Articles

Deadly Choices about vaccination

appThe year 2011 is starting out rather promisingly, at least from the point of view of science-based medicine. Its beginning coincides with the release of two — count ‘em, two! — books taking a skeptical, science-based look at vaccines and, in particular, the anti-vaccine movement. First off the mark is a new book by a man whom the anti-vaccine movement views as the Dark Lord of Vaccination, sitting up in Barad-dûr (apparently the University of Pennsylvania and Children’s Hospital of Philadelphia), a man utterly reviled by anti-vaccine quacks everywhere, Dr. Paul Offit. He has been subjected to considerable bile and harassment due to his simply standing up for the science behind vaccines. The book is entitled, appropriately enough, Deadly Choices: How the Anti-vaccine Movement Threatens Us All. Also being released is a new book by Seth Mnookin entitled The Panic Virus: A True Story of Medicine, Science, and Fear. Mnookin is a contributing editor at Vanity Fair and whose work has appeared in numerous publications. Because I got a copy of Deadly Choices before my copy of The Panic Virus arrived, I decided to review Deadly Choices first; after I’ve managed to read The Panic Virus, I’ll write a review of it as well. Both books are arrows shot at the heart of the pseudoscience and fear at the heart of the vaccine manufactroversy, and it might well be useful to compare and contrast the two once I’ve finished The Panic Virus.

In the meantime, let’s take a look at Deadly Choices, an excellent, well-researched book with which I have relatively few disagreements. It is a followup to Dr. Offit’s last book, Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure, which I reviewed back when it first came out. In contrast to Autism’s False Prophets, which concentrated primarily on the manufactroversy that claims that vaccines are responsible for the “autism epidemic,” Deadly Choices steps back to take a broader look at the anti-vaccine movement. Regular readers of SBM hardly need to be reminded how pervasive and dangerous the modern-day anti-vaccine movement has become. Indeed, it is a frequently discussed theme of this blog, given that the anti-vaccine movement is such a major force among the forces that deny the efficacy of scientific medicine and seek either to replace it with unscientific or pseudoscientific “alternatives” or to “integrate” pseudoscience into science-based medicine. Indeed, anti-vaccine sentiment infuses large swaths of what we refer to as “complementary and alternative medicine” (CAM), be it chiropractic, homeopathy, traditional Chinese medicine, or a wide variety of other modalities and systems.

In examining the modern anti-vaccine movement, Dr. Offit structures his book into three major sections. First, beginning in a chapter entitled The Birth of Fear, Dr. Offit begins with a description of the birth of the modern anti-vaccine movement, which in the U.S. Dr. Offit traces, in large part, to the broadcast of an irresponsible and anecdote-driven news documentary about the diptheria-pertussis-tetanus (DPT) vaccine in 1982, and in the U.K. to a scare about the DPT triggered by a presentation by Dr. John Wilson to the Royal Society of Medicine about horrific complications thought to be due to the pertussis vaccine in the DPT. Next, Dr. Offit goes back into history to describe the development of the anti-vaccine movement in the 1800s in England and notes parallels with the modern day anti-vaccine movement. Finally, the story shifts back to today, where he describes the situation now, how demands for vaccines turned into fear of vaccines, and what we might do about it.

1982: The birth of fear

Dr. Offit’s telling of the tale of how 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. This irresponsible bit of muck-raking used the very same technique that anti-vaccine activists have used since the very beginning. Indeed, a passage from Deadly Choices give you a flavor of how this documentary presented anecdotes designed to support the documentary’s thesis that the whole cell pertussis vaccine in use at the time resulted in brain injury:

POLLY GAUGERT, AGE 7, REACTION: FEVER, UNCONTROLLED SEIZURES, BRAIN DAMAGE. “I said that maybe she should not have had this shot because it seems to me that she was not quite herself,” recalled Polly’s mother. “And [the doctor] checked her all over and he said, ‘She looks okay to me,’ and then he gave her the shot. And the next morning when I was feeding her she went into a grand mal seizure…I didn’t know what was happening. I thought she was dying in my arms.”

