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Journal Club Debunks Anti-Vaccine Myths

American Family Physician, the journal of the American Academy of Family Physicians, has a feature called AFP Journal Club, where physicians analyze a journal article that either involves a hot topic affecting family physicians or busts a commonly held medical myth. In the September 15, 2010 issue they discussed “Vaccines and autism: a tale of shifting hypotheses,” by Gerber and Offit, published in Clinical Infectious Diseases in 2009.  

The article presented convincing evidence to debunk 3 myths:

  1. MMR causes autism.
  2. Thimerosal (mercury) causes autism.
  3. Simultaneous administration of multiple vaccines overwhelms and weakens the immune system, triggering autism in a susceptible host.

Gerber and Offit reviewed 13 large-scale studies that demonstrated no association between the MMR vaccine and autism. These included ecologic studies, retrospective observational studies and prospective observational studies.  The findings were consistent; the only outlier in all the studies of MMR was Dr. Andrew Wakefield’s small, discredited 1998 study, which was fully retracted by The Lancet in early 2010.

They reviewed 7 large-scale studies (again, ecologic, retrospective, and prospective) that consistently demonstrated no association between thimerosal and autism. They showed that the hypothesis was not biologically plausible, since the symptoms of mercury poisoning are distinct from those of autism and are not produced by the thimerosal in vaccines.

They showed that the overload hypothesis is not credible because

  1. The immunologic load has dropped from 3000 components in the 7 vaccines used in 1980 to less than 200 in the 14 vaccines recommended today.
  2. An infant’s immune system is capable of handling the thousands of antigens it is exposed to early in life.
  3. Vaccinated children are not more susceptible to infections.
  4. Autism is not an autoimmune disease.

The discussants ask “Should we believe this study?” and their answer is a resounding “yes.” They say “This month’s article clearly provides the science and statistics to dispel the theory that childhood vaccinations induce autism. A Cochrane review came to the same conclusion in October 2005.”

They ask “What should the family physician do?” They point to evidence that information and assurance provided by health care professionals can make a difference. They even suggest that physicians get a copy of the Gerber/Offit article and keep it handy for when parents are apprehensive about immunizing their child.

The Journal Club doctors evaluated the evidence rationally and accepted the logical conclusions. The anti-vaccine activists didn’t: instead, they have endangered our public health by rejecting or postponing immunizations and repeating myths. Shame on them!

Posted in: Vaccines

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76 thoughts on “Journal Club Debunks Anti-Vaccine Myths

  1. desta says:

    This is a good article to share with any parent.
    I’ve been looking for something short, formal, and non snarky (I love the snark, but I don’t think it changes minds) to help persuade the nervous parents I encounter from time to time.

    Thanks for the link.

  2. windriven says:

    So Dr. Hall, what is it that makes vaccine avoiders tick? It is clear that science won’t convince them.

    One presumes that the ultimate goal is to convince the luddites that universal vaccination is in everyone’s interest. But somewhere in their minds the calculation is that their interests or their children’s interests are better served by not vaccinating.

    Do they really believe, in the face of all evidence to the contrary, that vaccines cause autism? That is almost impossible to believe unless their only sources of information are Oprah and The View. This seems unlikely as at least some of the antivaxers are educated people.

    Have we as scientists done such a poor job demonstrating the superiority of science and technology over fear and superstition that people simply don’t believe the scientific evidence?

    Or is it more visceral? In trying to understand trolls like Th1Th2 it occurs to me that her fear may be the fear of a B-rated horror flick: the fear of some evil unseen presence infiltrating the pure and perfect bodies of her children. The idea of willingly injecting them with this evil spawn is repulsive. The other side of that coin seems to be the belief that truly caring mothers can protect their babies through sheer force of love.

    I don’t claim to know what actually keeps the antivaxers on the wrong side of the equation but it is certainly worth some effort to find out.

  3. DTR says:

    I agree that this is an excellent and necessary review of the research, and I agree with desta that “short, formal, and non snarky” is required to convince those parents who are nervous about vaccines but not ideologically anti-vaccine. The one drawback I see to the article is the involvement of Dr. Offit as co-author. To many anti-vaccine ideologs, a review written by “Dr. Proffit,” Satan-incarnate, is sufficient evidence to dismiss it. Perhaps these are people who would not be convinced by any evidence whatsoever unless presented by guys with names like Sears, Gordon, or Mercola, but, as mentioned under “Blog discussion with an SBM critic,” we need to be aware of how anti-vaccine ideologs will interpret/misinterpret the evidence we present.

  4. Myriam says:

    These three “myths” of your own…you mentionned here are not mine but I do not believe in massive vaccination !

