suffered permanent injury?

Also, no one has extrapolated the number of cases to today’s population. According to the Census Bureau the population today is about 1.6x that of 1963. Even if the mortality rate drops (probably would given improvements in medical care) the increased number of cases would likely still lead to hundreds of deaths per year.

What would the cost of care be for 5-6 million cases of the measles each year? Could our health care system really survive that kind of onslaught? What about the lost time at work for the sick or the parents caring for their kids? Travel restrictions? Quarantines? The world now is different than it was before measles vaccine. Outbreaks would be swift and global.

There is not an infinite pot of money to provide medical care to all those who would seek it during an outbreak or to provide life-long care for those injured or disabled. Vaccines appear to provide the most benefit for the least cost. Perhaps they can be made safer, but not vaccinating will kill more people and cost more money and lead to greater disruption of society.

mad the swine:
“4/0.07 = the MMR vaccine is 57.1 times more likely to cripple or kill a child than measles are.”

Others have pointed out the fallacy with this argument in the event that vaccination rates drop. But, from a purely selfish point of view, does this argument hold water? i.e. if an individual parent assumes vaccination rates remain high, are they better off to risk measles over the risk of vaccines today?

The answer is “no.” It turns out mad the swine completely butchered the statistical argument. Foremost, taking the ratio of cases of measles deaths versus vaccination-induced encephalitis fails to account for the disparity in the size of the at-risk population. The correct statistic would be to compare the relative risk of adverse outcomes in unvaccinated children versus vaccinated children. Secondly, comparing measles deaths to vaccine-induced encephalitis is an apples-to-oranges comparison. Measles comes with other serious complications, such as, oh yeah, measles encephalitis. It would be best to compare severe adverse outcomes in both populations.

So what is the rate of adverse outcomes in unvaccinated children today? Let’s take mad the swine’s estimate of 5% of 4,315,000 unvaccinated (i.e. 215,750). Then, using data from 2008 (On Wikipedia, I found 131 cases leading to 15 hospitalizations. Of the 131, 122 were not vaccinated yielding ~14 hospitalizations in unvaccinated children). So the risk of landing in the hospital due to complications from measles in an unvaccinated child is 14/215,750 or ~1 in 15,000. This is a heck of a lot higher than 1 in 1,000,000 risk faced with vaccination.

So, if you don’t vaccinate, you are not just selfish, you are also stupid.

(Final note: I’m sure my numbers are flawed to some extent, but I wanted to come at this from the numbers and argument offered by mad the swine. Perhaps someoone knows the true risk numbers in these populations?)

Sid:

Since there are risk factors for measles complications, a healthy child living in good conditions would be at little risk.

The presence of risk factors doesn’t mean that none apply to “a healthy child in good conditions”, nor does it mean that if you have no risk factors, you will not die. (Tell that to a person with lung cancer who has never smoked and never been exposed to second-hand smoke. Just because you don’t have special risk factors doesn’t mean you’re safe.)

In addition since mortality was falling for many years prior to vaccination why should we assume that the figure of 500 would have remained stagnant?

We shouldn’t. Truthfully, there is no way to know what the rate would be with modern medical care apart from letting everybody’s vaccinations lapse and seeing what happens. The price of this strategy has already been demonstrated in regions where lots of people skipped vaccination (or at least skipped MMR) — we can expect to see deaths increase. The only real questions are “how much” and “what about non-fatal negative consequences of measles”? You can wind up hospitalized from measles without actually dying, and modern medicine has some great techniques to assure that. You might wind up severely brain damaged due to measles encephalitis, but you wouldn’t be a death statistic. I don’t know about you, but I would consider that a significant factor to consider as well.

I’m quite certain that we would not see as many deaths as happened pre-vaccine, because medical science has improved remarkably. But that is not to say all cases would be minor, nor is it to say that the costs* would be less than the costs of vaccination.

*I’m not talking money here. I’m talking pain and suffering.

@The Gregarious Misanthrope

Good points. Along with the increase in number of individuals hospitalized, that means fewer beds available for other patients with diseases or injuries that cannot be prevented by vaccines. Over at antiantivax, I’ve linked to a study on the 2006 measles outbreak in Germany. That study includes a table showing the costs of treating the disease-caused injuries. It does not include the costs to the business who lost workers for periods of time, the non-monetary costs to families who had to miss work or have to live with the consequences of the disease, etc.

FYI, mad the swine has a history of poe-ing over at Ed Brayton’s Dispatches blog. At least in regards to culture war issues, he/she is actually a pretty reasonable person who pretends to be insane.

I’ve never heard mts comment on vaccines before, though, so I have no idea if this is also a poe. If those numbers are accurate, they are intriguing, though… it suggests those who chose to get a free ride based on herd immunity really are getting the incremental benefit they expect (though at the cost of everybody else’s child’s well-being…)

“the incredibly rare victim who gets trapped in a burning vehicle as a result of a stuck seatbelt”

As far as I know, there is no evidence that this has EVER happened. I have read comments on this from “urban legends” scholars.