Note how it appears that there was something wrong with Polly before she was given her vaccine, but this anecdote was presented as though her seizures were definitely due to the DPT. It’s the classic fallacy of post hoc ergo propter hoc, namely the fallacy of assuming that because vaccination occurred before Polly had seizures then the vaccine must have caused the seizures. Sometimes a temporal relationship implies causation, often it does not. Multiple other anecdotes were presented in support of a story that claimed that physicians knew about the problems with the DPT and had tried to cover it up. Highly dubious physicians like Dr. Robert Mendelsohn, whom I first encountered when I was in medical school and a friend gave me a copy of Mendelsohn’s book, Confessions of a Medical Heretic, which I remember as primarily a jeremiad against modern medicine that mixed reasonable criticisms of how modern medicine operated with rants that represented surgeons as bloodthirsty butchers who didn’t care if operations were necessary or not but were greed-heads who just wanted to cut. He was particularly harsh on obstetricians and gynecologists, whom he characterized as sacrificing women on the altar of surgery during childbirth. Not surprisingly, it turns out that Dr. Mendelsohn is anti-vaccine to the core, stating baldly that “while the myriad short-term hazards of most immunizations are known (but rarely explained), no one knows the long term consequences of injecting foreign proteins into the body of your child” and that “there is growing suspicion that immunization against relatively harm-less childhood diseases may be responsible for the dramatic increase in auto-immune diseases since mass inoculations were introduced.”

This birth of fear didn’t happen just because of one bad documentary. In describing how the anti-vaccine movement was reborn in the U.S. in the 1980s, Dr. Offit uses a slightly less explicit version of a technique he used in Autism’s False Prophets, wherein he describes the evidence for a link between the whole cell pertussis vaccine and neurological damage. In Autism’s False Prophets, Dr. Offit listed a panoply of studies that appeared to indict mercury in the thimerosal preservative used in vaccines in the U.S. before 2001 as a cause or contributor to autism in such a way that evidence for a link seemed persuasive, only to be followed by a chapter deconstructing that evidence and showing why it was not scientifically sound or convincing at all. For instance, he describes a very influential study that was released in the early 1980s by Dr. David Miller, a professor of community medicine at the Central Middlesex Hospital in London, that seemed to show a very strong link between DPT vaccination and seizures and other neurological problems. I must admit, at that point, early in the book, the evidence sounded convincing to me. Dr. Offit then followed up the description of this study with a listing of studies that failed to find any link between DPT and neurological injury or dysfunction, as well as a highly revealing description of how Miller, in bending over backwards to deflect any criticism that he was downplaying a potential link between his DPT and neurological injury, actually had inadvertently rigged his study to vastly overstate the rate of neurological injury and set it up to find massive false positives. This was more subtly done in Deadly Choices than in Autism’s False Prophets, and this is to the good, because it gives insight how, in the 15-year period during which followup studies to Miller’s were being done, there was real doubt over whether DPT caused neurological injury in some children.

It turns out, however, that the reason DPT: Vaccine Roulette takes such a prominent place in Deadly Choices is because it galvanized people who were either anti-vaccine or who were just suspicious of vaccines, among them a player whom we’ve discussed on multiple times before, namely Barbara Loe Fisher, co-founder and current president of the anti-vaccine group the National Vaccine Information Center. I’ve discussed Barbara Loe Fisher and the NVIC on multiple occasions before. Before the rise of Generation Rescue and Jenny McCarthy, Fisher’s group was the undisputed champion of anti-vaccine movements. Charismatic and media-savvy, Fisher became the go-to woman for any story about vaccines. She even managed to infiltrate herself onto the Vaccines and Related Biological Products Advisory Committee of the Food and Drug Administration, a position she held from 1999 to 2003. (Today, she sits on the Vaccine Safety Writing Group, National Vaccine Advisory Committee, U.S. Department of Health & Human Services.) Yes, Barbara Loe Fisher sits on the committee that decides which vaccines will be recommended for children. Fisher is a bit of an odd bird in that she played a major role in promoting and passing the legislation that formed the National Vaccine Injury Compensation Program, which, as Dr. Offit describes, arguably saved the vaccine program in the U.S. Before the VICP, vaccine manufacturers were abandoning vaccines in droves due to a tsunami of lawsuits. After the VICP, the federal government assumed first liability for vaccine injuries and created a relatively low threshold standard for compensating health problems attributed to vaccines. Fortunately, as Offit describes, its standards aren’t completely uncritical, as is best demonstrated by the failure of the Autism Omnibus. (I’ve written about the Autism Omnibus in detail.)