    And like I did not have my kiks vaccinate this makes facts proving to myself that the only kids who had some serious contagious sickness while it was epidemics at school WAS ALL vaccinated instead of those not vaccinated were not contaminated !

    What about scientific based medecines ?

  5. DTR says:

    @windriven:
    Yes, we have done a poor job demonstrating the superiority of science and technology over fear and superstition. This is a
    huge failing of the scientific community. In fairness, the deck is somewhat stacked against us. It’s much easier for a Sears to say “there’s no proof that vaccines don’t cause autism” than it is for a scientist to say “the evidence to date does not support a connection between vaccines and autism”. This is difficult for the nervous parent mentioned by desta to accept when what they want to hear from their doctor is, “this vaccine is 100% safe.”

    A question my wife often asks our kid’s doctor in these situations is, “what have you done with your kids?” Desta, perhaps this is an approach you could take with nervous parents (assuming you are a pediatrician).

    Back to the original point about the failure of scientists to convince the public. How do we do a better job on the “public relations” front? One idea is to take the fight onto enemy territory – live debates on Oprah, The View, The Doctors. As much as we scientists revile the debate format, the reality is that’s where our audience is – nervous yet non-ideological parents. Not to hijack the thread, but I’d like to hear other ideas from anyone (except Th1Th2).

  6. windriven says:

    @DTR

    “The one drawback I see to the article is the involvement of Dr. Offit as co-author. To many anti-vaccine ideologs,…”

    Do you believe that anti-vaccine ideologues would have been swayed if the article had been co-authored by Jonas Salk or Alton Ochsner?

  7. Watcher says:

    Heck no. But i might start to question it’s authenticity if it did :)

  8. CAyson says:

    I think a big factor is that it frequently becomes an issue of “us” vs. “them” where “them” is the collective healthcare industry, akin to any other massively structured organization that is perceived to have powerful, self-serving individuals driving its core.

    Anti-vaccine advocates are the equivalent of government conspiracy theorists. Consider what happens when you ask an anti-vaccine advocate, “If vaccines are so dangerous, why is there such a strong push to get everyone vaccinated?”

    The Catch-22 is that all the evidence proving that vaccines are not linked to autism, etc. etc. comes from the healthcare industry itself. It’s difficult to convince anyone of anything when they think you’re lying. Of course, it’s impossible for the layman to try and find the answer for themselves.

  9. This is a wonderful article to be in AFP. Too often we forget the disconnect between the (real) science and many Doctors working on the front line.

    (Anecdote Alert) I recently spent time with a number of family docs at a conference and of the 7 I spoke with, only 1 was aware of the recent happenings with Andrew Wakefield/his study (6 of them suggested that there MIGHT be some truth behind the vaccine/autism claim – thankfully all 6 still suggested that the risk was far less than the threat of the illnesses ‘we’ are vaccinating against).

    (In other words, DTR, I wonder the same thing – ‘how do we do a better job on the “public relations” front?’)

  10. DTR on stacked decks: “It’s much easier for a Sears to say “there’s no proof that vaccines don’t cause autism” than it is for a scientist to say “the evidence to date does not support a connection between vaccines and autism”. This is difficult for the nervous parent mentioned by desta to accept when what they want to hear from their doctor is, “this vaccine is 100% safe.””

    It’s not that hard. “The evidence to date does not support a connection between vaccines and autism” doesn’t say anything at all. It really doesn’t. There’s nothing in that statement that says anyone has looked for the evidence, so saying that none has been found is meaningless.

    A more meaningful statement would be something like, “Kids’ health is really important to all of us, and especially to parents who need to make decisions on behalf of their children. That is why so many different teams around the world have invested huge amounts of money and time looking hard for possible problems. With all this investment, this is what they have found and this is what they have not found.” That’s more informative and therefore more convincing.

  11. DTR says:

    windriven: Do you believe that anti-vaccine ideologues would have been swayed if the article had been co-authored by Jonas Salk or Alton Ochsner?

    No, I don’t believe that. Consider a hypothetical news story wherein Dr. Offit is referred to as a “controversial vaccine researcher” and Dr. Sears, quoted to provide “false balance,” dismisses the study using the “pharma shill” gambit. I wasn’t able to find an actual news report along those lines, but it seems possible. My point is the nervous parent is not going to be reassured, even if the meat of the news report gets the Gerber/Offit article right.

  12. daedalus2u says:

    I think the reason that some parents of autistic children have latched onto the anti-vaccine idea is because of displacement of the feelings they have for their autistic child onto Big Pharma and vaccines.

