The Brownstone Institute embraces old antivax lies about measles

I had no idea who Alan Cassels was before yesterday, when I encountered him as apparently the newest addition to the stable of the far right wing antivax, antimask, anti-“lockdown” wingnuts at the “spiritual child of the Great Barrington Declaration” known as the Brownstone Institute. At least, I thought I didn’t know who he was. It turns out that I didn’t remember, because I discovered with a quick search of this blog that in 2012 I had actually written a post about him, taking him to task for the misinformation he had laid down in a post for the blog Pharmawatch Canada entitled Time to outlaw vaccine propaganda: Are we taking the easy way out by labeling vaccine questioners anti-science loonies?. Let’s just say that I applied some not-so-Respectful Insolence to him

It turns out that Cassels hasn’t gotten any better after 12 years. His first entry for the antivax Brownstone Institute, Mainstream Measles Mongers, is a doozy, as it is unequivocal evidence that what I had been predicting for a long time about Brownstone has come to pass. Basically, what I’ve been predicting is that the Brownstone Institute’s pivot to COVID-19 antivax would soon lead them to becoming just antivax, and this article is the clearest indication of this transformation, as it resurrects tropes about the measles and the measles vaccine that were old when I first discovered the antivax movement 25 years ago. I’m only surprised that Cassels didn’t claim that the MMR (measles-mumps-rubella) vaccine causes autism, although I have no doubt that the Brownstone Institute will soon embrace that old antivax chestnut in due course.

In the meantime, Cassels’ post is basically a restatement of an antivax trope that I dubbed “the Brady Bunch gambit” or the “Brady Bunch fallacy” in 2015. (I’ll explain again what that is in a moment, but for now, the embedded links can tell you if you don’t want to wait.) I suppose that I shouldn’t be surprised that the Brownstone Institute “went there,” because I’ve long been pointing out how similar the antivax arguments against vaccinating children against COVID-19 are to old antivax arguments before the pandemic against vaccinating children against the measles, and Cassels makes the predictable claims, and, although he doesn’t directly invoke the Brady Bunch, he does basically use the same argument that 50+ years ago the measles was no big deal. I’ll explain, but first, who is Alan Cassels?

His page on the Brownstone Institute website describes Cassels thusly:

Alan Cassels is a drug policy researcher and author who has written extensively about disease mongering. He is the author of four books, including The ABCs of Disease Mongering: An Epidemic in 26 Letters.

Oh, goody. So he appears to be one of those who take valid criticisms of the medicalization of certain conditions and incorrectly applies them to conditions for which the criticism of “disease mongering” is utterly inappropriate, such as vaccine-preventable infectious disease. Indeed, take a look at his other books:

Alan Cassels has been immersed in pharmaceutical policy research and healthcare journalism for the past 23 years, mostly studying and writing about how prescription drugs are regulated, marketed, prescribed and used. His niche is in exposing the large gap between the marketing and the science around prescription drugs, medical screening and other forms of disease creation. His books include Selling Sickness: How the World’s Biggest Pharmaceutical Companies are Turning us All into Patients (co-written with Ray Moynihan), The ABCs of Disease Mongering: An Epidemic in 26 Letters, and Seeking Sickness: Medical Screening and the Misguided Hunt for Disease. 

In most of his writings Cassels swings his axe against the folly of practitioners and profiteers increasingly selling us tests, treatments and theories of disease that threaten to turn more and more of us into patients. He believes that humans need clean, clear health information as urgently as they need clean water.  His recent book, The Cochrane Collaboration: Medicine’s Best Kept Secret (published in 2015) weighs into the history of a stellar international organization which produces some of the world’s highest quality medical information.

I can tell just from the titles that there are likely valid criticisms of pharmaceutical companies. There might even be valid questioning of screening tests. However, as Elton John once sang, I’ve seen that movie, too. Unfortunately, what often happens is that someone who is appropriately skeptical of certain medical practices and of big pharma ultimately ends up turning into a denialist crank, although, wow. Cassels is basically echoing the lies of Andrew Wakefield and his acolytes, minus the claim that MMR causes autism.