Perhaps the most devastating argument Dr. Offit uses against Barbara Loe Fisher and the anti-vaccine movement in general is to dismantle their claim that they are not “anti-vaccine,” but rather pro-safe vaccine. Barbara Loe Fisher was on an important FDA advisory committee for nearly five years and has been a prominent presence in the press whenever stories about vaccines occur since 1982. During that time, Dr. Offit observes, she has never spoken out in favor of a single new vaccine. Not one. The haemophilus influenza type B (Hib) vaccine, a vaccine that has saved thousands of lives over the last two decades since it was introduced by preventing huge numbers of cases of Hib meningitis and other complications, reducing the incidence of a disease that was, when I was in medical school, one of the most feared scourges of young children? She opposed it. Hepatitis B vaccine? Fisher opposed it, promoting dubious science, since refuted, that the vaccine caused multiple sclerosis. After joining the Vaccines and Related Biological Products Advisory Committee, Fisher’s very first vote was to oppose the introduction of the pneumococcal vaccine, which was ultimately approved by a vote of 11-1. She also, not surprisingly, opposed the introduction of the HPV vaccine. All the while, Fisher wrote about how she thought vaccines caused immune problems, neurological problems, and all manner of chronic health issues while decrying the concept of herd immunity and claiming that “natural” infections are better than vaccination. Dr. Offit then contrasts Fisher with a man named John Salomone, who identified a real problem with U.S. vaccination policy (the use of the oral polio vaccination, which, because it consisted of a weakened version of the polio virus, could on rare occasions reconstitute itself into a fully functional polio virus and thus cause polio) and advocated for a change to the inactivated polio vaccine. While Fisher did little but rail against doctors, label all vaccines as dangerous, equate physicians who opposed her to Nazi doctors, and try her best to prevent any new vaccines from being approved, Salomone brought about real improvement in how we vaccinate.

Offit is correct that real vaccine safety advocates work for changes that will bring about real improvements in vaccine safety. Anti-vaccine advocates work to label all vaccines as risky and to prevent as much vaccination as possible.

History

Noting that the “past is prologue” in a chapter, Dr. Offit next moves on to a discussion of the history of the anti-vaccine movement. While I think I understand why he chose to present the issue the way he did, I was disappointed in that he in essence traced the development of the first anti-vaccine movement to the middle of the 19th century in England, when in fact anti-vaccine movements sprung up far earlier. To read Offit in this respect, I got little sense of how the anti-vaccine movement of the mid-19th century was a direct descendent of the anti-variolation movements that had sprung up a century earlier. Arthur Allen included in his book Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver, a particularly good discussion of how anti-variolation activism ran rampant in Boston in 1721. There and then, Cotton Mather and a physician named Zabdiel Boylston were pilloried in the press and popular opinion for their promotion of variolation, a much less safe precursor to Edward Jenner’s cowpox vaccination in which smallpox puss was inoculated into the skin with a needle, resulting in a mild case of smallpox that would ultimately confer immunity. Ironically, Benjamin Franklin, who was 16 at the time and would later become a champion of variolation in Philadelphia, was part of the press that attacked Mather and Boylston.

Be that as it may, I’m sure the reason that Dr. Offit chose to place the origin of the anti-vaccine movement in the 1800s was because it is a cautionary tale of how government policy can inadvertently backfire. Although it’s not new news, in the context of tracing the origins of the modern anti-vaccine movement Dr. Offit convincingly demonstrates that one of the consequences of the Vaccination Act of 1853, which made vaccination against smallpox mandatory for infants. In 1867, 1871, and 1873, followup acts were passed that made vaccination compulsory. During this same time period, resistance to vaccination increased, with rallies, protests, and increasing civil disobedience.

