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Antivaccine nonsense Medicine

Whooping cough returns in Michigan

The other day, I noted a contrast between certain parts of the developed world (namely, Europe) where, thanks to fears of the MMR vaccine stoked by Andrew Wakefield and the credulous and sensationalistic British press, MMR uptake rates have fallen and, predictably, measles incidence has skyrocketed, and the rest of the world, where polio is now on the verge of being eradicated, thanks to vaccination campaigns. It’s evidence that the antivaccine movement, inspired by Andrew Wakefield and promoted by antivaccine groups like Generation Rescue, the National Vaccine Information Center, the Australian Vaccination Network, and Safeminds, has harmful consequences to public health. Of course, it’s entirely predictable that, where vaccination rates fall, vaccine-preventable diseases will tend to make a comeback. Indeed, it was antivaccine fear mongering based on religion and suspicion of Westerners that delayed progress in the eradication of polio, progress that is only now getting back on track.

Other vaccine-preventable diseases are also making a comeback, unfortunately, as I found out when I read Trine Tsouderos’ excellent article in the Sunday paper entitled Whooping cough returns as vaccine use drops, changes. The situation is a little more complex than that for the resurgence of measles due to catastrophic declines in MMR uptake in the U.K. and parts of continental Europe, but once again it’s a situation where less vaccination equals more disease. First, here’s the description of the success:

Hundreds of thousands of people in the U.S. — mostly babies and toddlers — were coming down with whooping cough each year when vaccines against “this menace,” as one newspaper called it, were introduced in the 1930s and 1940s.

A childhood scourge for centuries, this sometimes fatal disease seemed destined to become little more than a memory in the U.S. — with only about 1,000 cases nationwide over the next 40 years.

Now here’s the current situation:

In Michigan, 315 cases were reported in 2008, according to the state Department of Community Health. A year later, the incidence of whooping cough had nearly tripled to 902 reported cases. And by 2010, the number of reported cases in Michigan had risen to 1,564.

Similar outbreaks have been seen in other states as well. In California, nearly 10,000 cases of whooping cough were reported in 2010 — the most since the 1940s, according to the U.S. Centers for Disease Control and Prevention. Ten babies died.

Here’s where the complicating factor comes in. Although, as Tsouderos points out, pertussis vaccination rates remain high, there are pockets of low vaccine uptake in many states. Moreover, there is evidence that pockets of unvaccinated children can easily form the nidus for outbreaks of pertussis, measles, and other vaccine-preventable diseases, it’s about more than just that. For instance, states with lax policies with regard to religious and philosphical exemptions to vaccination tend to have elevated pertussis incidence, and the risk of developing vaccine-preventable diseases is markedly elevated in those claiming exemptions. For instance, those exempted from vaccination have been 35 times more likely to have had the measles than vaccinated children. A recent study reported that unvaccinated children are 23 times more likely to get pertussis than vaccinated children.

So what’s the other part of the equation besides pockets of unvaccinated children that allow local outbreaks to occur? Trine Tsouderos explains:

The vaccine children receive today is different from the ones introduced 70 years ago. Some of the original immunizations were “whole-cell” vaccines, made from killed whole cells of the bacterium that causes whooping cough. Eventually, those old whole-cell vaccines led to the development of the diptheria-tetanus-pertussis shot, or DTP, which became a mainstay in the school immunization routine.

“That whole-cell vaccine works well at the beginning and it lasts and lasts and lasts,” said Dr. Roger Baxter, codirector of the Kaiser Permanente Vaccine Study Center.

But, he added: “That fantastic immune response is accompanied by a, well, fantastic immune response.”

In other words, the body’s reaction to the vaccine sometimes included pain and fevers that could be, in extremely rare cases, high enough to lead to seizures, he said. “This was terrifying to parents,” Baxter said.

Of course, the fact that pertussis immunity can wane with time is touted by antivaccine activists as “evidence” that “natural” immunity is better than vaccine-induced immunity. Unfortunately, the price of “natural” immunity is a child’s actually getting the disease. That price in the pre-vaccine era was morbidity and, yes, mortality. There were 36,000 deaths from pertussis and pertussis-related complications between 1926 and 1930, and in 1934 there were 260,000 reported cases of pertussis. By 1976, thanks to the vaccine, there were around 1,000 cases. So, yes, “natural immunity” might be longer-lasting and more persistent, but the price of that “natural immunity” is death and suffering.

As is the case with so many vaccines, as the incidence, morbidity, and mortality from pertussis plunged, fewer and fewer parents had ever seen a case. Consistent with human nature, where a risk we can see is almost always more compelling than a risk we can’t, because parents didn’t know or know of parents whose children suffered–or even died–from pertussis anymore and didn’t see their children as being at risk for the disease, they became more suspicious of the vaccine and less tolerant of any possible side effects. When reports of seizures and encephalopathy from the whole-cell pertussis component of the DTP (diptheria-tetanus-pertussis) surfaced in the late 1970s and early 1980s, they led to a documentary written and produced by Lea Thompson entitled DPT: Vaccine Roulette, which first aired on a local NBC affiliate in Washington DC on April 19, 1982, and then ultimately was aired nationally on The Today Show, and then later to a book by Barbara Loe Fisher and Harris Coulter, DPT: A Shot in the Dark. Both used anecdotes over epidemiology and were very compelling at causing fear. As Steve Novella pointed out, later evidence did not support an association between the whole cell pertussis component of the DTP and encephalopathy, but the damage had been done.

