“Vaccine Awareness Week,” misinformed consent, and, of course, Nazis and eugenics

I’m ba-ack.

Yes, as hard as it is to believe, thanks to the forced migration of this blog from its old home on ScienceBlogs to its brand spanking happy shiny new home right here, it’s been nearly four weeks since last I laid down a heaping helping of that Insolence, Respectful or not-so-Respectful, that my readers crave. In the interim, I’ve been frantically transferring content from the old blog to the new, with help from Alain and a couple of others whose advice has been appreciated. For better or worse, here I am. Contrary to what some rather silly antivaxers are saying, I’m not going anywhere for the foreseeable future.

This is a good thing, because what should appear to my eyes the other day, as I emerged from the whole process of transition and thought, Hey, enough sitting around. It’s time to get back into the fray and test the new blog, but a nice, juicy bit of antivaccine nonsense from the grande dame of the antivaccine movement, Barbara Loe Fisher. Yes, I thought, this is a particularly appropriate way to dip my toes back into the blogosphere again, given that vaccines are probably the most frequent blogging topic here and that Fisher is one of the longest-distorting antivaccine activists out there, having been spreading antivaccine pseudoscience since the early 1980s (and being regularly featured here for at least a decade). And there are Nazis, too, because antivaccine activists can’t discuss vaccine policy without invoking Nazis and eugenics. Or so it seems.

Vaccine Awareness Week, or: How I kept worrying about nonexistent harms from vaccines

The occasion for Fisher’s rant is a made up week that she and über-quack Joe Mercola have dubbed “Vaccine Awareness Week,” which this year runs from November 5-12. In reality, it should be called “Antivaccine Pseudoscience Awareness Week,” because what Fisher and Mercola try to use this week to frighten parents out of vaccinating and, of course, to liken any sort of school vaccine mandate to fascism, because freedom, I guess. In any case, Fisher has laid down a heaping helping of nonsense, as she does every year in November, this year entitled From Nuremberg to California: Why Informed Consent Matters in the 21st Century. That’s right. As I mentioned above, she went there. As you can tell from the title, she will liken vaccines to the unethical and horrific human experimentation carried out by the Nazis during World War II. You can either watch her claims in video form (below, that is, if you can stand it) or read along with me. It’s a 44 minute video; so I recommend the latter:

Fisher begins, fairly predictably, invoking the concept of informed consent and pointedly referring to it in the context of the Doctors Trial at Nuremberg in 1947, which is where Nazi doctors who carried out horrifically unethical human experimentation on Jews and others whom they viewed as inferior were tried for their crimes. Informed consent, of course, is the principle that, before any person agrees to be part of a human experiment (or to receive any medical treatment, for that matter), that person has a right to be fully informed of the potential risks and benefits of the medical treatment being proposed and to be able to chose to accept or refuse that treatment. Even more predictably, Fisher then launches into a frequent claim made by antivaxers:

Today, when a person publicly advocates for informed consent protections in vaccine laws, an “anti-vaccine” label is usually immediately applied to shut down any further conversation.^6,7 Perhaps because a conversation about ethics opens up a wider conversation about freedom. The right and responsibility for making a decision about risk-taking rightly belongs to the person taking the risk.

When you become informed and think rationally about a risk that you or your minor child may take — and then follow your conscience — you own that decision. And when you own it, you can defend it. And once you can defend it, you will be ready to do whatever it takes to fight for your freedom to make it, no matter who tries to prevent you from doing that.

I find it amusing that one of Fisher’s references is to one of her own blog posts whining about how the Disneyland measles outbreak of 2015 unleashed what she called a “media hatefest attacking parents and civil liberties.” Not exactly. What it did do was to direct the media’s attention to the antivaccine misinformation being spread by the likes of people like Barbara Loe Fisher. In the post, Fisher tried to claim the mantle of the victim and accuse those who want to protect children from infectious disease and parents from the pseudoscience and misinformation spread by Fisher as “race and class baiting.” Her other reference is to a NYT article about a woman named Elena Conis, who wrote a book Vaccine Nation: America’s Changing Relationship with Immunization. She appears to fall for the sort of “tell both sides” fallacies and doesn’t think the word “antivaxer” is appropriate to describe many people. That is, of course, a statement with which few of us who advocate for vaccines would disagree, but it also ignores the fact that there is demonstrably a subset of the vaccine hesitant who are in actuality antivaccine, people like Barbara Loe Fisher. Coney is also quoted as saying:

>We reflexively blame outbreaks of vaccine-preventable diseases on supposedly irrational anti-vaccinationists. In doing so, we often neglect to consider the shortcomings of vaccination and the many reasons children lack vaccinations: age, religious beliefs, medical contraindications, poverty, challenges accessing healthcare, and more. It’s not just about philosophical objections.

Which is a well, duh! statement that ignores the fact that public health officials do look at all causes. However, the evidence is quite overwhelming that many of the recent outbreaks that we’ve experienced in the US, particularly measles outbreaks, are directly as a result of low vaccine uptake and that even relatively small decreases in vaccine uptake can lead to outbreaks of vaccine-preventable disease. The most recent (and largest) example is the measles outbreak among Somali immigrants in Minnesota, which is directly attributable to the belief that the MMR vaccine causes autism, a belief that white, affluent antivaxers, inspired by Andrew Wakefield, actively promoted—and still promote.

From there, Fisher dives into a claim frequently made by antivaxers, that vaccines are dangerous to certain children and that they sometimes don’t work:

The act of vaccination involves the deliberate introduction of killed, live attenuated or genetically engineered microbes into the body of a healthy person, along with varying amounts of chemicals, metals, human and animal RNA and DNA and other ingredients13 that atypically manipulate the immune system to mount an inflammatory response that stimulates artificial immunity.¹⁴

There is no guarantee that vaccination will not compromise biological integrity or cause the death of a healthy or vaccine vulnerable person either immediately or in the future. There is also no guarantee that vaccination will protect a person from getting an infection with or without symptoms and transmitting it to others.¹⁵

Note the clever phrasing. Yes, strictly speaking, it is true that there is no guarantee that vaccination will not cause harm. No responsible physician says otherwise. Also note the even cleverer wording about causing harm “immediately or in the future.” This is clearly meant to reference something that a casual reader might not be aware of, namely how Fisher and other antivaxers think that vaccines cause autism and all sorts of chronic health problems, like diabetes and autoimmune diseases, as long term complications from their use. Of course, as I’ve discussed here many times, the evidence is overwhelming that there is no correlation between vaccination and the development of autism, nor is there any compelling evidence that vaccines cause diabetes, autoimmune diseases, or other chronic diseases. Indeed, vaccines are remarkably safe, as any intervention intended to be administered to millions of healthy children in order to prevent disease should be.

Similarly, strictly speaking, there is no guarantee that any given vaccine will prevent disease. As we know, even very effective vaccines, like the measles vaccine, have measurable failure rates. The measles vaccine might well be greater than 90% effective, but that means that in a single digit percentage of children it will fail to provide immunity. The influenza vaccine is of variable effectiveness from year to year, because scientists and infectious disease specialists have to predict which strains of the flu will predominate every year, and sometimes they get it wrong.

Here’s the thing, though, that Fisher intentionally obfuscates. She presents the choice as that of the Nirvana fallacy. Either vaccines are perfectly safe, or they are worthless. Either vaccines work 100% of the time, or they are pointless. The real world doesn’t work like that. Medicine doesn’t work like that. No medical intervention is 100% effective, nor is any intervention 100% safe. It is the balance between risks and benefits that is important, and there vaccines win. Not only are they incredibly safe, having saved more lives than any other medical intervention devised by the human mind, but they are remarkably safe. Fisher knows this, as do most of the more savvy antivaxers. However, she gets around the safety of vaccines by trying to imply that there are these children for whom vaccines are deadly but whom science can’t identify:

Despite large gaps in scientific knowledge, government health officials direct physicians to vaccinate 99.99 percent of children regardless of known or unknown risks.16,17 Reports published by physician committees at the Institute of Medicine confirm that vaccines, like infections, can injure and kill people, and that:

• Very little is known about how vaccines or microbes act at the cellular and molecular level in the human body^18,19,20
• The Institute of Medicine confirms that an unknown number of us have certain genetic, biological and environmental susceptibilities that make us more vulnerable to being harmed by vaccines, but doctors cannot accurately predict who we are^21,22
• Clinical trials of experimental vaccines are too small to detect serious reactions before they are licensed^23,24
• The U.S. recommended child vaccine schedule through age 6 has not been adequately studied to rule out an association with allergies, autoimmunity, learning and behavior disorders, seizures, autism and other brain and immune dysfunction²⁵

It is not true that “very little” is known about how vaccines or microbes work at the cellular and molecular level. Quite a lot is known, actually. The references cited by Fisher describe the gaps in our understanding, but having gaps in our understanding of how microbes and vaccines work is not the same thing as there being “very little known” about how they work. Similarly her second bullet point is a bit of an overreading (to put it mildly!) of the Institute of Medicine reports that she’s cited. Let’s just say that it’s a bit of a—shall we say? creative interpretation of the IOM report. For instance, it’s funny (actually, no it’s not) how she neglected this conclusion of the IOM:

The committee’s efforts to identify priorities for recommended research studies did not reveal a base of evidence suggesting that the childhood immunization schedule is linked to autoimmune diseases, asthma, hypersensitivity, seizures or epilepsy, child developmental disorders, learning disorders or developmental disorders, or attention deficit or disruptive behavior disorders. While the committee found that there is no scientific evidence to justify the majority of safety concerns, perceptions dictate parental support and actions. Therefore further study of the full immunization schedule as well as further study to understand stakeholder perceptions and how they are formed may help improve awareness and education efforts. Stakeholder concerns should be one of the elements used to drive searches for scientific evidence, but these concerns alone, absent epidemiological or biological evidence, do not warrant the initiation of new high-cost randomized controlled trials. The committee concludes that data from existing data systems may be used to conduct observational studies and offer the best means for ongoing research efforts of the immunization schedule’s safety.

The committee found no significant evidence to imply that the recommended immunization schedule is not safe. Furthermore, existing surveillance and response systems have identified adverse events known to be associated with vaccination. The federal immunization research infrastructure is strong. A key component is the VSD project, which with ongoing support will be able to feasibly address the committee’s identified key research questions. Although the committee concludes that protection of children from vaccine-preventable diseases is of higher importance than testing of alternative immunization schedules without epidemiological or biological evidence indicating a safety problem, VSD should continue to examine the health outcomes of people who choose alternative schedules.

This is hardly an endorsement of Fisher’s claims. Indeed, one recommendation of the IOM very explicitly rejects antivaccine recommendations:

The Department of Health and Human Services should refrain from initiating randomized controlled trials of the childhood immunization schedule that compare safety outcomes in fully vaccinated children with those in unvaccinated children or those vaccinated by use of an alternative schedule.

Indeed, the IOM concluded that the current Vaccine Safety Datalink database is adequate to study the current vaccine schedule and detect adverse outcomes that might be associated with specific vaccines.

Now, here’s where a real contortion of logic follows:

For these reasons, vaccination is a medical procedure that can be termed experimental each time it is performed on a person. By extension, “no exceptions” mandatory vaccination laws create a de facto uncontrolled, population-based scientific experiment that enrolls every child at birth and never ends, sacrificing an unknown number of vaccine vulnerable children.

Further, the U.S. Congress and Supreme Court have declared federally licensed vaccines to be “unavoidably unsafe,” removing civil liability from doctors who give vaccines and drug companies that sell vaccines in what has become a very lucrative multibillion-dollar business in the U.S.26,27

The only part of what Fisher writes here that can be said to be accurate is that vaccination is a medical procedure. As for vaccines being “unavoidably unsafe,” well, explaining why that claim is a distortion and misinformation would take as long as what I’ve written already; so I’ll just refer you to posts written before by yours truly and, of course, Dorit Reiss.