    I discuss the physiology of this in my blog post on xenophobia. My hypothesis is that neurologically typical individuals tend to feel xenophobia toward people they cannot communicate “in sync” with via body language. Usually this exhibits as racism and other forms of bigotry. When the feelings of xenophobia are invoked by one’s own child, the parent cannot rationalize those feelings as being due to the child actually being “the other” as can be done with racism and other forms of bigotry. In times past children with parents who felt that way were considered to be changelings, non-human infants of identical appearance left by fairies while their “real” child was stolen. Of course if a parent couldn’t love their child the problem “had” to be with the child and not with the parent.

    I think what the anti-vaxers have done is displaced the hatred they feel toward their child onto something else, autism, Big Pharma, Paul Offit, Orac, vaccines, mercury, anything that provides a focus for their hatred and anger that is not their child, a scapegoat.

    In a sense this is actually good for the child and the parent, to a point. Hating the child is extremely damaging to the child. Displacing that hate onto something else does protect the child. It does not protect the parent, who still needs to come to terms with the actual cause of their feelings. To the extent that the objects of their hatred really are unavailable to injure, it is better to hate something that can’t be injured than to hate your child who is injured just by being not loved unconditionally.

    Scapegoats are only useful as a temporary crutch, to get the hater over the acute phase of hating while they come to terms with the root cause of their actual feelings. If someone is sufficiently rational, this will eventually happen. It is when it doesn’t happen that individuals degenerate into denialism and delusional thinking. Unfortunately there are any number of scam artists who are all too willing to feed on that anger, hatred, denialism and delusional thinking to get power, money and other things from those vulnerable individuals.

  13. DTR says:

    @Alison Cummins
    Your point is well taken, and the tone and substance of your more meaningful statement is exactly what the nervous parent needs to hear. But it also illustrates my “stacked deck” point perfectly: it is difficult and time consuming to convey a science-based argument, especially considering that your last line (this is what they’ve found and not found) leaves the bulk of the argument unsaid.

  14. Mojo says:

    American Family Physician, the journal of the American Academy of Family Physicians, has a feature called AFP Journal Club, where physicians analyze a journal article that either involves a hot topic affecting family physicians or busts a commonly held medical myth. In the September 15, 2010 issue they discussed “Vaccines and autism: a tale of shifting hypotheses,” by Gerber and Offit, published in Clinical Infectious Diseases in 2009.

    Is the Journal Club feature freely available anywhere online? That might be more persuasive to some antivaxxers than the article it discussed (excellent though the article is), for reasons mentioned above.

  15. Ian says:

    @DTR, windriven: The point of the article isn’t to convince ideologues, but to assure concerned parents.

  16. Harriet Hall says:

    “Is the Journal Club feature freely available anywhere online?”

    I think it is only available to AFP subscribers.

  17. Th1Th2 says:

    From the link it states:

    “even conservative estimates predict the capacity (of the newborns) to respond to thousands of vaccines simultaneously.”

    What are you waiting for? It’s time to join the Club of Nuts.
    http://www.facebook.com/pages/Id-pay-100-to-watch-Paul-Offit-get-10000-vaccines-at-once/114950415208947

  18. windriven says:

    @DTR

    We have differing diagnoses of the problem at hand. You see this as science v. woo. I don’t. At least I don’t for some set of anti-vaxers for whom I don’t think any exposition of science will be enough. I’m coming to believe that their response is entirely emotional. Consequently, I think the only way to sway them is through emotional appeals.

  19. Joe says:

    AFP access: “Online access to new issues is restricted to AAFP members and paid subscribers … The content of each issue is made freely available about one year after publication.”

  20. Dawn says:

    Oh, now that Th1Th2 has started cherry-picking, I WILL respond.

    Here’s the full quote (bolding mine):

    Vaccines do not overwhelm the immune system. Although the infant immune system is relatively naive, it is immediately capable of generating a vast array of protective
    responses; even conservative estimates predict the capacity
    to respond to thousands of vaccines simultaneously [30].
    Consistent with this theoretical exercise, combinations of
    vaccines induce immune responses comparable to those
    given individually
    [31].

    No one is saying that ANYONE should receive thousands of vaccines at one time. They are saying that the infant immune system can respond to and develop immune responses to the diseases the vaccines help prevent.

    Obviously, Th1Th2 is a concrete thinker and, like those – um – persons over at AOA, cannot deal with analogies (which I have noticed before, example the cars analogies used previously. Guess instead of a Mustang they should have used a Pinto.)