Fortunately, scientists developed an acellular pertussis vaccine. These vaccines didn’t have the same side effects of fever, febrile seizures, and the like, but recent evidence suggests that they are probably not as good at producing long-lasting immunity as the old whole cell pertussis vaccine was. It’s a trade-off, as is all vaccine development. The very aspect of the whole cell pertussis vaccine that allowed it to produce longer-lasting immunity was the very aspect of it that also resulted in more side effects:

Developing vaccines can be a balancing act, trying to trigger as good an immune response as possible in as many people as possible for as long as possible without also triggering unacceptable side effects.

“You can make a safer vaccine and people have better trust in it,” said pediatrician Dr. Kathryn Edwards, director of the Vanderbilt University Vaccine Research Program, but the unwanted side effects — like fevers and pain — can be associated with better, longer-lasting protection.

Antivaccine activists use this observation as an excuse to claim that the pertussis vaccine “doesn’t work” and that “natural immunity” is much better. However, even immunity from a pertussis infection wanes over time, and, more importantly, as I pointed out earlier, the price of this “natural immunity” is the disease, with all its attendant risks, up to and including death. Faced with that tradeoff, I’d say that vaccination makes far more sense than taking the risk of disease. One has only to look back nearly 80 years, when a quarter of a million people per year were developing pertussis and thousands of them died. While it’s true that medicine has advanced a lot since then and the mortality rate from pertussis would likely not be nearly as high, the suffering from the disease is still incalculable, as anyone who’s seen a baby with pertussis coughing and struggling for breath would attest.

When it comes down to it, arguments from antivaccine activists that the pertussis vaccine “doesn’t work” and the argument that, if the vaccine is so effective, then why is pertussis making a comeback are a smokescreen. Vaccination resulted in a massive decline in incidence of pertussis. When reports 30 years ago suggested that the vaccine wasn’t safe enough, a safer vaccine was developed. The tradeoff was that its immunity is probably not as long lasting. However, given how safe the vaccine is, that characteristic of the vaccine only suggests that booster shots at an older age are a good idea, not that we should abandon the vaccine. Yet that is the argument that antivaccine activists are making, with their characteristic binary thinking: That if the vaccine isn’t perfect and doesn’t provide immunity as long-lasting as the disease, then we should abandon the vaccine and promote “natural” immunity. Just never mind the cost.

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]

448 replies on “Whooping cough returns in Michigan”

Jen in TX, for everyone’s sake please move to California or someplace sane and get that child some of the forbidden medicine!

Ignore the flower bashers.

Great post, Orac. And very timely. With pertussis incidence on the rise, it’s a good time to remind adults to get their booster shots. Pertussis vaccine isn’t just for kids; adults can often have pertussis in a milder form, presenting an increased risk of spreading the disease.

If people think that their decision to vaccinate or not has no consequences, the may want to read about a parent’s frightening encounter with pertussis, all stemming from the late ’70s scare you mention.

Also glad that you mentioned that natural infection doesn’t provide lifelong immunity, either. Numbers I have come across suggest natural immunity lasts from 3-20 years, with vaccine-induced immunity being 3-12 years.

I’m very glad I got my Tdap vaccine this summer.

But not to worry! Jean has the cure: “Whooping Cough is easily fixed by one administration of a homeopathic remedy which works within 2 minutes”

“The very aspect of the whole cell pertussis vaccine that allowed it to produce longer-lasting immunity was the very aspect of it that also resulted in more side effects”

The Dutch National Institute for Public Health and Environment (RIVM) paid for a lot of work on the toxic and antigenic effects of the whole cell pertussis vaccine. These are due to lipopolysaccharide (LPS) from the bacterial outer membrane.

See http://igitur-archive.library.uu.nl/dissertations/2007-0619-201035/index.htm for information on LPS-engineering to decrease toxicity and improve vaccine efficacy.

As Steve Novella pointed out, later evidence did not support an association between the whole cell pertussis component of the DTP and encephalopathy,[…]

You wouldn’t stop lying, would you Orac?

The committee concluded, “The evidence is consistent with a causal relation between DPT vaccine and acute encephalopathy, defined in the controlled studies reviewed as encephalopathy, encephalitis, or encephalomyelitis” (IOM, 1991, p. 118).

h_ttp://www.nap.edu/openbook.php?record_id=9814&page=3

What else do you have in mind germ denier?