In contrast, Dr. Offit convincingly argues that mandatory vaccination, which is what we have in the U.S., is far more effective. Mandatory, in contrast to compulsory vaccination, requires vaccination as a precondition for using certain public services, specifically the public schools. The message is that you don’t have to vaccinate you kids if you really don’t want to. No one from the government is going to come around and fine you or force you to vaccinate them, as what happened in England in the middle and latter parts of the 19th century. However, if you don’t vaccinate there’s a price to pay. If you don’t vaccinate, your kids can’t go to public school because they would then have the potential to bring disease there and serve as the nidus for epidemics. Since that policy was instituted, vaccination rates in the U.S. has skyrocketed. In contrast, Dr. Offit points out that the proliferation of religious and philosophical exemptions is threatening our high levels of vaccination. He also points out (and I agree) that these exemptions are unlikely to be rolled back, using as his justification the argument that the law has a hard time touching faith healers and parents who choose prayer instead of effective medicine for their children, even when children die as a result. Unfortunately, I have a hard time arguing with Dr. Offit here. I also have a fairly hard time arguing too strongly against religious exemptions, given the primacy of the First Amendment. Philosophical exemptions, on the other hand, should be eliminated or made much harder to obtain.

Perhaps the most persuasive part of this section is a description of the parallels between the anti-vaccine movement of the mid- to late 1800s and the anti-vaccine movement of today, which include the recurring themes and tactics of:

  1. Doctors are evil
  2. Public rallies
  3. Paranoia
  4. False claims of vaccine harm
  5. The claim that vaccines are somehow “unnatural”
  6. Rejection of the germ theory of infectious disease
  7. The lure of alternative medicine
  8. Fear of Science
  9. The argument that vaccines are an act against God
  10. Mass marketing

There are also some interesting contrasts, too. For instance, in the 1800s, anti-vaccine activism tended to occur among the poor and the working class, mainly because compulsory vaccination laws were explicitly targeted at the poor. In contrast, today the anti-vaccine movement is primarily a product of educated, affluent people living in highly affluent neighborhoods. Even so, the sameness of the arguments used 150 years ago with those used today is striking.

What to do?

Dr. Offit finishes with a discussion of the state of the anti-vaccine movement now. Included are deservedly unflattering portrayals of the usual suspects, including Jenny McCarthy and Jim Carrey, J.B. Handley, Bill Maher, and the organizations involved in promoting anti-vaccine views, such as Generation Rescue. He also points out how a new element has entered the anti-vaccine repertoire, namely personal intimidation, an art at which J.B. Handley has demonstrated his skill through his misogynistic attacks on Amy Wallace and his tendency to try to threaten and bully journalists who have the temerity to criticize him or the anti-vaccine movement. (I myself have fallen victim to this sort of intimidation.)

Ironically enough, this sort of personal opprobrium against Dr. Offit has continued, as the anti-vaccine blog Age of Autism, which is in essence Generation Rescue’s propaganda arm, gave Dr. Offit an “award”: Age of Autism Awards 2010: Dr. Paul Offit, Denialist of the Decade. This appears to be a relatively new talking point among the anti-vaccine set. Stung by being lumped in with evolution denialists, anthropogenic global warming denialists, not to mention quacks and “alternative medicine” advocates (denialists of science-based medicine), apparently anti-vaccine activists have decided that they’ll try to appropriate the term “denialist” by referring to those who refute their pseudoscientific nonsense as “vaccine safety denialists” or some similar term.

Perhaps the most useful chapter in the entire book is Dr. Offit’s chapter analyzing the claims of Dr. Bob Sears, whose “alternate vaccine schedule” has tortured pediatricians everywhere, with its “spreading out” of vaccines and Sears’ recommendation to exclude certain vaccines as not sufficiently safe. Dr. Offit has taken on Dr. Sears before, as has our very own Dr. John Snyder. In any case, Dr Offit makes the convincing case that “Dr. Bob,” if not a full-fledged anti-vaccinationist, is at the very least an anti-vaccine sympathizer, given that he regurgitates these anti-vaccine talking points, all of which are exaggerated or false:

  • Vaccines have a high rate of serious side effects.
  • Vaccine-preventable diseases aren’t that bad.
  • Vaccines contain dangerous ingredients. (Yes, it’s the dreaded “toxins” gambit!)

As an added bonus, Dr. Offit spends a bit of time taking on Dr. Mehmet Oz’s misstatements about vaccines and a lot more time indulging in a richly deserved skewering of Dr. Bernadine Healy, former director of the NIH, who was named Age of Autism’s Person of the Year in 2008 and has put herself back in the news by “questioning” the current vaccine schedule using talking points cribbed from the anti-vaccine movement.