  21. Dawn says:

    I have no idea how my blockquote became italicized…

  22. DTR says:

    @windriven, Ian
    My concern is not for the idealogues. I agree that the true believers of any dogma cannot be swayed by evidence. My concern, rather, is for the concerned parent, who may be swayed by a propagandistic misinterpretation of the evidence. My point was only that Dr. Offit’s name on the article is fuel on the fire of that propaganda effort.

    “Consequently, I think the only way to sway them is through emotional appeals.” This sounds intriguing. What emotional appeals do you envision working to convince an anti-vax idealogue?

  23. Harriet Hall says:

    Examples of emotional appeals that might work:
    Videos of infants with pertussis struggling to catch their breath.
    Interviews of grief-stricken parents who have lost their child due to a vaccine-preventable illness.

  24. windriven says:

    @Harriet Hall

    Absolutely! I’ve seen the video of the child laboring to breathe. Anyone who can look at that and eschew vaccination for their child is built of stronger stuff than I am.

  25. vtmom says:

    PKIDs (Parents of Kids with Infectious Disease) has great videos available on a host of vaccine preventable diseases. Very emotional but with good info. http://pkids.org/im_videos.php.

  26. Enkidu says:

    Most of the anti-vaxers I’ve had conversations with are fearful of the “toxins” in the vaccines and their potential side-effects, autism being just one of many. I keep running into this argument: the CDC admits that side effects are vastly under-reported on VAERS, therefore, we cannot know the “true” risks vaccines pose to us. For example, if the CDC says that the chance of encephalitis is 1:1,000,000 from the MMR, anti-vaxers are suggesting that it is in reality much more common because they think of the CDC numbers as bad, low-ball guesses. They discount numbers from clinical trials because the sample sizes aren’t big enough (and they are run by big pharma!).

    It’s a frustrating, losing battle. I did once ask them that if the side-effects from vaccines are under-reported, would they also think that the side-effects from disease are under-reported? I really didn’t get an answer for that.

  27. Th1Th2 says:

    Dawn,

    “No one is saying that ANYONE should receive thousands of vaccines at one time. They are saying that the infant immune system can respond to and develop immune responses to the diseases the vaccines help prevent. ”

    Before you make that claim was there a newborn who had been given an obscene amount of vaccines and I mean a thousand times at once? (Y/N)

  28. windriven says:

    @ Chris

    Hear, hear!

    @ Dawn

    Is this the same Dawn who offered to smack me for responding to the Thing? Chris is right, talking to Thing is like talking to a brick only more frustrating. At least the brick has the sense to keep its mouth shut.

  29. Dawn says:

    @Windriven: yeah, you can smack me back. :)
    I just hate it when people cherry-pick evidence since they are obviously thinking no one will call them on it. I shouldn’t have. (goes to sit in the naughty corner).

    (stands up, shamefacedly)
    @Chris: yeah, I won’t respond to the concrete thinker who obviously can’t tell the difference between an analogy and an actual situation, and who obviously has NO idea about what a newborn is exposed to from birth on. (sits back down in the naughty corner)

  30. Calli Arcale says:

    windriven:

    Do they really believe, in the face of all evidence to the contrary, that vaccines cause autism? That is almost impossible to believe unless their only sources of information are Oprah and The View. This seems unlikely as at least some of the antivaxers are educated people.

    Education does not protect people from believing crazy things. Just look at the politicians for some rather high-profile examples.

    On a more down-to-earth level, I know college-educated people who think that NASA faked the Moon missions. I know college-educated people who believe the Constitution does not prohibit the establishment of a religion, as long as it’s Christian. (Maybe they thought the founders had their fingers crossed when they signed the thing? I dunno.) Heck, just look at the tax protesters. There are some very educated people among them, who somehow fall for the arguments that just using certainly language (and/or avoiding other language) protected them from paying taxes. Education doesn’t mean you know everything; in fact, one of the paradoxes of getting an education is that although you increase your knowledge, in most cases you increase your self-assessment of your knowledge far out of proportion to that. And it is no guarantee whatsoever of being able to apply critical thinking skills. An engineer with a PhD might pontificate about a vaccine-autism connection, oblivious that he/she is merely parroting bad arguments that have long since been demonstrated wrong.

    Yes, many of these people really do believe that vaccines cause autism, or can cause autism, or can worsen it or trigger it in susceptible individuals. Even the educated ones, even the ones who don’t watch Oprah or the View. I suspect a great many have gotten on the bandwagon via other channels — through autism support groups or through the Internet.

  31. windriven says:

    @Calli Arcale

    A cogent argument indeed, and one that brings me great sadness. What, after all, is the point of education? Is it simply to acquire a collection of facts and skills; a trade school with compulsory E Lit classes? Or is the point of an education first and foremost to learn to think?