I’ve had pertussis as an adult. I’ve had asthma since I was two or three, so respiratory tract infections are really common occurrences for me in winter. In winter 2010, what started off feeling like bronchitis soon got to the point where the blood vessels, in my eyes and across my cheeks, were bursting with the force of the coughing. Nothing relieved it, I was purple from lack of oxygen, coughing and retching with such force that I was incontinent.

I have never felt so wretched in my life, even after neurosurgery, or when in hospital after a trapped kidney stone caused sepsis. My doctor had to watch videos on youtube to compare the ‘whooping’, even after a positive swab, because he couldn’t believe what he was seeing.

I cannot imagine being a tiny baby, or a pre-verbal child, and not being able to either articulate how terrible you feel, or to understand what the hell is happening to you.

I had mumps in 2006, not as bad as pertussis, but if you have to take several oral medications every day and can’t even swallow your own saliva, then life gets messy. One of my ovaries swelled up so badly that it twisted on it’s stalk, and almost required surgery to remove it.

As an immune-compromised adult, it’s a terrifying thought that it may not be cancer that kills me off in my 40s (typical in my family), but measles, or flu in my 30s. I can’t have any vaccine cultured in a certain medium that I’m allergic to, or any vaccine that raises ICP. It saddens me that some people are so cavalier about vaccines, that they don’t believe in a social contract, that they actually think babies, or people too ill to be vaccinated should just die off, because the alternative is to “contaminate” their precious bodily fluids.

Completely overlooked (once again) is the recent evidence that shows a diminished immune response with prophylactic acetaminophen use. One wonders to what degree this is playing a role in the resurgence of pertussis?

http://www.medpagetoday.com/PrimaryCare/Vaccines/16458

BTW, for those who have been following my rants about acetaminophen overuse and its possible link to autism, this may be of interest and will surely ruffle a few feathers!

It seems anti-vaxxers are always touting data that proclaims that “more educated parents”** are less likely to vaccinate( AoA; Mike Adams) so we might expect that those pockets of lower vaccination rates will permeate and encircle large cities, settling in affluent hipster havens and well-heeled suburbs… perhaps declaring yourself against vaccines won’t stay as fashionable as it is now.

I can’t fathom how buying into alt med, natural-is-better memes ever were considered hip, cool, *fashionable* in the *first* place? Isn’t the essence of hip being able to out-think the average person, be in the fore-front of the new, *not* being a follower?

Smart, quick, no-nonsense, reality-seeking, complex- never go out of style.

** people define “educated” differently, purely by amount. We could also look at age-related data ( Thomson-Reuters, Sept 2011)

One notes that the review Thingy cites is from 1994. One also notes that Thingy also completely ignored the other studies cited by Dr. Novella, most of which are more recent. One also notes that febrile seizures in general (which were more common with the whole cell pertussis vaccine) do not increase the risk of permanent neurological damage.

Those tempted to be swayed by Thingy @4 will note that Thingy calls Orac a liar for not commenting on a report from 1991, though Orac points readers to Steve Novella’s post referencing “later evidence”, which in this case means studies from 1993, 1994, 2008, and 2010, all of which, the alert reader will note, are later than 1991.

Steve Novella finishes up with a comment quite applicable to the Thingy: “What we also see in this story is that anti-vaccine activists, like Fisher, froze their opinions about DTwP back in the early stages of anecdotal reports.”

One notes that the review Thingy cites is from 1994. One also notes that Thingy also completely ignored the other studies cited by Dr. Novella, most of which are more recent.

R U blind Orac? IOM, 1991. Now show me a study that refutes the already established causation between DPT and acute encephalopathy? Well? Show me your germ theory denialism skill.

Isn’t the essence of hip being able to out-think the average person, be in the fore-front of the new, *not* being a follower?

If anything, the essense of hipness is seeming to be those things. Appearance and reality frequently differ.

One also notes that febrile seizures in general (which were more common with the whole cell pertussis vaccine) do not increase the risk of permanent neurological damage.

Having fun moving the goalpost? We’re talking about acute enceohalopathy, aren’t we?

@ Jen in TX:

You’ll note that there is not the faintest shred of a hint of a connection with autism there. Unless you want to claim that getting a fever protects against autism, the article you cite simply stands as an example of SBM developing better knowledge and practices.

Even as early as 1979, there were data to suggest that the reports of horrible consequences following DTP were very likely not causally connected to the vaccine.

Hello! Yooohooo! IOM, are you there?

He states (with evidence, mind you), “So while there were more minor reactions to DTwP, there was no increase in seizures or compared to DTaP, which supports the conclusion that DTwP does not increase the risk of these neurological events.” Emphasis added for Thingy’s benefit.

That does not in any way refute nor challenge the already established link between DPT and acute encephalopathy (IOM, 1991). Next.

1991 – 1979 = 12. Todd W cites evidence predating Thingy’s citation by twelve years, and Thingy thinks its citation trumps his evidence.

2008 – 1991 = 17. Steven Novella cites evidence postdating Thingy’s citation by seventeen years, and Thingy thinks its citation trumps his evidence.

Those unacquainted with Thingy can see just one reason why it is pointless to try to carry on a discussion with Thingy. Its constant insults and deliberately offensive language are other reasons.