In the final chapter, Dr. Offit correctly identifies the problem as a lack of trust between parents and health officials, pointing out that it’s easy to come up with conspiracy theories about, for example, pharmaceutical companies because they are to most people faceless institutions with profits as their primary motive. To try to combat this impression, he introduces us to scientists from Merck who work on vaccines, their dedication, and their passion. That’s good. What’s not so good is that Dr. Offit fails to acknowledge adequately that there is good reason why many people distrust pharmaceutical companies. We’ve written about some of those very reasons myself, including pharma ghostwriting, seeding trials, and conflicts of interest. Let’s just put it this way. I like Dr. Offit, and I wanted to like this book, but even to me this argument fell flat because it more or less dismissed the contention that not all distrust of pharmaceutical companies is unreasonable or overblown. Far better is his pointing out that parents whose children have been injured or killed by vaccine-preventable diseases represent an underutilized resource for countering the misinformation of the anti-vaccine movement.

Finally, one other problem with the book that I had is that Andrew Wakefield is only mentioned relatively briefly when arguably he should have a whole chapter devoted to him, given his extreme prominence in the anti-vaccine movement and how much damage his shoddy, litigation-funded science did to herd immunity in the U.K. True, Wakefield featured prominently in Autism’s False Prophets, but that does not justify giving him such short shrift in Deadly Choices. He is simply too seminal a figure in the anti-vaccine movement of the last 12 years. As far as I’m concerned, it can’t be repeated enough times just how badly Wakefield violated medical ethics and utterly and thoroughly discredited his work is.

Those complaints aside, though, Deadly Choices is a timely and important book that serves to counter the misinformation promulgated by the anti-vaccine movement. In particular, Dr. Offit writes:

…far from being unwilling to study whether parents’ concerns about mercury were real, public health officials and academic investigators had performed many studies to determine whether mercury in vaccines caused autism or other problems. It didn’t. And those studies cost tens of millions of dollars to perform.

The same statement could apply to all the studies of the MMR vaccine and autism as well. In fact, the same could be said of all the research inspired by fears stoked by the anti-vaccine movement. More’s the pity, and Dr. Offit’s book reminds us just how much time, effort, and money have been wasted chasing fanciful hypotheses of vaccine injury, thanks to the anti-vaccine movement. Relatively minor deficiencies aside, it’s a primer on the anti-vaccine movement that I heartily recommend to SBM readers.

Posted in: Book & movie reviews, Vaccines

Leave a Comment (18) ↓

18 thoughts on “Deadly Choices about vaccination

  1. crich83 says:

    I was on my way to Amazon to see when Offit’s new book was scheduled to be released. I had thought it was being released sometime in 2011. Good to know its already out in stores, will have to purchase tomorrow.

  2. Catherina says:

    I am sure it is an evil anti-vaccine plot that made Amazon.co.uk push back the release date for Deadly Choices to March 17. Pout.

  3. desta says:

    My only gripe with these skeptical books is the way they are titled. They are provocative, but perhaps so much so that it may end up just being a ‘preaching to the choir’ event.

    I need more skeptical books with stealthier titles so that I can give them to parents I know who are on the fence or leaning anti-vax. As it is written (correct though I believe it to be), I can see parents on the fence or leaning anti-vax being turned off by what may strike them as a polemical book.

    In the end, then, I’ll end up reading it, and sharing with some fellow skeptics, but I don’t need any more convincing, you know?

  4. S.C. former shruggie says:

    There’s something to that, desta. That said, I’ve seen people on the bus reading books debunking a plethora of fad diets and diet hoaxes to try the hoax diets listed therein.

    Some fence-sitters aren’t real fence-sitters, sadly, they’re concern trolls trolling real life. Then there are people like me who get right suckered by multiple woos but eventually do get around to checking the evidence and quickly sort it out.

    It’s up to people to decide whether they’ll hear evidence contrary to what friends, family or favourite celebrities have encouraged them to think, or shut it out. Not much you can do about that.

  5. Scott says:

    @ desta:

    In this particular case, I disagree. The point can’t be made strongly enough that not vaccinating a child is playing Russian Roulette with their health. It IS dangerous, and that’s the central point we need to be getting across.

    Sometimes it’s called fear-mongering, but when the risk is real, it’s just education.

  6. desta “I need more skeptical books with stealthier titles so that I can give them to parents I know who are on the fence or leaning anti-vax. As it is written (correct though I believe it to be), I can see parents on the fence or leaning anti-vax being turned off by what may strike them as a polemical book.”