Nazis, Nazis, everywhere, all wanting to vaccinate your child

Fisher devotes a lot of verbiage to her belief that the DPT vaccine injured her son. This vaccine covered diptheria, pertussis, and tetanus, and used a whole cell-derived pertussis vaccine, from there she moves on to philosophy and, of course, likening current vaccine mandates to unethical human experimentation carried out by the Nazis. To understand what she’s referring with respect to the DPT vaccine, you need to be aware of an old documentary known as 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. This particular bit of muckraking was arguably the spark that resulted in the big bang of the modern anti-vaccine movement. In particular, it launched the anti-vaccine career of, yes, Barbara Loe Fisher. Charismatic and media-savvy, in the 1980s Fisher became the go-to woman for any story about vaccines, although later she was supplanted by even more charismatic antivaccine spokespeople, such as Andrew Wakefield and Jenny McCarthy. She even did some good, being instrumental in the creation by Congress of the Vaccine Court through the National Childhood Vaccine Injury Act of 1986. As the decades wore on, though, she became more clearly antivaccine. Be that as it may, it was thought that the whole cell pertussis vaccine (abbreviated DTwP, for diptheria-tetanus-whole cell pertussis, as opposed to the DTaP, which is now used and in which the “a” stands for “acellular”) was responsible for encephalitis and brain damage in children, based on sensational case reports in the media, like the ones in Vaccine Roulette. Early studies suggested that there might be an association between the whole cell pertussis vaccine and the encephalopathy attributed in the media to it, but, as Steve Novella pointed out, later studies did not support his association. It is actually very unlikely that DPT actually caused Barbara Loe Fisher’s son’s health problems.

Even though it is unlikely that the DPT actually injured Fisher’s child in the way that she thinks it did, none of that stops her from invoking the dreaded specter of “scientism” and blaming current vaccine policy on pure utilitarianism:

But, the stark reality is that the scientification of every branch of philosophy has elevated prominent scientists and physicians promoting “consensus science” into positions of authority, whose judgment should never be questioned. Long held cultural values, such as respect for freedom of thought, speech, conscience and religious belief are being called into question, which in turn affects court decisions and the making of laws.

Nowhere is this more visible than in public health law using the materialist philosophy of utilitarianism to legally require all Americans to use an increasing number of vaccines without their voluntary informed consent. So how did we get here? How did science come to dominate how we define what is true and good for the individual and society in the 21st century?

I’m always amused when antivaxers claim that scientists and “consensus science” should “never be questioned,” even as they question scientists and consensus science. In any case, whenever someone makes an argument like this, I like to respond: Well, if we aren’t going to make health policy decisions based primarily in science, then on what basis do we make health policy decisions? Religion? Whatever the current administration happens to think?

Fisher makes a lot of explicit analogies between current vaccine policies and Nazi eugenics programs, which weren’t exactly utilitarian. They were, rather, driven by an ideology of racial superiority in which a whole class of human beings, Jews, was viewed as an enemy to the “body” of the German volk that must be exterminated in order to preserve the health of the volk. The Holocaust was arguably not a utilitarian genocide. Rather, it was an ideologically-motivated genocide. Indeed, the Nazi Reich did things that were clearly against its own interest in order to pursue this genocide, things that were not very utilitarian at all, such as diverting trains that could have been better utilized sending troops and supplies to the Eastern Front to the purpose of shuttling Jews to Auschwitz. Why? Ideology. Yes, it was more complicated than that (everything in history is), but blaming the Holocaust strictly on utilitarianism is a distortion. It was the Nazi ideology that the state and the volk were the most important considerations in medicine that drove the view that Jews and other hated races were not only expendable but enemies to be exterminated.

And, no, this doesn’t help:

When doctors were charged with crimes against humanity at the Doctor’s Trial at Nuremberg for carrying out horrific scientific experiments on captive children and adults in the concentration camps, including vaccine experiments, they pointed to U.S. eugenics laws and invoked a utilitarian defense, claiming it was moral to sacrifice the health and lives of individuals to advance scientific knowledge that could save the lives of many more.^94,95

I love how Fisher slipped “including vaccine experiments” into her description of the horrors of the concentration and death camps. Her attempt to associate in the minds of her readers vaccines and the Holocaust isn’t even the least bit subtle. Neither is her invocation of the slippery slope fallacy:

It is for this reason that the debate about vaccination transcends vaccination. It is the tip of the spear in a much larger war that is being waged on cultural values and beliefs in America, which is why I call it The Vaccine Culture War. Because if the state can tag, track down and force citizens against their will to be injected with biologicals of known and unknown toxicity today, there will be no limit on which individual freedoms the state can take away in the name of the greater good tomorrow.