IOM in 1994 (from “DPT Vaccine and Chronic Nervous System Dysfunction:
A New Analysis”):

Children who experienced the rare but serious acute neurologic disorder within 7 days after receiving DPT were no more or less likely to experience documented chronic nervous system dysfunction or to have died within 10 years of the acute disorder than children who had not received DPT within 7 days prior to the onset of the disorder. There were no special characteristics associated with the acute or chronic nervous system illnesses linked to DPT exposure.

BTW, for those who have been following my rants about acetaminophen overuse and its possible link to autism, this may be of interest and will surely ruffle a few feathers!

You mean in the sense of its being content-free and thus requiring people to look around for which version of this dopey notion Shaw is peddling?

Wow.

Look at what I quoted @14. Look at what Thingy pretended to quote @16. Thingy “thinks” (for lack of a better term) it wins by simply removing the relevant words and pretending they were never there — even though anyone can look back two comments earlier and see them quite plainly, and then click over to Steven Novella’s post and observe that I quoted him correctly. Thingy doesn’t seem to grasp that this is the Internet, and you can’t just pretend that someone said one thing when they actually said another.

Again, for those who are unfamiliar with Thingy, this is why it is pointless to try to carry on a discussion with Thingy.

LW,

Don’t be so dramatic. Actually, I was trying to bold that “relevant word” to correspond to my comment. I have no idea that it didn’t show up until you told me. So here it is again.

He states (with evidence, mind you), “So while there were more minor reactions to DTwP, there was no increase in seizures or encephalopathy compared to DTaP, which supports the conclusion that DTwP does not increase the risk of these neurological events.” Emphasis added for Thingy’s benefit.

That does not in any way refute nor challenge the already established link between DPT and acute encephalopathy (IOM, 1991). Next.

Enough of your excuses and show me the evidence.

Now show me a study that refutes the already established causation between DPT and acute encephalopathy?

First you need to show us a study that has established causation between DPT and acute encephalopathy. “Consistent with” is not the same as “established.” Note that the 1991 IOM report is also consistent with there being no causation between DPT and acute encephalopathy. A 1993 IOM report (of which all of the authors were also authors of the 1991 report) makes this quite clear:

In August 1991, the Institute of Medicine released a report entitled Adverse Effects of Pertussis and Rubella Vaccines, which examined, among others, the relation between immunization with whole-cell diphtheria-tetanus-pertussis (DTP) vaccine and both acute encephalopathy and chronic neurological damage. The committee reviewed information from a wide range of both professional and lay sources and found that the evidence is consistent with a possible causal relation between DTP vaccine and acute encephalopathy, although it is insufficient to establish causality.

Cowan, et al. “Acute encephalopathy and chronic neurological damage after pertussis vaccine.” Vaccine. 1993 Nov;11(14):1371-9. PMID: 7906066

@ LW

You have to understand Thingy’s basic premise though. According to it, had those children not received the DPT, then they would never have gotten the disorder. The premise being that vaccination is, if not the only, certainly the major cause of infection today.

Much like Emily in the previous thread, avoiding disease is simply a matter of will power. Or washing your hands, or something. Whatever it is, it’s much easier, safer and more reliable than vaccines.

Todd W.,

Again the IOM report in 1994 does not in any way refute, challenge, or overturn the previous finding in 1991 which had already established causality between DPT and acute encephalopathy.

Note that the 1991 IOM report is also consistent with there being no causation between DPT and acute encephalopathy. A 1993 IOM report (of which all of the authors were also authors of the 1991 report) makes this quite clear:

The committee reviewed information from a wide range of both professional and lay sources and found that the evidence is consistent with a possible causal relation between DTP vaccine and acute encephalopathy, although it is insufficient to establish causality.

You’ll never find that from the original and official report. Next.

Completely overlooked (once again) is the recent evidence that shows a diminished immune response with prophylactic acetaminophen use. One wonders to what degree this is playing a role in the resurgence of pertussis?

http://www.medpagetoday.com/PrimaryCare/Vaccines/16458

How has this been overlooked? Diminished =/= none or not protective. I think it’s a bad policy to administer acetaminophen as a pre-prophylaxis or even to reduce an uncomplicated fever surrounding vaccines but there are many more obvious targets than Tylenol.

BTW, for those who have been following my rants about acetaminophen overuse and its possible link to autism, this may be of interest and will surely ruffle a few feathers!

Why? The director of a notorious quack laboratory, Great Plains dribbles some unsubstantiated drek about yet another autism causation because of what he believes is the autism epidemiology in Cuba is going to ruffle whose feathers Jen? I see you are easily impressed and snookered.

^What [email protected] 5 said, +1^

Had pertussis as an adult, caught from an unvaccinated patient on oxygen, brought into the ER at the same time as my spouse. I had had the childhood series, but not an adult booster, because at the time folks still thought the childhood immunizations lasted forever.