    You noted: “Education doesn’t mean you know everything…”
    Indeed, perhaps the second most important thing I learned in school was just how little I really knew about anything.

    But doesn’t this bring us back to the nut of the problem here? The bloggers here at SBM and many others have done a fine job making the case for vaccination as safe and effective. But reasoned elucidation falls rather short with the target group we’re discussing.

    We will continue to make gains with the reasonable and the reasoning cohorts. But what of the others? Being a bit more of a social Darwinist than is politically correct, I’d be happy to leave them to their fates. Unfortunately their irrationality impinges on the rest of us by opening a chink in herd immunity.

  32. Th1Th2 says:

    Dawn,

    “I just hate it when people cherry-pick evidence since they are obviously thinking no one will call them on it. I shouldn’t have. ”

    Oh I am sure pro- vax hate it when they are cornered. I
    thought their level of ignorance about vaccines is so obvious that it can easily be debunked. All they have to do is ‘sit on the corner’ because even if they resort to mere analogies they are still amiss.

  33. Th1Th2 says:

    Dawn,

    “yeah, I won’t respond to the concrete thinker who obviously can’t tell the difference between an analogy and an actual situation, and who obviously has NO idea about what a newborn is exposed to from birth on. (sits back down in the naughty corner)”

    Afraid to face your own ghost?

  34. windriven says:

    @Dawn

    I recognize each of the words but when Thing assembles them into sentences their meanings drift away like smoke on a windy day.

    “I thought their level of ignorance about vaccines is so obvious that it can easily be debunked.”

    After two Tylenol and a cup of Irish coffee I understand this to mean that she thinks little of vaccine advocates and their arguments supporting vaccination. Inherent in this assertion is her belief that the huge body of scientific evidence supporting vaccine safety and efficacy can be summarily dismissed as ‘ignorance.’ Christmas is coming and I foresee a Merriam-Webster under her tree.

    “All they have to do is ‘sit on the corner’ because even if they resort to mere analogies they are still amiss.”

    After spending time with this sentence I thought I must be suffering early onset Alzheimers because I couldn’t tease the barest flicker of meaning out of this string of words. But then I realized that I knew my own name and where I was and the date and so forth. So perhaps it isn’t me who suffers debilitation.

  35. daedalus2u says:

    T1T2, While an infant is in utero, it has a bacterial population of zero. When it is born, it passes through the birth canal which has a very large population of bacteria. The only thing that keeps the infant from dying due to the bacteria is its immune system.

    There are at least thousands of different bacteria the infant is exposed to, each of which has at least a hundred antigens. So exposure to 100,000 antigens in the first moments of life is something that every infant experiences.

    The only reason those bacteria do not cause an infection is because the infant’s immune system produces an appropriate response.

  36. Dawn says:

    @daedalus2u: no, unfortunately, Th1Th2 believes that infants are sterile beings and don’t get exposed to bacteria unless evil parents allow them to go outside and have sick people cough on them. I am well aware of the unsterility of birth and the colonization of newborns during birth but he/she doesn’t believe in it. (and, just a minor correction: a fetus in utero has a bacterial population of zero until the amniotic sac breaks. They can be fully colonized with bacteria prior to birth if the membranes are ruptured for a long time. Not necessarily pathogenic, but still colonized).

    @windriven: I give up. As you said, when Th strings words together, they make no sense. Irish Coffee? I’d ask you to share but can’t drink at work (and Th1 could easily drive anyone to drink).

  37. Th1Th2 says:

    daedalus2u,

    “There are at least thousands of different bacteria the infant is exposed to, each of which has at least a hundred antigens. So exposure to 100,000 antigens in the first moments of life is something that every infant experiences.”

    Please expound. Whicf part/s of the newborn is/are being exposed naturally to ’100,000 antigens’?

    There are areas in the human body that are physiologically sterile, that is, free of any microorganisms/biological contaminants, like the blood, CSF and muscle tissues. They do not come in direct contact with the external environment. Are they also being exposed to ’100,000 antigens’? If ever you have to get your blood drawn by a phlebotomist, does the phlebotomist exposes your blood naturally to ’100,000 antigens’ or does the phlebotomist collect the blood aseptically into a sterile tube?

    “The only reason those bacteria do not cause an infection is because the infant’s immune system produces an appropriate response”

    Appropriate response? They are called infants for a reason, I tell you that.

  38. lillym says:

    I can’t help myself

    “They are called infants for a reason, I tell you that.”

    What is the reason they are called infants?

  39. Th1Th2 says:

    lillym,

    “I can’t help myself

    What is the reason they are called infants?”

    Infants cannot help, protect and support themselves alone.