I feared this might be true, but I’ve been ignoring that reality because it would take away my favorite analogy for why it’s silly to place an overemphasis on minuscule risks in the face of obvious large benefits. 🙁

I suppose airbags? But the problem is there that they are a bit controversial… pretty much just complete crackpots are anti-seatbelt these days. Can I just pretend that seatbelts result in a small number of deaths, so that I can make my point about how that pales in comparison to the large number of lives they save? Pretty please???

Sid Offit says:

Do the seatbelts have needles sticking out of them?

Bravo, Sid, you have finally revealed the core of the anti-vax movement: Irrational fear and appeals to emotion.

Numbers? Data? Reality? Fuck dat shit, dem needles is SCARY!

Reading this makes me want my entire family to get the MMR again. And I just got a booster last year!

Some good news, for a change– I was thrilled to see a very high uptake of H1N1 vaccine at my child’s elementary school. Perhaps non-coincidentally, he goes to a public school in a poorer neighborhood with a high population of Somali immigrants. And guess what– they appreciate vaccination!!! Perhaps they or their close relatives have seen firsthand the ravages of vaccine-preventable diseases and know said diseases are nothing to be toyed with.

Also, no one has extrapolated the number of cases to today’s population. According to the Census Bureau the population today is about 1.6x that of 1963. Even if the mortality rate drops (probably would given improvements in medical care) the increased number of cases would likely still lead to hundreds of deaths per year.

————————

Deaths were falling throughout the 1st half of the 20th century as population was expanding

Brian Deer’s expose of Andrew Wakefield’s scientific fraud,

Wasn’t there something supposed to move forward on his professional misconduct case on December 19th? I might be thinking of something else.

Also, if 1 in 1,000,000 children get encephalitis from the MMR shot, is that the same as 1 in 1,000,000 children “crippled”?

@Calli

The price of this strategy has already been demonstrated in regions where lots of people skipped vaccination (or at least skipped MMR) — we can expect to see deaths increase.
—————-
England? 2 or 3 deaths during the 14 year panic created by the abominable Dr. Wakefield?

I believe Wakefield’s work can also be seen in the drop in MMR uptake throughout Europe, which means many more attributable deaths and disabilities. And let’s not forget the MMR isn’t only about measles (see the rubella outbreak link I gave).

Here’s a thought that will probably get lost in the thread:

Vaccines are, I understand, less effective for older persons, especially the elderly. Has anyone thought about whether the rates of vaccination required for heard immunity against various diseases are going to increase as the baby boomer generation ages?

If so, this would seem especially problematic since at the same time the large baby boomer population is getting older, vaccination rates are actually declining instead of rising.

Sid,What do you think about vaccination of adult people. For example if you are going to travel to Africa, will you get vaccinated against malaria? Or will you get vaccinated against tetanus? Do you think the vaccines are unsafe to the adults or only that they unsafe to the children?
I’m just curious about that.

anon,

First, I’m ashamed to almost share a handle with you.

Second, you are not an objective observer. If you were, you would concede that there are numerous studies done that illustrate the safety and effiacy of vaccines.

You’ve clearly taken time to cherry-pick research that supports your view, so unless you’re dense or google-deficient, you know about these studies. And I already know what you’re going to say, and no, I am not going to point you in the direction of these studies, because I’m pretty sure you know where they are.

And finally – and critically, I might add – way to go with the “if you get measles and die it’s your own fault” gambit. Nothing screams non-objective anti-vaxer by pulling out one of the old canards, mainly that if you get sick, it’s your own fault.

@Karl

Interesting thought. Generally, children have been (I think) the main vectors for expansion of vaccine-preventable diseases, but with a growing older population whose “natural” or vaccine gained immunity has waned, the elderly population may become a significant potential pool for diseases to spread.

If it’s any consolation, my medical school’s lecture on vaccination today placed a strong emphasis on how vaccine scares damage national vaccination programs.

History shows the effect lasts about 20 years – a whole generation of parents can be scared off vaccines by the media spouting nonsense.

At least doctors are being educated about these things.

I think adults can decide for themselves based on a risk/ reward basis. If someone wants a flu shot they should get it.
If I had to go somewhere where malaria was present I’d seriously look at the disease’s risks. As to tetanus the risks are wildly exaggerated (about 50% of the population is vulnerable yet there occur only about 50 cases per year) As we as a society moved off the farm the dangers of tetanus have fallen dramatically. As to the safety of vaccines I’d theoretically be more concerned with those whose immune systems are still developing. Although I, at this point, don’t subscribe to the idea that vaccines – at least regarding known and excepted adverse events are all that dangerous. I’m concerned with the unknown. And I don’t view vaccine preventable diseases threatening enough to embark upon a never-ending journey of vaccination

I think adults can decide for themselves based on a risk/ reward basis. If someone wants a flu shot they should get it.
If I had to go somewhere where malaria was present I’d seriously look at the disease’s risks and possibly vaccinate.