Months upon months of coughing until I vomited. Coughing until I was incontinent. Intermittent fevers that left me delirious for days on end. Charley horse cramps all through my ribs and belly, resulting in vomiting all over again. Dehydration and all the misery that goes with it, when you can’t keep anything down. And zero sleep of course, forget about a solid eight hours of getting your head down–I was lucky to get a few hours per night, at most. At a job where I had no sick days and no health insurance. (Aside: A hearty Fuck You to states where insurers can refuse coverage for pre-existing conditions.)

People would deliberately inflict that on a child? I wouldn’t inflict it on my worst enemies. As soon as the TDaP became available to me, you better believe I got it. At least as an adult, you know what is going on and to just keep sipping half-strength Gatorade and chicken broth for the dehydration, even though you feel like hammered shit and it doesn’t really stay down. You know that the reason your spouse is cranky when fetching you another glass of water is because he didn’t get any sleep either. Kids can’t rationalize that stuff, they just feel even more miserable.

-This message brought to you by a fully vaccinated Big Pharma employee.

Hm. I’m curious: Orac, you mention the antivaccine people are saying that natural immunity is better than vaccine-induced immunity. If vaccine-induced immunity fails and someone gets the disease, wouldn’t they just then get natural immunity? Unless I’m wrong about that, it doesn’t even seem like a reason not to get vaccinated.

Granted, they have a bunch of other excuses that they give to avoid vaccination, this one just seems particularly flawed.

Give it up, guys. We’ve been outfoxed.

The first study that Thingy likes, no matter how old, no matter how small, no matter how inconclusive, is the final word and no subsequent study, no matter how recent, no matter how large, no matter how conclusive, even if performed by the very same people as performed the first study, can ever dispute a single word of Thingy’s favorite study.

Once it’s in Thingy’s Bible, It Is Written.

You’ll never find that from the original and official report. Next.

Serve up #4. What do you have germ denialist?

Actually, the way I see it, Science Mom, Dr. Shaw is kind of putting his neck on the line here. Some in the “biomed” community are not at all happy about this and that’s all I’m going to say about it!

Kings of Ferrets, that, and also, if natural immunity is good, why are live virus vaccines bad?

Please do not feed delusional, etc, etc, SFB Troll.

@ Jen in TX: Doctors and nurses have known for years that fever is an important part of the immune response…so there may be an association with decreased immune response with the use of an antipyretic such as Tylenol/acetaminophen. The other link you provided is to a crank website.

It has always been a trade-off about the use of Tylenol pre or post immunization, for parents whose children have a diagnosed severe seizure disorder…where grand mal seizures or status epilecticus may be triggered by high sustained fevers.

Both of my children (born in 1970 and 1976), received whole cell pertussis vaccines. My older child spiked a moderate fever and cried inconsolably for 4 hours, following the first shot and to a lesser extent the second shot of the three shot series. My son, who was severely neurologically impaired, had none of those effects.

This is how the anti-vax cranks and their websites work. They headline any reports, that “hint” of a serious adverse event post immunization…then “dead” silence when, following thorough investigation, no link was found. Hence, we still have the notorious anti-vax websites still “headlining” “Another (or 4 more) deaths from HPV Vaccine”…long after the VAERS investigations showed no link between HPV vaccine administration and deaths from suicide or a motor vehicle accident weeks, or months, after the HPV vaccine was administered.

The notorious anti-vax websites and some lesser ones, continue to spread the false information…they are deliberately non self-correcting. That is the difference between reputable internet source and real journalists and the crank web sites and their yellow “journalists”.

Ray P, Hayward J, et al. Encephalopathy after whole-cell pertussis or measles vaccination: lack of evidence for a causal association in a retrospective case-control study. Pediatr Inf Dis J. 2006 Sept;25(9):768-73.

Took about 5 seconds in PubMed. I would call you a lazy sloth but it would be disrespectful to my gentle tree dwelling mammalian friends. Then again, my Little Grasshopper, perhaps you are merely unschooled in PubMed-fu, the more esoteric and scientific cousin of Google-fu.

@ Jen in TX

Actually, the way I see it, Science Mom, Dr. Shaw is kind of putting his neck on the line here. Some in the “biomed” community are not at all happy about this and that’s all I’m going to say about it!

Oh goody. Another Brave Maverick Doctor™ in the making. I can’t wait to hear about his martyrdom at the hands of “the biomed community” or “Big Pharma.” Maybe he and AJW and Burzynski can exchange notes.

Does he have any evidence for this supposed correlation?

Actually, the way I see it, Science Mom, Dr. Shaw is kind of putting his neck on the line here. Some in the “biomed” community are not at all happy about this and that’s all I’m going to say about it!

If you have something to say, then say it. Does this sort of breadcrumbing make you feel special? Dr. Shaw is a quack with no MD and touts ridiculous hypotheses as fact. He doesn’t have a bit of sway with the scientific and medical communities so I don’t see what he has got that “puts his neck out”.