He begins, predictably, by referencing all the recent news stories about measles outbreaks around the world that have come about because vaccine hesitancy has led too many parents to be fearful of vaccines. Since measles is highly transmissible and as a consequence requires a high percentage of population immunity (95% or more, generally) from vaccination to prevent outbreaks, it’s often the “canary in the coal mine” when it comes to declining vaccine uptake, the first disease to reappear in a big way when vaccine uptake falls. This is nothing new. The same thing happened in the UK and Europe in the early 2000s after Andrew Wakefield’s fraudulent research linking MMR to autism caused confidence in MMR vaccination to plummet. It’s happened on a smaller scale, off and on, in the US in areas where high degrees of vaccine hesitancy led to localized outbreaks. Of course, just because something is not new does not mean it’s nothing to worry about, but Cassels tries to convince you otherwise:

I have not done an exhaustive analysis of current measles coverage, but from the dozen or so stories I have seen, the reporting seems to contain surprisingly consistent take-home messages: Measles is deadly, outbreaks are caused by too many unvaccinated children, and so we need to give more vaccines to everyone. Some conclude with: We need mandatory measles vaccination policies. No room for nuance there.

Then the scientific literature such a this paper concludes with the following statement:

Measles continues to pose a substantial and preventable health care burden, with serious complications, hospitalization and inpatient mortality.

In other words, be scared. Be fearful, and run, don’t walk, to the next clinic offering you or your kid a measles shot because you might not be up-to-date.

I swear. Antivaxxers are partying like it’s 1999 these days. No, seriously. This article could just as easily have been written in 1999, 2008, 2011, 2015, or whenever; yet Cassels trumpets his minimization of the threat of measles as though he had discovered something new. Regular readers, of course, can predict where Cassels will go next, and, unsurprisingly, he wastes no time in going there in the name of “context”:

How far back do you have to go in British Columbia, a Canadian province of 5 million people, to see what measles looks like? The last case in BC was apparently in 2019 but you have to go back to 2018 to see a report from the BC Centres for Disease Control report on the matter. The short report makes illuminating reading. 

There were 6 cases of measles that year, in a population of 5.1 million. (math alert: Hence if you lived in BC you had a 1 in 850,000 chance of catching measles that year). There were no measles deaths. What do we know about the six cases reported? Of those six cases half were fully immunized with two shots, one had one, and one had a history of “childhood vaccines.” So maybe one could conclude that 4 to 5 of those 6 had some level of measles immunization. Hmmm. What is going on? 

Oooh! Oooh! I know, Mr. Kotter!

What’s going on is that, in the guise of “providing context,” Cassels is deceptively leaving out important real context by cherry picking a couple of recent studies in locations and populations with high MMR uptake. Here’s the second:

This paper looked at the recent experience with measles in the US (2002-2016) and reported there were 1,018 measles hospitalizations over that 14-year period. That is 73 hospitalizations per year. There were a total of 34 deaths or about 2.4 deaths per year. That is out of a population of 327 million people. So your chances of dying from measles in the US was about 1 in 136 million.

Again, this is in a population in which over 90% of school age children have been vaccinated! Seriously, does Cassels even realize how deceptive citing this paper is? I strongly suspect that he does but doesn’t care. I also strongly suspect that he knows most of the rubes who read the bleatings of Brownstone Institute flacks don’t see the deception.

Cassels soon goes on to invoke “history,” as you will see, but right here he is leaving out a lot of history, namely the situation with respect to measles before the vaccine was licensed in the early 1960s. Let’s look at Cassels’ “history,” in which he invokes his version of the Brady Bunch gambit in order to convince you that measles was not that big a deal (and therefore your children don’t need to be vaccinated). Basically, the Brady Bunch gambit is a form of “measles wasn’t that bad before the vaccines” that cites old sitcoms from the 1950s and 1960s where kids getting measles was played for laughs, with measles portrayed as “just a childhood illness that we all got”, were weaponized to argue that measles isn’t dangerous.

I named the gambit after Is There A Doctor in the House?, a 1969 episode of the classic sitcom The Brady Bunch that antivaxxers were widely referencing at the time. The episode featured the complications and hijinks that ensued when all the Brady kids caught the measles in rapid succession, a situation that was (mostly) handled humorously, with the six kids not looking sick other than some red dots painted on their faces and hands to simulate the skin lesions characteristic of the disease. (Heck, I remember a scene where the kids were all playing Monopoly, laughing, with Marcia saying, “If you have to get sick, sure can’t beat the measles.” In 2019, Maureen McCormick, the actress who played Marcia, noted that she got really sick with the measles and that it was not “a fun thing” as portrayed in the episode.) It’s worth noting that this episode also features “natural immunity”. When Mike and the family maid Alice catch the measles near the end of the episode, it is revealed that they had never had measles as kids but that Mike’s wife Carol had and was therefore immune to measles as an adult.