    I actually really like the title, thought it was assertive and “tell it like it is”, but upon reflection, I have to agree with your point. I don’t think I’d give it to a friend on the fence or leaning anti-vax…like you said. Be nice to have something a little more warm and cozy, attachment parenty for those folks.

  7. desta says:

    Scott said
    “The point can’t be made strongly enough that not vaccinating a child is playing Russian Roulette with their health. It IS dangerous, and that’s the central point we need to be getting across.

    Sometimes it’s called fear-mongering, but when the risk is real, it’s just education.”

    Oh, I completely agree with the message of the title. I don’t think anything in the title is over stated.
    And I often find myself unable to tolerate much less couch my objection to pseudoscience claims in more friendly terms. But I’m also assuming I’m not the target audience.

    However, I doubt that any of the borderline antivax folks I know would read it, though I do think a title/message that sounded a little more formal would possibly crack a door open just a tiny bit.

    It seems that most people I know with some antivax or other pseudoscience leanings can think rationally about many aspects of life, with a few (possibly dangerous) exceptions. Nevertheless, none of them have changed their minds from my eye rolling and screaming ‘shenanigans’ about their goofier ideas.
    All of them think of themselves as critical thinkers who are considering evidence.

    It seems that some of them default to the uncritical position out of fear (especially with vaccines), and I don’t know how productive it is to fight fear with fear, at least in the labeling.

    For example, pretend the universe is inside out, and Glenn Beck is right about everything. Regardless, there is no way I would bother buying a book with the title ‘It Turns Out Glenn Beck Knows All.’

    Then again, I have no idea what behavioral research says on this topic. Does it help to fight fear with fear in advertising? Someone must have looked at this already.

  8. Davdoodles says:

    I see the usual pro-epidemic cranks have shown up at Amazon to regurgitate their ad hominem nonsense about Dr Offit.

    Ten Bazillion Innoculations in one 20 gallon syringe!

    My favorite, entitled, surprisingly truthfully “Unscientific Pseudoscience – Manipulation of Statistics”, begins:

    “Without vaccines children get sick and recover with life long immunity. With vaccines they (1 in 107) can become permanently disabled and are not necessarily immune… AUTISM: Incidence was 1 in 100,000 now it is 1 in 107. The number of vaccination injected into children and the incidence of Autism have a direct correlation. More vaccines = More Autism.”

    And continues grindingly, in that vein (“Vaccines contain DNA of animals, plants, viruses, and bacteria…” Zzzzzzz zzzz.

    Finally, by way of conclusion, or possibly excuse: “I am retried from radiology.”

    Indeed.
    .

  9. Chris says:

    Davdoodles, I have been there. It was interesting how the tone mostly changed for a little when someone with the same first name as me replied to the charge that “you don’t know what it is like to have a disabled child” with “yes, but my kid was disabled by an actual disease.”

    Also, don’t you love the former registered nurse, Nakken? Oh, yeah… she never saw a kid die from measles. Funny, Dr. Offit saw more than one since he was in Philadelphia when almost half a dozen children from a pair of anti-medicine churches died of measles in the 1990 measles epidemic.

  10. We might assume that the default position is to be pro-vaccine (safe, effective and rational) but in fact it’s not. The default position is, “If it ain’t broke, don’t fix it.” A healthy child ain’t broke.

    Since, as David Gorski points out, pharmaceutical corporations *are* motivated by self-interest, any rational person takes what they say with a grain of salt. This is healthy skepticism.

    Getting from these very sensible starting points to accepting multiple (profitable to pharmaceutical corporations) inoculations of healthy children against diseases that nobody we know has (or if they did, they weren’t obviously harmed by them)… well, that’s not obvious. Rational perhaps, but it goes against common sense all the same.

    Yes, it’s essential to identify when individuals and organizations are creating unwarranted fear. If I discover that someone is lying to me I’m likely to reject the agenda they are promoting.

    I think it’s also important to recognize that there will always be skepticism about the necessity of vaccines that will always lie ready to be exploited by fear-mongers.

