The vilest antivaccine lie that won’t die: Shaken baby syndrome as “vaccine injury”

Way back in the day, when I first encountered antivaccine views in that wretched Usenet swamp of pseudoscience, antiscience, and quackery known as misc.health.alternative, there was one particular antivaccine lie that disturbed me more than just about any other. No, it wasn’t the claim that vaccines cause autism, the central dogma of the antivaccine movement. Even ten years ago, that wasn’t a particularly difficult myth to refute, and, with the continuing torrent of negative studies failing to find even a whiff of a hint of a whisper of a correlation between vaccination and autism, refuting that myth has only gotten easier over the years. Indeed, I know it’s gotten pretty easy when even the mainstream media start to accept that the claim that vaccines cause autism is a myth and report matter-of-factly on issues such as Andrew Wakefield’s fraud and don’t give nearly as much copious and prominent media time to the likes of Jenny McCarthy. No, what I’ve found to be one of the most disturbing antivaccine claims of all is the assertion that shaken baby syndrome is a “misdiagnosis for vaccine injury.”

I first learned of this vile concept when I learned of the case of Alan Yurko. Yurko gained “fame” (if you can call it that) when he was sentenced to life in prison without parole for the murder of his 10-week-old son, who was shaken to death. Somehow, Yurko became the centerpiece of a campaign (Free Yurko) that featured as the centerpiece of its argument for Yurko’s innocence the claim that shaken baby syndrome (SBS) is in realty “vaccine injury.” Unfortunately, ultimately Yurko was released early, not because the courts agreed with the lie that it was vaccine injury, not SBS, that killed Yurko’s son. Rather, it was because apparently the coroner’s office where the autopsy was done on the dead baby was the most shoddily run morgue ever and incompetent coroner ever.

If you ever wanted to know how low antivaccine zealots can sink, let Australian skeptic Peter Bowditch describe it:

I want you to think about a dead baby. This baby was ten weeks old when he died. The autopsy revealed bleeding around the brain, in the eyes and in the spinal column. There were bruises on the sides of his head. Another thing that the autopsy showed was four broken ribs. These fractures had started to heal, and therefore indicated a pattern of physical abuse prior to the date of death. The father admitted to holding the baby by his feet and hitting him shortly before he died. I now want to you to form an opinion of the father. If you are the sort of person who opposes vaccination, you would see this man as a hero. You would see him as a martyr to the cause and would try to get him released from prison. In a breathtaking demonstration of what it can mean to believe that the end justifies the means, the anti-vaccination liars have adopted Alan Yurko as a symbol that they can use to frighten parents into refusing vaccination for their children. You can read a loathsome justification for this murderer at http://www.woodmed.com/ShakenBabyAlan.htm.

The claim that SBS is in reality due to “vaccine injury” ignores the wealth of clinical data indicating that SBS (also sometimes called “abusive head trauma”) is a distinct clinical entity that has been well-studied and is probably underdiagnosed. Although there is some controversy over the pathophysiology of SBS and how much force is necessary to produce it (hence the additional term to describe it). Whatever controversy there is over the symptoms and findings in SBS, there is no controversy that SBS is not “vaccine injury.”

Unless, of course, you’re a rabid antivaccine loon like Catherine Frompovich.

So off the deep end is Frompovich that she penned a post for the Orwellian-named International Medical Council on Vaccination with the even more Orwellian-named subtext “critical thinking for a critical dilemma” entitled Bone Density Test Can Disprove Shaken Baby Syndrome. Pseudoscience doesn’t get much more vile than this.

Frompovich starts out by touting her antivaccine cred:

Before I delve into the topic I want to discuss, perhaps you may want to know that I have co-authored several papers with Dr. Harold E. Buttram, MD, regarding topics such as Brain Inflammation, Basics of the Human Immune System Prior to Vaccines, and Shaken Baby Syndrome, which can be accessed at the International Medical Council on Vaccination website starting with Vaccines and Brain Inflammation at http://lawreview.byu.edu/articles/1325789487_13Seeley.FIN.pdf. In order to access the other papers, you will have to scroll through IMCV’s archives. Dr. Buttram’s name appears first on all articles.

Harold Buttram is downright “famous” (if you can call it that) as the guru of the antivaccine movement claiming that SBS is in reality vaccine injury. He’s made a name for himself over the years. As I’ve noted, his bogus hypothesis has been featured in the journal of the crank organization, the American Association of Physicians and Surgeons. It also turns out that Buttram is a favorite of Medical Voices, which ultimately became the International Medical Council on Vaccination. You’ll note that Buttram, unlike many “luminaries” of the antivaccine movement, doesn’t show up on the blogs or websites of the “big three” antivaccine groups, Generation Rescue (and its associated blog, Age of Autism), SafeMinds, or the National Vaccine Information Center. Here’s an observation. If your brand of antivaccine pseudoscience is so crazy that even AoA, Safeminds, and NVIC want nothing to do with you, you ought to take another look and ask yourself is maybe–just maybe–you’re so wrong as to be not even wrong. When, for instance, the likes of Jenny McCarthy, Barbara Loe Fisher, J.B. Handley, and even Jake Crosby take a look at your bizarre hypothesis and respond, “Meh, I don’t think so,” you really ought to take a second look and consider the possibility that you might be a total loon. Of course, part and parcel of being a total loon is that you don’t realize you’re a total loon, and certainly Harold Buttram doesn’t realize it. In any case, Frompovich has no clue that being associated with Buttram is not something a normal person would be proud of.