Cassels doesn’t refer to The Brady Bunch, but he might as well have:

Those of us born before 1970 with personal experience pretty much all agree that measles is a big “meh.” We all had it ourselves and so did our brothers, sisters, and school friends. We also had chicken pox and the mumps and typically got a few days off school. The only side effect of those diseases was that my mom sighed heavily and called work to say she had to stay home to look after a kid with spots. 

If you were lucky, yes, that’s all you experienced. Thousands weren’t so lucky, and hundreds had the ultimate lack of luck. I also note that the measles vaccine was first licensed in 1963; so…before 1970? I was born before 1970 and I was vaccinated against the measles. As an aside, these days I’m glad that I got a booster dose of MMR the year before the pandemic because of reports of waning immunity in people my age who might not have gotten the whole series as a child. Cassels, like antivaxxers then and now, however, dismisses the dangers of measles by, in essence, saying, “What’s the deaths of a few hundred children in a population of millions”?”

No, seriously. He’s that despicable:

It’s hard to find what the death rate from measles was in Canada before the measles vaccine was released in the early 1960s but if we take the US as a proxy, in 1955 there were 345 measles deaths in the US population of 165 million. (math alert: that’s a one in 478,000 chance of dying of measles in the pre-vaccine era). 

Lots of people got measles back then as did me and my brother and sisters, but very few died. Other reports note that the US death rate from measles, pre-vaccine was about 1 in 10,000 but this is likely to be an exaggeration because back then our parents who had a kid with a fever and a rash wouldn’t have gone to the doctor or reported it to the government. In other words, the 1 in 10,000 number only refers to the ten thousand people sick enough to have their case reported to the government or hospitalized. The true death rate in the entire population is likely much, much lower. How many of our moms phoned the government or even the doctor if the kid had spots and a fever? Almost none I’d conjecture.

It is true that, according to the CDC, in the US that meant roughly 3 to 4 million cases a year, of which 48,000 victims were hospitalized,and 1,000 developed encephalitis, with around 400-500 deaths a year, year in, year out, every year. Indeed, the reason we worry about measles outbreaks is that we know that the disease is so transmissible that even small breakdowns in herd immunity due to low vaccine uptake can lead to serious problems.

Note the sleight of hand here, however. Cassels normalized to the entire population of the US, even though most adults had “natural immunity” from prior infection and the deaths were largely among children. Indeed, the CDC notes that “nearly all” children got the measles before the age of 15, meaning that deaths were nearly all children under 15, a population of roughly 55 million in 1955. Second, given that children aren’t supposed to die in the day and age of advanced medicine, 300-400 children dying represent a lot of dead children killed by a single cause. Pediatricians know this. To Cassels, however, what’s a few hundred kids a year killed by measles among friends?

Unless, of course, you’re one of “those” people:

Thanks both to widespread vaccination and natural immunity, by the early 2000s measles was essentially declared eradicated in the US and Canada, but still very much active in the developing world, where lack of proper nutrition (particularly vitamin A) puts malnourished kids at risk of all kinds of diseases, including measles.

And, later:

We are told that globally measles is a huge deal. Like any disease it’s certainly a bigger deal if you are poor and don’t get enough to eat. However, in 2019, the World Health Organization reported 839 cases in 23 states comprising 328 million people, thus making the rate about 1 in 391,000. It’s true that kids in poor countries can die from measles, yet they also die from everything else that kills poor, malnourished people living in countries without clean water or sanitation or functioning health care systems. Many infectious diseases including measles attack the most immune-compromised, who also happen to be the poorest, least robust people on the planet.

The miniscule numbers we’re talking about in the developed world, however, suggest that the risk of death from measles is wildly overblown. 

Funny how Cassels fails to mention the measles outbreak in Samoa in 2019 that killed dozens of children in a small country in a year. Guess what? Antivaxxers like Sherri Tenpenny, Robert F. Kennedy, Jr., and James Grundvig tried to deny that measles was deadly then, too, trying desperately to blame other factors, like poverty, poor nutrition, and vitamin A deficiency, while RFK Jr. falsely tried to blame the measles vaccine itself. Once again, this is an old and common theme among antivaxxers, that kids in wealthy developed nations don’t need the vaccine because the disease isn’t a threat to the “right” kind of children. It’s just those poor (and mostly darker skinned) people in poor countries who are at risk. Funny how antivaxxers make the argument that it’s poverty and malnutrition that predispose to deaths from measles but never seem to want to actually do anything about the poverty and malnutrition.