    What is the difference between people who overcome common sense to accept vaccination, and people who don’t? Is it that the former have the imagination to fear diseases they don’t know, whereas the latter only fear what they can see — that is, the needle? Perhaps the former have faith that technology can make our lives better and want to get the best of everything for their children, whereas the latter are more DIY? I’m sure this has been a heavily targeted area of research. Do we know what it says?

  11. weing says:

    “What is the difference between people who overcome common sense to accept vaccination, and people who don’t?”

    Frankly, I see it the other way around. I think it’s just entropy in action. The environment changes and some diseases come by and remove some of us from the gene pool. If you are vaccinated, you remain in the gene pool.

  12. ConspicuousCarl says:

    # Alison Cummins on 04 Jan 2011
    at 10 :27 am
    Since , as David Gorski points out ,
    pharmaceutical corporations * are *
    motivated by self -interest, any rational
    person takes what they say with a
    grain of salt . This is healthy
    skepticism .

    Yeah, but everyone involved in any issue is trying to sell a drug, sell a book, keep their job as a spokesperson, or maybe just avoid admitting that they were wrong at dinner last week, so the appeal to skepticism in the face of self interest is sharp on all edges.

  13. ConspicuousCarl,

    Financial (or other) self-interest can never be a reason to discard something entirely. (More pithy common-sense: Even a stopped clock is right twice a day.) But it’s a reason to reserve judgement until you get more information.

  14. tmac57 says:

    According to this article in the Infectious Disease News on Dec. 1 2010, the bigger issues may be low rates of vaccination for adults,as the rates for children remain high.

  15. Paddy says:

    @Alison Cummins,

    Vaccines provide a very small share of pharmaceutical companies’ income, so the motivation to risk their reputation by fraudulently skewing the data is slight.

    Vaccine denial is a career choice for many spokespeople of vaccine denial, so the motivation to skew the data is huge.

    As for communicable diseases being a “nebulous” threat… what do you find so vague about the danger they pose? The biology, and risks, of what they do, and how, is often pretty well worked out. Take the three diseases protected against by the much-maligned MMR jab, for instance; their major risks include the following:

    Measles Complication Rates (per case of measles):
    Pneumonia: 6 in 100
    Encephalitis: 1 in 1,000
    Death: 2 in 1,000

    Rubella Complication Rates (per case of rubella):
    Congenital Rubella Syndrome: 1 in 4 (if woman becomes infected early in pregnancy)

    Mumps Complication Rates (per case of mumps):
    Testicular atrophy: 1 in 7 in men
    Miscarriage: 1 in 4 in the first trimester
    Meningitis: 1 in 10

    On the other hand, consider the actually observed risks of MMR, after decades of its application and observations:

    MMR Complication Rates (per injection given):
    Encephalitis or severe allergic reaction: 1 in 1,000,000

    The “default” choice of any parent should be to protect their child, and in this case, MMR provides a very necessary degree of protection.

    Refs:
    http://www.cdc.gov/vaccines/vac-gen/6mishome.htm#risk
    http://www.mja.com.au/public/issues/189_08_201008/sen10220_fm.html

  16. ConspicuousCarl says:

    tmac57on 04 Jan 2011 at 9:24 pm

    According to this article in the Infectious Disease News on Dec. 1 2010, the bigger issues may be low rates of vaccination for adults,as the rates for children remain high.

    Something annoying I noticed when reading about the recent increases in pertussis (which requires several shots for the best immunity) is that the fine print on vaccination statistics sometimes says “received at least 1 shot”. I don’t know enough about it to be sure if that matters, but it is really easy for a layman like me to wonder if a 95% vaccination rate for pertussis isn’t hiding an important detail like parents getting their kids the first round and being counted, and then slacking off when rounds 2 and 3 are due.

  17. Paddy,

    Sorry I wasn’t clear. My point is not that vaccination is not supported (it certainly is, by science) but that unless you are familiar with the science it’s not at all obvious. As most people are not familiar with the science they are vulnerable to anti-vax ideas.

    You cite complication rates for infectious diseases, but most people today have never known anyone who had measles and this remains abstract, something that happens to other people, people not like them. On the other hand, injecting a foreign substance into your beautiful, perfect baby is counterintuitive. I’m actually impressed that so many people do accept the science. Even though I accept the science I’m not particularly surprised when others don’t.

  18. Paddy says:

    Alison,

    Sorry for misunderstanding your position. All the best,

    Paddy

Comments are closed.