  40. Harriet Hall says:

    What is the reason they are called infants?”

    Th1Th2 says the reason is “Infants cannot help, protect and support themselves alone.”

    Elderly people with dementia cannot help, protect and support themselves alone. Should we call them infants?

  41. daedalus2u says:

    T1T2, every part.

    When an infant is in utero, they are bacteria-free (before the membranes break).

    Don’t you know that the skin without an immune system is not an effective barrier to bacteria? Don’t you know that gut bacteria would grow through the gut if there was no immune system to stop them? Without an immune system bacteria would swim up and into the bladder and into the kidneys. The eyes would become infected too.

    Internal tissue compartments are only nominally sterile. Very often there are bacteria in the blood, but the immune system controls them before they cause disease.

  42. Dawn says:

    @Daedalus2u: No, Th1Th2 won’t accept that. Babies are sterile until WE inject them with horrible toxins, don’t you know. All their children are naive (I STILL haven’t figured out what they mean by that). Back in the day, babies didn’t die of infections. It’s all modern medicine’s fault that babies die! Babies are good, and sterile, and naive and it’s the PARENTS fault if anything ever happens to them. Babies don’t get infections, or injured or eat things they are not supposed to. They walk on sidewalks, never play in the grass, and never, ever, ever get hurt.

  43. Th1Th2 says:

    Harriet Hall,

    “Elderly people with dementia cannot help, protect and support themselves alone. Should we call them infants?”

    Infants are unable to help, protect and support themselves NOT because they are demented or suffering from cognitive dysfunction. Babies being babies, as simple as that.

    It’s up to you whether to label a demented adult or a severely autistic child an ‘infant’ if ever they are manifesting signs of infantile behaviour.

    1. Harriet Hall says:

      Th1Th2
      You professed to know why infants are called infants. You were asked to clarify “What is the reason they are called infants?”
      You said the reason is “Infants cannot help, protect and support themselves alone.”
      As if not being able to help, protect and support oneself was the definition of infant.
      Which you now deny.
      Now you say “babies being babies”

      So why are they called infants instead of just babies?

      You are not making even smidgen of sense even in this very minor point.

  44. Th1Th2 says:

    daedalus2u,

    “Don’t you know that the skin without an immune system is not an effective barrier to bacteria?”

    Newsflash! Do you know that your thick skin is part of what Science called the Innate Immune System?

    “Don’t you know that gut bacteria would grow through the gut if there was no immune system to stop them?”

    It’s called the Normal Flora and guess what, it’s part of the Innate Immune System too.

    “Without an immune system bacteria would swim up and into the bladder and into the kidneys. The eyes would become infected too. ”

    The fact is, you were born with a functioning immune system called the Innate Immune System. You are not just a believer or you lack self-esteem.

    “Internal tissue compartments are only nominally sterile. Very often there are bacteria in the blood, but the immune system controls them before they cause disease.”

    So how do you plan to make yourself infected?

  45. windriven says:

    @Th1Th2

    ENOUGH! Would you please take a deep breath and write, as succinctly and clearly as you are able, the workings of the immune system as you understand it? Your comments are like Fourth of July fireworks going off first in one direction, then in another. Clearly there are commenters and even bloggers on this site who are willing to invest the time to try to understand your position. So please, no metaphors, no analogies, sitting on corners: how do you believe the immune system to work?

  46. Th1Th2 says:

    Harriet Hall,

    Infants, babies, newborns, neonates, little ones, little angels, suckling, bambino whatever you want them called, got any problem with that?

    I hope you’re not a pediatrician. It’s embarrassing.

    1. Harriet Hall says:

      Th1Th2,
      What I call them is irrelevant. Stick to the subject. You professed to know why infants were called infants and you were asked to explain. You haven’t explained.

  47. Th1Th2 says:

    windriven,

    “how do you believe the immune system to work?”

    1. Innate Immune System
    2. Adaptive Immune System

    It’s not a personal belief but rather an established scientific fact. This information is found in every Immunology, Anatomy and Physiology, Biology, Pediatric, Maternal and Child Health books. If you’re having a hard time finding it, they are mostly discussed in Chapter 1.

  48. dedicated lurker says:

    Hey, little thing one: if you get a cut your blood/muscle tissue is exposed to the air. Thus it is exposed to antigens. How do those fields stay sterile, unless you’re seriously arguing it’s possible for someone to never cut themselves?

  49. dedicated lurker says:

    Oh, and all those work in a child born with SCID.

    Why do they die of infection and disease?

  50. Enkidu says:

    I know it’s against the normal policy of this site, but can we please ban Th1Th2? S/he kills every thread s/he enters by taking it in the direction of constant stupid.