I can prove that the 1991 IOM paper does not establish causality (from p. 118):

Conclusion

The evidence is consistent with a causal relation between DPT vaccine and acute encephalopathy, defined in the controlled studies reviewed as encephalopathy, encephalitis, or encephalomyelitis. On the basis of a review of the evidence bearing on this relation, the committee concludes that the range of excess risk of acute encephalopathy following DPT immunization is consistent with that estimated for the NCES: 0.0 to 10.5 per million immunizations.

There is insufficient evidence to indicate a causal relation between DPT vaccine and permanent neurologic damage.

An excess risk of 0.0 per million doses means that there is zero excess risk. In other words, no causality.

James Gavin,

Adverse events associated with childhood vaccines other than pertussis and rubella. Summary of a report from the Institute of Medicine.

“The committee found that the evidence favored the rejection of a causal relation between diphtheria and tetanus toxoids and encephalopathy, infantile spasms, and sudden infant death syndrome.”

*Yawn*. Next.

Cynical Pediatrician,

Ray P, Hayward J, et al. Encephalopathy after whole-cell pertussis or measles vaccination: lack of evidence for a causal association in a retrospective case-control study. Pediatr Inf Dis J. 2006 Sept;25(9):768-73.

Did you even bother reading the conclusion?

In this study of more than 2 million children, DTP and MMR vaccines were not associated with an increased risk of encephalopathy after vaccination.

Being “not associated with an increased risk” does not mean absence of causality. Next.

An excess risk of 0.0 per million doses means that there is zero excess risk. In other words, no causality.

10.5 is better.

“Being “not associated with an increased risk” does not mean absence of causality. Next.”

…so says the delusional SFB Troll…who has its own “special way” of interpreting the English language, its own “cherry-picking-the-data-technique” and a “unique” facility of pathologically lying. It needs “terminal disinfection”.

-Next.

Takeaway point for folks following at home: never, ever take one of Thingy’s citations as supporting its positions without first reading them to see the context… because 99 times out of 100 the citation actually supports current medical practices despite what Thingy thinks (or claims) it says.

Also watch for ideosyncratic redefinitions of common terms… notably “infection”, which is one of its bugaboos. Sometimes communication with Thingy really goes at cross-purposes because English ain’t Thinglish.

In summary Th1Th2 is indeed a classic crank with severe perceptual filters augmenting a huge propensity for confirmation bias… its value here is mainly one of entertainment.

(I hereby propose a Crank of the Year award, sculpted from Cubic Plutonium* or its cheapest and most environment-friendly synthetic substitute. Thingy should be among the 2011 nominees.)

— Steve

* Yes, I spent some time on Usenet back in the day… the cranks there were of a much more entertaining and less potentially-dangerous variety than Th1Th2, let me tell you.

Thingy is evidently operating off its own (undisclosed) definition of causality. This goes with its own definition of infection. There is no point trying to carry on a discussion with someone who does not speak the same language we do.

I hereby propose a Crank of the Year award, sculpted from Cubic Plutonium

Belated thought; maybe a Klein bottle sculpture? Something that appears solid on first glance but doesn’t hold water is probably the best geometric representation of crankery I can think of.

— Steve

@ Anton P. Nym: Great post. I figured out how to find out where SFB Troll cherry-picked its data. I simply “copy” Thingy’s latest “cherry-picked” sentences…then “paste” it on the Google search field.

And, you wonder why I find that the Th1Th2bot makes more sense than Thingy….

“Some in the “biomed” community are not at all happy about this and that’s all I’m going to say about it!”

It’s definitely not a good idea to provide details. You rile up the “biomed” community goons, and first thing you know they’re stalking you on their Segways and putting adjuvants in your mailbox.

Last year (I think), the county in Iowa where my parents live, population of about 21K, I think, had 13 cases of whooping cough. Scaled to the population of Michigan, that would constitute about 7000 cases and it would scale to 23000 cases in California, more than twice as many as in the recent outbreak.

I do not know about the vaccination status of the county

Orac @8

I’m not interested in responded to a delusional troll, but you might be interested to note that studies by two separate research group have shown that children who seemed to develop acute encephalopathy following vaccination with DTP in fact had pre-existing mutations that cause that symptom, unrelated to vaccination.

The reported reactions are due to channelopathies, most commonly (ca. 70%) due to mutations in SCN1A. SCN1A is minimally expressed at birth but then reaches maximal expression at around the time when seizure disorders begin to manifest; this happens both in humans and in (unvaccinated!) rats, and has nothing to do with vaccination. I believe that about 700 different SCN1A mutations have been identified; some cause only febrile seizures, some cause more serious seizure disorders such as generalized epilepsy with febrile seizures plus, severe myoclonic epilsepsy borderland, and severe myoclonic epilepsy of infancy (Dravet syndrome). Since many of the mutations are temperature-sensitive, increased body temperature (whether due to a warm bath or to fever associated with natural infection or vaccination) reveals the underlying problem as with increasing age of the child the defective protein increasingly replaces the normal protein product (of a related gene).