Today the battlefield of the 200-year war on microbes is littered with human casualties far too numerous to count while, in a natural fight to survive, the microbes have evolved to evade the vaccines. And the scientists and physicians in leadership positions determined to win that war continue to fire away, stepping around the bodies of vaccine-damaged children lying on the ground.

Do I think that public health officials flying the science flag with a utilitarian star on it wake up every day and say to themselves, “I want to hurt a child today?” Of course not. Most doctors and scientists want to help, not harm people. Do I think they have lost their way, blinded by a utilitarian pseudo-ethic that makes it easy to ignore the bodies lying on the ground so they can allow themselves to believe that human sacrifice is ethical when it serves the greater good? Yes, I do.

Antivaxers often like to invoke visions of secret vaccine police breaking down parents’ doors in the middle of the night in order to inject their children with horrible, toxic vaccines, all in the name of the “greater good,” and that’s exactly what Fisher is doing here. Of course, school vaccine mandates are nothing like this. All that they say is that, in order for a child to attend school or day care, the child must be vaccinated, and they allow for medical and, in most states, personal belief exemptions to that mandate. Antivaxers like Fisher like to paint these mandates as doctors walking over the bodies of dead children sacrificed on an “altar reminiscent of the one that a 19th century August Comte built for his Religion of Humanity,” as Fisher puts it rather histrionically in her post, but that’s not what they are.

Which brings us back to informed consent.

Informed consent versus misinformed consent

The very principles behind informed consent is that the patient has a right to know the risks and benefits, as well as the uncertainty surrounding the magnitude of those risks and benefits, of any medical intervention before deciding whether to undergo that intervention and that the patient has a right to refuse. Accuracy of the assessment of the magnitude and particulars of the risks and benefits of an intervention is key to proper informed consent, which is why I coined the term “misinformed consent” to describe what Fisher advocates. (At least, I think I coined it; it’s quite possible that someone thought of it before I did.) The reason, as I’ve explained many times, is that what Fisher is advocating is that physicians misinform parents about the risks and benefits of vaccines, just as she does, such that the risks are vastly exaggerated (or, as in the case of the vaccine-autism link, made up and not supported by science), and the benefits hugely downplayed or even completely denied. It’s something that Fisher has been doing for at least seven years and probably a hell of a lot longer. (Seven years ago is when I first started writing about her doing it.)

Indeed, true informed consent is anathema to antivaxers. I can provide two examples easily, both of which simply involved requiring parents to be counseled about the potential consequences of failing to vaccinate. In California, for instance, before passing SB 277 in 2015, the bill that eliminated nonmedical exemptions to school vaccine mandates in California, California tried passing AB 2109. All AB 2109 did was to require parents to visit a physician or other enumerated health care provider for counseling before the state would grant a personal belief exemption to school vaccine mandates. You’d think that if Barbara Loe Fisher and other antivaxers were in favor of informed consent, they’d be all for this law. Surprise! Surprise! They weren’t.

There was a similar incident in my state. A couple of years ago, the Michigan Department of Health and Human Services passed a rule that required parents wishing a personal belief exemption to school vaccine mandates to go to their local county health office for an educational program on vaccines and the potential consequences of not vaccinating. Antivaxers in the state howled, and the Republican legislature tried to pass an incredibly ill-advised package of bills that would have reversed the rule, barred the MDHSS from making rules like it in the future, and made it more difficult for public health officials to keep unvaccinated children out of school in the event of an outbreak. I kid you not.

No, the claim by Barbara Loe Fisher that she wants informed consent with respect to vaccines is either a self-delusion or a lie, as it is for all die-hard antivaccine activists. What she really wants is misinformed consent, even if she has to invoke eugenics and Nazis to try to convince you otherwise—not to mention to try to hit you up for money for the NVIC as well, with Joe Mercola matching every contribution.