    “T1T2, While an infant is in utero, it has a bacterial population of zero. ”

    Except my infant daughter, who was born with a GBS infection (my yucky vaginal GBS decided it didn’t want to stay vaginal and entered the womb, infecting my daughter and causing my water to break 13 weeks early). She was born 2 hours after my water broke via emergency c-section. We were lucky, her spinal tap came back negative and she didn’t develop meningitis.

  51. mark says:

    @ Enkidu

    In total agreement with you re banning Th1Th2.

  52. Th1Th2 says:

    dedicated lurker,

    “Hey, little thing one: if you get a cut your blood/muscle tissue is exposed to the air. Thus it is exposed to antigens. How do those fields stay sterile, unless you’re seriously arguing it’s possible for someone to never cut themselves?”

    If there’s a breach or break in the innate barriers then the adaptive mechanism of the immune system will be activated for immediate clearance of the infection.

    It’s possible for someone to reject deliberate inoculation.

    “Oh, and all those work in a child born with SCID.

    Why do they die of infection and disease?”

    What’s the problem? Are their being stripped of their skin?

  53. Th1Th2 says:

    Enkidu,

    “Except my infant daughter, who was born with a GBS infection (my yucky vaginal GBS decided it didn’t want to stay vaginal and entered the womb, infecting my daughter and causing my water to break 13 weeks early). She was born 2 hours after my water broke via emergency c-section. We were lucky, her spinal tap came back negative and she didn’t develop meningitis.”

    There is not an infection found in your daughter, that is, if your going to based it on daedalus2u’s earlier statement: “The only reason those bacteria do not cause an infection is because the infant’s immune system produces an appropriate response”

    You had PROM and that was it.

  54. Enkidu says:

    Th1Th2: I had PROM because the bacteria infected the womb, including my daughter. She tested positive for infection at birth (2 hours after my PROM).

    The bacteria caused my membranes to rupture, which is not what typically happens (usually, your membranes rupture and then the bacteria can enter the womb afterwards).

    I’d love (NOT) to hear how this could have been prevented in your fantasy world.

  55. windriven says:

    @Thing

    “If there’s a breach or break in the innate barriers then the adaptive mechanism of the immune system will be activated for immediate clearance of the infection. ”

    For “immediate clearance of the infection?” Really? The otherwise healthy, beautiful, wife of a friend of mine DIED at the ripe old age of 38 from a strep infection that went too far before she sought medical attention. No breach or break of the innate barriers. And let me assure you that her adaptive immune system did not clear the infection immediately.

    Thing, you seem to know some of the words. But you don’t seem to understand the actual principles. The immune system is a marvelously adaptive system for identifying, remembering and attacking foreign bodies. But it isn’t perfect. Sometimes it goes off the rails and attacks native tissues (autoimmune diseases). Sometimes it responds too slowly or with insufficient vigor to stem the tide as happened to my friend Jan. And we aren’t born with our immune systems ‘knowing’ every pathogen out there. That requires exposure: infection or vaccination.

    It is this last item that you seem to miss. Babies gather some immunities from their mothers. Other immunities they have to acquire for themselves. I am aware of only two avenues by which this can occur. The person (infant, toddler, teenager, adult, geezer) can be vaccinated with a debilitated form of the organism or sometimes fragments of the pathogen, or the person can survive a bout of the actual disease. Take smallpox. The fatality rate of smallpox (now eradicated thanks to vaccination) was around 30%. Three of every ten people who caught the disease died of it.

    Infectious disease has been around since long before the appearance of humans. It has, from time to time, decimated populations. Contemplate, if you will, the bubonic plague, influenza pandemics, the curse of polio. These are all infectious diseases. They have throughout the course of history killed millions of human beings – many of them helpless infants and children.

    To this very day children in the third world die for lack of access to vaccines that are common in the US and Europe. How to you rationalize this with your queer notions about immunology and vaccination?

  56. Th1Th2 says:

    Harriet Hall,

    “What I call them is irrelevant. Stick to the subject. You professed to know why infants were called infants and you were asked to explain. You haven’t explained.”

    I already did. Suit yourself. You can even ask an ‘infant’ if you’re not satisfied.

  57. Th1Th2 says:

    Enkidu,

    “The bacteria caused my membranes to rupture, which is not what typically happens (usually, your membranes rupture and then the bacteria can enter the womb afterwards). ”

    I will be a little nitpicky with the words “not typical” especially coming from the mouth of a physician.

  58. windriven says:

    @Thing

    Why do you have such animosity towards people who spend more than 20 years of their lives in school and who dedicate their lives to helping others?