In short, children who, in the anti-vax meme, appeared to be ‘developing normally as babies and toddlers … making eye contact, even potty trained, but then suddenly lost all those skills’ have been explained in studies of allegedly vaccine-injured children to have had pre-existing mutations that produced those symptoms, including developmental regression. None of this was known at the time of the previous Institute of Medicine reports.

–Reyes IS, Hsieh DT, Laux LC, Wilfong AA. Alleged Cases of Vaccine Encephalopathy Rediagnosed Years Later as Dravet Syndrome. Pediatrics. 2011 Aug 15.

–Berkovic SF et al. De-novo mutations of the sodium channel gene SCN1A in alleged vaccine encephalopathy: a retrospective study. Lancet Neurol. 2006 Jun;5(6):488-92.

–Li BM et al. Autism in Dravet syndrome: prevalence, features, and relationship to the clinical characteristics of epilepsy and mental retardation. Epilepsy Behav. 2011 Jul;21(3):291-5

–Catarino CB et al. Dravet syndrome as epileptic encephalopathy: evidence from long-term course and neuropathology. Brain. 2011 Oct;134(Pt 10):2982-3010.

–Wiznitzer M. Dravet syndrome and vaccination: when science prevails over speculation. Lancet Neurol. 2010 Jun;9(6):559-61.

–Neville B. Dravet syndrome and ‘immunization encephalopathy’. Dev Med Child Neurol. 2010 Jun;52(6):590-1

–Okumura A, Uematsu M, Imataka G, Tanaka M, Okanishi T, Kubota T, Sudo A, Tohyama J, Tsuji M, Ohmori I, Naiki M, Hiraiwa-Sofue A, Sato H, Saitoh S, Shimizu T. Acute encephalopathy in children with Dravet syndrome. Epilepsia. 2011 Nov 16.

–Wolff M, Cassé-Perrot C, Dravet C. Severe myoclonic epilepsy of infants (Dravet syndrome): natural history and neuropsychological findings. Epilepsia. 2006;47 Suppl 2:45-8.

In regard to Thingy’s comments

Ray P, Hayward J, et al. Encephalopathy after whole-cell pertussis or measles vaccination: lack of evidence for a causal association in a retrospective case-control study. Pediatr Inf Dis J. 2006 Sept;25(9):768-73.

Did you even bother reading the conclusion?

To quote Inigo Montoya
“You keep using that word. I do not think it means what you think it means.”

Thingy is taking “correlation does not mean causation” to also mean that “lack of correlation does not mean no causation.” Of course, a lack of correlation is strong evidence against causation, whereas correlation is only weak evidence for correlation.

Ack! Preview is your friend! The last sentence above should read:

Of course, a lack of correlation is strong evidence against causation, whereas correlation is only weak evidence for causation.

@ Jen in TX: Doctors and nurses have known for years that fever is an important part of the immune response…”

OMG, don’t make me laugh, lilady. If fever is sooo important, then why have (some, not all) “doctors and nurses” been spending so much time telling parents to shove Tylenol into the mouths of babes at any sign of a slight temp increase all these years as well as before and after vaccinations, complete with “helpful” freebie samples and coupons from J&J sales reps? Where on earth is that evidence that you all are always hollering about?

There’s no evidence to suggest that fever is harmful. Dehydration is harmful (and even more so with antipyretic use) and heatstroke (not from fever) is harmful. The underlying reason for the fever (infection) may (or may not) be harmful. Fever phobia and the widespread use of fever suppressing drugs is bullshit medicine that has killed and injured babies. Maybe that’s the reason for the hostility towards this idea? The idea that the “evidence based medicine” that you all champion might have gotten it all wrong?

Consider the 1991 IOM report cited by W. Kevin Vicklund @39.  

Let’s suppose the true risk is the absolute top end of the range: 10.5 cases of encephalitis per million (even though that’s not what later research showed).  The rate of death from pertussis in California in 2010 was 1/1000 (ten deaths in 10,000 cases). That is a death rate of 1,000/1,000,000, or nearly a hundred times the absolute maximum rate of encephalitis, not death, from the whole-cell vaccine, that isn’t used anymore anyway.  

So, to support the proposition that EBM has “gotten it all wrong,” you present… EBM? Much hilarity doth ensue.

Orac, you really must provide some evidence to support your assertion that a paper that is almost fifteen years old is the cause of a current European measles outbreak. Either that or stop making the claim. And provide us some data regarding alleged falling immunization rates as well.

If fever is sooo important, then why have (some, not all) “doctors and nurses” been spending so much time telling parents to shove Tylenol into the mouths of babes at any sign of a slight temp increase all these years

Because some folks don’t go by Evidence Based Medicine, or they shovel pills out in order to get annoying patients out the door with a minimum of hassle. Sadly not everyone (in any profession) always follows best practices.

Where I work we offer limited medical information to people calling on the telephone… though I am not a medical professional and am not qualified to offer any such information, I do know that a fever has to be pretty high and prolonged for it to be considered worth recommending that someone see a doctor about it or use antipyretics.