As to tetanus the risks are wildly exaggerated (about 50% of the population is vulnerable yet there occur only about 50 cases per year) As we as a society moved off the farm the dangers of tetanus have fallen dramatically.

In regards to the safety of vaccines, I’d theoretically be more concerned with those whose immune systems are still developing. Although I, at this point, don’t subscribe to the idea that vaccines – at least regarding known and excepted adverse events are as dangerous as some contend. Unknown risks are however a concern.

Basically I don’t view vaccine preventable diseases, those affecting children and adults, threatening enough, in the absence of specific risk factors, to embark upon a never-ending journey of vaccination

But if I thought the mumps etc… were dangerous I’d vaccinate and except the inherent risks that accompany any drug/medical intervention

Dan Weber @51
The GMC has pushed the 19 December decision on Wakefield off to the end of January 2010. Carmel Wakefield, the asshole’s wife, has a plea for support posted on AoA. She rather disingenuously decries the money spent going after her husband when it could have been better spent elsewhere. Damned right it could have been better spent. If her husband hadn’t been such a money grubbing ass, it might have been.

Yes, the lawsuit also strikes me as an attempt to discourage reporters and publishers from writing about the anti-vaccine movement. It’s a SLAPP case, but as you already pointed out, there’s no anti-SLAPP law in this jurisdiction.

Sid @ 29,

Before the measles vaccine CDC estimates 3-4 million cases yearly. If deaths were 500 that gives us one death per 8,000 cases.

You are making the dangerous assumption that measles deaths were accurately reported, they weren’t
http://www.ncbi.nlm.nih.gov/pubmed/16235165
http://www.ncbi.nlm.nih.gov/sites/entrez/15106092

Since there are risk factors for measles complications, a healthy child living in good conditions would be at little risk.

Another wrong assumption. Previously healthy children did and still do die of measles complications, in fact, the majority of deaths were in children and adults with no underlying conditions (see links).

In addition since mortality was falling for many years prior to vaccination why should we assume that the figure of 500 would have remained stagnant?

The case fatality rate reached a plateau in the ~8 years prior to vaccine introduction, it was only then that mortality declined. The case-fatality rate was just as high during the 1989-1991 U.S. outbreak as it was pre-vaccine.

And I don’t view vaccine preventable diseases threatening enough to embark upon a never-ending journey of vaccination

Then what, pray tell, WOULD be so threatening? Just what probability of death or severe disability would convince you?

Scott @63
I suspect Sid’s threshold is near 100% except for someone he cares about. The rest of humankind can go suck an egg as far as he is concerned.

Sid has attempted to minimize the impact of catching vaccine preventable disease for as long as I’ve seen his posts here. I wish him personally all the whoops he can handle and all the shingles he can stand.

Personally I think it’s 101%, since no evidence would ever cause him to actually THINK about it. Still, hope springs eternal.

Can I just pretend that seatbelts result in a small number of deaths, so that I can make my point about how that pales in comparison to the large number of lives they save? Pretty please???

Seatbelts can cause fatal injuries in a small percentage of MVAs from rupture of internal organs beneath the belt. This of course is much smaller in number than the number of deaths prevented by seat belt use.
BTW, the scenario of escaping death or injury by being “thrown clear” of a MVA is a myth. A lot of MVA deaths occur when an occupant is ejected partly or completely from a car, which rolls over and crushes him or her – a good reason to wear a seatbelt.
I now expect that Stoney Sid will give up the use of seatbelts to save his spleen from rupture.

BTW, the scenario of escaping death or injury by being “thrown clear” of a MVA is a myth. A lot of MVA deaths occur when an occupant is ejected partly or completely from a car, which rolls over and crushes him or her – a good reason to wear a seatbelt.

Is there still any prevalent belief that being thrown clear is a means of “escaping” injury? I would think that has been long abandoned.

I mean, when you realize that the first step in “being thrown” from the accident involves going headfirst through the windshield, you start to think that maybe that isn’t the best course of action. Put that together with watching NASCAR drivers walk away from a 15-rollover crash and the idea that staying secure in your seat is a good idea starts to make sense.

#60
Thank you for the answer.
(blockquote)And I don’t view vaccine preventable diseases threatening enough to embark upon a never-ending journey of vaccination (/blockquote).
But, why not?. Do you prefer to suffer preventable diseases rather than take the vaccines when you are an adult, and therefore you are not going to become autistic? Do you fear allergic reactions? Do you prefer to have the real disease than to prevent it with vaccinations?

Tetanus correction. It’s not 50% of the population that’s vulnerable, it’s 50% of those over 50. Still tens of millions of people though.

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