Next up is yet another old antivax claim, that “natural immunity” to measles is superior to vaccine-induced immunity:

In Canada and the US, even with upwards of 90% vaccination coverage among children there are still outbreaks, mostly in middle and high schools. 

This is not “failure to vaccinate” as the media will tell you, it is “vaccine failure.” Basically the vaccine doesn’t seem to work in some people. At the same time there hasn’t been a measles-caused death in Canada or the US for at least 20 years. Let that sink in for a bit as you soak in the epidemic measles-mongering we’re currently experiencing. 

Then there is the not-often-quoted fact that “wild measles” is different from the one we’re all vaccinated against, and this is not a bad thing. Researchers have found that we should be glad for wild measles still circulating in the community because it tends to boost people’s immune systems (even among the vaccinated) when they come in contact with it. An Italian study found that if you actually get measles, your immunity is lifelong, whereas your immunity after getting the two doses of measles vaccine declines within 10-15 years. 

I love how Cassels transparently cherry picks studies like this while ignoring other information. Far from “boosting the immune system,” “wild” infection with measles does the opposite, causing “immune amnesia” that lasts up to three years and results in an increased death rate during that period due to other infectious diseases. Yes, it is true that there has been some waning of immunity due to the vaccine in people my age, which is why in 2019, after waning immunity had apparently contributed to measles cases in middle-aged and older people, I decided that it would be a good idea to get a dose of MMR, just in case. In any event, Cassels is just plain wrong when he claims that a “wild” measles infection “boosts the immune system.”

Yet, Cassels calls the warnings over measles outbreaks “disease mongering,” saying:

This is what is happening with measles. Big media and government overhyping the nature of an illness, which history has shown us can be a precursor to some very bad public health policies such as mandatory vaccination programs and other coercive measures. Does it make sense to be measles-mongering when the level of herd immunity, obtained through natural immunity and vaccination is already pretty substantial? Doing so is the equivalent of crying wolf or shouting fire in a crowded theatre. You unnecessarily alarm people and thus, down the road, when you do need them to pay attention to something actually serious, no one will trust you.

It’s rather telling how Cassels puts all the blame for declining trust in public health authorities on them and ignores the role that organizations like the Brownstone Institute and the now well-organized, well-funded antivaccine movement have played in spreading misinformation, disinformation, and conspiracy theories about vaccines, of which his article is but one example. Moreover, like antivaxxers going back decades, Cassels isn’t satisfied with just claiming that the disease being vaccinated against is harmless—”no big deal”—and that therefore the vaccine is unnecessary. He also has to claim that it’s not safe, repeating a number of favorite tropes of antivaxxers:

The reporting of drug or vaccine adverse events to health authorities is so poor that maybe 1 in 100 adverse events ever get reported to a government agency. That was the conclusion of the Harvard Pilgrim study on the rate of reporting to VAERS (the Vaccine Adverse Event Reporting System). (math hint: if you hear of a drug or vaccine that caused 1,000 reported adverse events, then multiply that by up to 100—so the true number possibly suffering that adverse event could be about 100,000 people).

Yes, antivaxxers do like to cite that Harvard Pilgrim study, don’t they? Sorry, it doesn’t demonstrate that “only 1%” of all adverse events are ever reported to the Vaccine Adverse Event Reporting System (VAERS). While it is true that only a small proportion of minor adverse events are reported, a much higher proportion of severe adverse events are reported, as Dr. Vincent Iannelli explains. Moreover, as I like to explain, antivaxxers like Cassels like to portray VAERS as the be-all and end-all of vaccine safety monitoring in the US. It’s not. As a passive reporting system (one that does not actively seek reports but relies on patients and healthcare providers reporting to it), it is primarily a hypothesis-generating system—a “canary in the coal mine,” if you will—that produces possible adverse events attributable to specific vaccines that need to be confirmed with other reporting systems. These systems include active reporting systems (systems that actively search for adverse events after vaccination), such as the Vaccine Safety Datalink (VSD), which are not subject to the problem of underreporting that passive monitoring systems are. He also ignores all the other active monitoring systems for drug and vaccine safety in countries other than the US. How convenient. It’s also a deceptive argument almost identical to the one he made 14 years ago.

Next up, predictably:

US statistics drawn from a pool of people seeking compensation for injury or death caused by vaccines reported that between 1988 and 2023 there were 1,048 such reports linked to the MMR vaccine (the one that contains measles vaccines) made to the National Vaccine Injury Compensation Program in the US.