— Steve

Moreover, there is evidence that pockets of unvaccinated children can easily form the nidus for outbreaks of pertussis,

There is no evidence. Just unfounded speculation.

To further the analysis started by LW @55, the number of live births in California was about 512,000 in 2010. Allowing for death and anti-vax sentiments, let’s assume 500,000 full-dose equivalents @ 4 doses, an ~97% uptake rate (which is probably high). That gives about 2 million doses, or at worse 21 extra cases of encephalopathy.

@58

So glad you find all of this so fucking hilarious. My severely autistic, nonverbal child has had a flare up of his bowel problems this week and is in severe PAIN. Think that’s “hilarious” too?

I have been screaming about this shit for three years and I AM PISSED. Pissed at mainstream medicine for doing this to him and pissed at those on the “other” side who have gone out of their way to keep this information from getting out in order to protect their precious St. Andy. My kid is caught in the middle of all this, along with all the other kids who are suffering and their parents who are seeking answers.

Now if you’ll excuse me, I’ll be at the gastroenterologist’s office today with my self-abusing son, so if I don’t respond to your lovely posts right away, do forgive me.

“That gives about 2 million doses, or at worse 21 extra cases of encephalopathy.”

And in exchange we *wouldn’t* get 10 extra cases of death from pertussis.

Jen in TX, I don’t think anyone here finds a child’s agony to be amusing.

What is risible (because one can either laugh at it or cry because of it, so laughter is the more productive response) is the blatently-unreasonable scapegoating of medicine that results from some peoples’ wild flailing-about for something to blame. It may be a coping mechanism for dealing with the stresses of parenting a sick child, but that doesn’t mean it’s good or healthy; drinking and spousal abuse are also coping mechanisms that aren’t acceptable.

The cosmic joke is that too many people have turned their backs on the very medical research that may offer help; it’s like drowning people refusing to wear life-jackets because they’re afraid of being choked.

VACCINES DO NOT CAUSE AUTISM. WAKEFIELD IS A FRAUD. THIS IS PROVEN IN MULTIPLE SCIENTIFIC STUDIES AND AT LEAST ONE LEGAL COURT.

The way to help autistic children and their parents is not to revisit measles and polio on everyone else. It’s to find the real causes, and to discover new therapies for the kids and means of helping parents help their kids. And going after “Big Pharma” doesn’t do anything to help that.

— Steve

Jen in TX, no one here finds your situation the least bit hilarious. But we also didn’t know your current situation until you told us, so no comment on this post could possibly refer to your son’s current misery.

@ Jen in TX:

I note that you are completely unable to actually support your claims, instead attempting to resort to emotional blackmail. It is blindingly obvious that I was referring to your unsubstantiated incoherent ravings as “hilarious,” not your son’s condition. I strongly suspect that you realize this full well and are attempting to shut down criticism by invoking an entirely unrelated issue.

@ Jen in Tex: You should have provided the article that you apparently read in the “Pediatrics” Journal entitled “Fever and Antipyretic Use in Children” (March 1, 2011.

I stated in my post (#34), directed at you:

“@ Jen in TX: Doctors and nurses have known for years that fever is an important part of the immune response…so there may be an association with decreased immune response with the use of an antipyretic such as Tylenol/acetaminophen.”

Here is the direct quote from the Pediatrics Journal article:

“Despite insufficient evidence, many pediatricians recommend the routine practice of pretreatment with acetaminophen or ibuprofen before a patient receives immunizations to decrease the discomfort associated with the injections and subsequently at the injection sites and to minimize the febrile response.9,17,37,–,39 In addition, results of 1 recent study suggested the possibility of decreased immune response to vaccines in patients treated early with antipyretics.”

The article in Pediatrics also discusses “febrile” seizures, which I did NOT make reference to. I discussed the trade off for fever causing grand mal seizures and/or status epilecticus in a child with a previously diagnosed seizure disorder. You do know Jen, don’t you, that a “febrile seizure” is not a “grand mal seizure” and that a “febrile seizure” is not “status epilepticus”? You do know, don’t you Jen, that “febrile seizures” do not lead to neurological impairment and that “grand mal” seizures may lead to neurological impairment and that “status epilepticus” is a life threatening event that can lead to Todd’s paralysis and profound neurological loss?

Jen, if you had any education in seizures disorders or actually had a child with a grand seizure disorder, you would know that there is a world of difference between febrile seizures and grand mal seizures/status epilepticus.

Let’s suppose the true risk is the absolute top end of the range: 10.5 cases of encephalitis per million (even though that’s not what later research showed).  The rate of death from pertussis in California in 2010 was 1/1000 (ten deaths in 10,000 cases). That is a death rate of 1,000/1,000,000, or nearly a hundred times the absolute maximum rate of encephalitis, not death, from the whole-cell vaccine, that isn’t used anymore anyway.  

Thank you for not arguing about causality.

Just to be absolutely clear: nowhere in the 1991 IOM report or the original NCES study does it claim to have established a causal relation between DTP and acute encephalopathy.

The only thing clear is that you are a germ denialist. Read it again #4.

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