In any case, you might think that the idea that SBS is vaccine injury was an antivaccine lie so unbelievable and so outrageous that it would have died off by now through the sheer contempt and ridicule so justly heaped upon it by anyone with a modicum of critical thinking skills. You’d be wrong, as there are no depths to which some antivaccine activists will not sink. But apparently as recently as December 2010 Frompovich made a presentation before U.S. Food and Drug Administration’s Advisory Committee on Childhood Vaccines (ACCV) about Shaken Baby Syndrome, along with Harold Buttram. What I wouldn’t give to have been a fly on the wall in that room. Were I a member of the ACCV, I don’t know if I would have laughed or cried at the presentation. Maybe a bit of both. Either that, or I might have sat there in stunned silence, unbelieving that anyone would present an idea so patently wrong and actually believe it.

Frompovich’s credulity, however, leads her to exult over a paper published in a law journal by someone named Matthew B. Seeley entitled Unexplained Fractures in Infants and Child Abuse: The Case for Requiring Bone-Density Testing Before Convicting Caretakers. The basic thrust of the article is that not all cases of unexplained fractures in infants are due to abuse. In other words, it’s rather a massive straw man argument. Here’s why. First, unexplained long bone fractures are not pathognomonic for child abuse. What’s far more suspicious are injuries that are not consistent with the history given. Second, the term SBS is falling out of favor; the preferred term is now “abusive head trauma,” which doesn’t limit the potential cause of injury to shaking. Third, recent reviews have been very clear in emphasizing that the diagnosis of abusive head trauma is not a trivial matter and can be at times difficult. Indeed, they emphasize other conditions that can cause the usual triad (subdural haemorrhage, retinal haemorrhage and encephalopathy) that characterize the diagnosis. A review from just last year, for example, provides what it characterizes as the “exhaustive” list of conditions that can result in this triad:

  • Chronic subdural haemorrhage
  • Accidental falls
  • Resuscitated SIDS
  • Cortical vein and sinus thrombosis
  • Inflicted injury
  • Vitamin D deficiency
  • Second impact syndrome (a second head injury, often very mild, occurring days or weeks after a first)
  • Aneurysm rupture
  • Rare genetic conditions

Notice that none of the conditions listed above includes “vaccine injury.” There is no evidence that vaccine injury can cause the triad associated with SBS/abusive head trauma.

Indeed, the review is also notable for its emphasizing a “pragmatic” approach to diagnosing SBS/abusive head trauma. Another review describes the process of diagnosing SBS/abusive head trauma:

SBS is known to be difficult to detect and diagnose. Clinicians should use their own clinical judgment as each individual case is different and needs to be considered carefully on its own evidence…The diagnosis of SBS must be considered in any infant or young child who collapses with no obvious causes. Clinicians must maintain a low threshold of suspicion for considering this diagnosis.16 The diagnosis of SBS is usually made following a careful medical and social history taking. This ought to be supplemented by appropriate investigations.

[…]

Birth history, developmental milestones, and vitamin K status are also important to note. In most cases where a history of injury is given, it is reported to be of a minor nature and is not consistent with the severity of the infant’s condition. A review of checklists of risk indicators for child abuse in emergency departments, shows that three history items are worthwhile considering: delay in seeking medical advice, an inconsistent history, and clinical findings that are incongruent with the history narrated by the accompanying adult.17

The authors conclude that the clinical diagnosis is usually based on a patient history that does not explain the clinical features. They also emphasize:

Laboratory investigations are necessary in order to exclude other medical conditions such as rare metabolic diseases (glutaric aciduria), coagulation disorders, and infective encephalopathy.24,25 Other investigations should include a septic screen to exclude infection–as subdural collections could be associated with meningitis, urine screening for toxicology, and a metabolic screen. It is also important to do a full blood count, repeated after 24-48 hours, which may demonstrate a rapidly falling and low haemoglobin level.

The paper that Frompovich touts advocates the use of single photon absorptiometers to measure bone density in children. While this might well be a valid tool to estimate bone density in infants, but this argument does not in any way support the idea promoted by antivaccine loons that the SBS/abusive head injury triad can be caused by vaccines. In fact, Frompovich even admits that Seeley would likely “bristle at the thought that vaccines can contribute to SBS.” I have no idea what Seeley would think. For one thing, he’s not a pediatrician, and he published no primary studies on this issue, nor is he a neuroscientis. Rather, he is an exercise scientist wrote a medical-legal review that is basically designed to suggest to other lawyers what sorts of techniques can be used to sow reasonable doubt in a jury considering cases of child abuse of babies who present with the SBS triad, and, quite frankly, I don’t know whether he’s pandering to a law audience or being incredibly simplistic when he argues that there’s a huge degree of doubt because it’s impossible to do a randomized trial to determine whether shaking can cause the SBS triad.

I kid you not. That’s really what he writes, which is one reason why I was underwhelmed. Frompovich, not surprisingly, eats this up, so much so that she starts advocating subjecting children to bone density tests as routinely as Apgar scores and, in a triumph of speculation over evidence, suggests that the birth dose of hepatitis B vacine should not be given before a serum vitamin D test is done.

I have to wonder what Seeley thinks of his law review article being coopted into the service of a particularly vile bit of antivaccine pseudoscience. In essence, Frompovich’s invocation of Seeley’s review article is designed to sow fear and doubt about the very existence of SBS and then to imply, not so subtly, that if SBS is difficult to diagnose then it could well be vaccine injury. Never mind that, again, there is no credible evidence that SBS is in any way related to vaccine injury, and never mind further that the intricacies and controversies in diagnosing SBS do not in any way demonstrate that vaccines cause the triad of findings that characterize SBS. By publishing this sort of nonsense, the IMCV has demonstrated that there are no depths to which it would not go in trying to discredit vaccines.

Except that I just noticed that the IMCV went even lower. It published an article that I apparently missed when taking on Frompovich’s article. It’s an article by Harold Buttram himself saying–you guessed it!–that vaccines cause SBS.