Next to the flu vaccine or the DPT shot, the MMR vaccine had the third-most number of people seeking compensation for injury. If the 1,048 reports are only a tiny fraction of the people actually hurt by the vaccine, the true number could be closer to 100,000. Remember, this is a ‘disease’ that caused 34 deaths over a 14-year period in the US. 

What deceptive bullshit. Again, the problem here is that so many of these claims to the National Vaccine Injury Compensation Program (NVICP) are for conditions that are not caused by vaccines, such as autism (which is not caused by MMR or other vaccines) and sudden infant death syndrome (which is also not caused by MMR or other vaccines). I would also turn Cassels’ math technique back on him and point out that 1,048 reports over a 35 year period come out to an average of just under 30 cases a year in a population of 245 million (1988) to 332 million (now). Should I do the math?

OK, OK, I know. It’s mainly just children who get the MMR, so that’s 63 million (1988) to 75 million (now) in the denominator. Yes, I could go back and look up the true numbers per year and normalize to the actual population of children that year, but I think you get the idea. As for Cassel’s claim that these 1,048 cases represent only 1% of the true number of compensable injuries, that’s utter nonsense too. People do not take their claims to the Vaccine Court if they are minor, and we know from Dr. Iannelli that severe adverse events after vaccination are nowhere near as underreported as antivaxxers like to claim, which makes sense. Who’s likely to go to much trouble to report a sore arm or a rash? Not many people. However, severe reactions are another matter entirely and much, much more likely to be reported. Seriously, Cassels is engaging in obvious antivax sophistry of the sort antivaxxers have been using for decades and that he, apparently, has been using at least since 2012.

Finally, Cassels tries to invoke the Cochrane Collaboration:

For a final comment to those who say the measles vaccine is “incredibly safe,” I hope they are right but I would also ask what reliable research are they pointing to in order to support that conclusion. 

A 2012 meta-analysis from the Cochrane Collaboration (which takes no money from the pharmaceutical industry) examined all the data they could find around the globe on the safety of the MMR vaccine. They found 57 clinical trials with a total of 14.7 million children who had received the MMR vaccine. Cochrane’s conclusion stated that: “the design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate.” 

One notes that, unlike the case with other studies that he cites, in this case there is no link to the actual 2012 study. That always gets my skeptical antennae a’-twitchin’. First, one notes that this Cochrane review finds that the efficacy of the vaccine in preventing measles is at least 95%. So much for Cassels’ claim near the end of his article that the vaccine “may or may not protect you”!

Also, one notes that the 2012 version is not the most recent version. The review was updated in 2021. Guess what? Its conclusion is now a lot less waffling, which is a good thing given how the methodolatry of Cochrane often leads to its waffling on results that are rather well-established.

The authors wrote:

Overall, the studies found that MMR, MMRV and MMR+V vaccines did not cause autism (2 studies 1,194,764 children), encephalitis (2 studies 1,071,088 children) or any other suspected unwanted effect.

Our analyses showed very small risks of fits due to high temperature or fever (febrile seizures) around two weeks after vaccination, and of a condition where blood does not clot normally (idiopathic thrombocytopenic purpura) in vaccinated children.

And concluded:

Existing evidence on the safety and effectiveness of MMR/MMRV vaccines support their use for mass immunisation. Campaigns aimed at global eradication should assess epidemiological and socioeconomic situations of the countries as well as the capacity to achieve high vaccination coverage. More evidence is needed to assess whether the protective effect of MMR/MMRV could wane with time since immunisation.

Oops! Seriously, don’t cherry pick the version of the review that you want to use to make your point. I will point out what you’ve done.

Cassels’ article is just another indication of how far down the antivaccine rabbit hole the Brownstone Institute has gone. It started out just being antivax with respect to COVID-19 vaccines, but, as I predicted (and as was always going to be the case eventually), it’s become increasingly radical, more generally antivax. In this case, it’s just providing a platform for someone like Cassels to regurgitate a bunch of old antivax misinformation, disinformation, conspiracy theories, and lies about the MMR vaccine, in particular the claim that measles isn’t dangerous, that because of that health authorities are therefore overreacting to measles outbreaks, and that “natural immunity” is better. While it’s true that neither Cassels nor Brownstone Institute has—yet!—repeated the central lie of the 21st century antivaccine movement, namely the lie started by Andrew Wakefield (a lie later generalized to all vaccines) that MMR vaccines cause autism, I expect that either Cassels or another Brownstone Institute flack will get around to doing so sooner or later.

Probably sooner. Oh wait…