  59. Harriet Hall says:

    Th1Th2 said “Suit yourself. You can even ask an ‘infant’ if you’re not satisfied.”

    I think I already did.

  60. Th1Th2 says:

    windriven,

    “For “immediate clearance of the infection?” Really? The otherwise healthy, beautiful, wife of a friend of mine DIED at the ripe old age of 38 from a strep infection that went too far before she sought medical attention.

    Was she aware she had strep before seeing a doctor? Was she on medications? How did the doctors intervene? Need more info.

    “No breach or break of the innate barriers. And let me assure you that her adaptive immune system did not clear the infection immediately. ”

    This is because she was sick. First off, she had an active infection at that time that means there was already a letdown of the innate barriers. I do not know how long she stayed in the hospital but every time a patient comes in for treatment, most likely her innate system is battered with series of tests and intrusive procedures.

    “The immune system is a marvelously adaptive system for identifying, remembering and attacking foreign bodies. But it isn’t perfect. Sometimes it goes off the rails and attacks native tissues (autoimmune diseases). ”

    That holds true for Adaptive Immunity, the secondary defense. However, the Innate Immunity would always takes precedence over the former by preventing and repelling pathogens from establishing an infection. The Innate Immune System would respond via non-adaptive mechanism (no vaccine needed).

    “And we aren’t born with our immune systems ‘knowing’ every pathogen out there. That requires exposure: infection or vaccination.”

    The Innate Immune System, the one you were born with, is capable of recognizing a wide array of pathogens or group of pathogens thru PAMPS by TLRs and PRRs. Again, no vaccine or intentional infection needed.

    “It is this last item that you seem to miss. Babies gather some immunities from their mothers. Other immunities they have to acquire for themselves. I am aware of only two avenues by which this can occur. The person (infant, toddler, teenager, adult, geezer) can be vaccinated with a debilitated form of the organism or sometimes fragments of the pathogen, or the person can survive a bout of the actual disease. Take smallpox. The fatality rate of smallpox (now eradicated thanks to vaccination) was around 30%. Three of every ten people who caught the disease died of it.”

    Wrong. Disease exposure and deliberate inoculation will only make the person to acquire one thing and that is infection. The smallpox vaccine did not eradicate smallpox.

    “To this very day children in the third world die for lack of access to vaccines that are common in the US and Europe. How to you rationalize this with your queer notions about immunology and vaccination?”

    Vaccines are NOT their physiologic need but rather food, clean water, clean environment and other things like that.

  61. weing says:

    windriven,

    I suggest you consider the following question:
    How many legs does a cow have if you count the tail as a leg?
    Then you can consider the question:
    How many infections occur if you count acquired immunity via a vaccine as an infection?
    Then you can just ignore the idiot’s ravings and put the Maginot line of innate immunity protecting against Germ(an)s in its proper perspective.

  62. Chris says:

    It is late at night. I am tired, and have had a bit of wine. But I must inquire:

    The troll is obviously clueless. Why do you even bother? Is it for your own amusement?

    All I have to say is that trolls tend to starve if they are not fed. This site is often reluctant to ban, so it is up to you to ignore.

  63. windriven says:

    @weing

    You made my morning! The aphorism about counting the tail as a leg is one of my favorites. And yes, I’m now done with the Thing.

    @Chris
    Mea culpa, mea culpa.

    I had picked up that English might not be her first language and have labored under the delusion that this might then be a communication issue, that somehow we were not clear. I am disabused of this delusion now.

    How is it that the same species that can tease out the physics of the early universe, divine the majestic scaffolding that is evolution, produce artists like Saint-Saens and Cezanne, can also produce individuals of such refractory ignorance?

  64. Th1Th2 says:

    weing,

    “How many infections occur if you count acquired immunity via a vaccine as an infection?”

    Antibody Response in Serum and Nasopharynx after Naturally Acquired and Vaccine-Induced Infection with Rubella Virus
    N Engl J Med 1971; 285:1333-1339December 9, 1971

    Antibody Response to Varicella-Zoster Virus after Natural or Vaccine-Induced Infection .
    THE JOURNAL OF INFECTIOUS DISEASES * VOL. 146, NO. 2 * AUGUST 1982 C 1982 by The University of Chicago.

    Characteristics of vaccine-induced and natural infection with adenovirus type 4 in naval recruits. Amer. J. Epid., 1968, 88: 45–54

    The effect of a human interferon preparation on vaccine-induced rubella infection.
    Department of Virology, St Thomas’ Hospital and Medical School, London SE1 7EH, England

  65. Calli Arcale says:

    weing:

    Then you can just ignore the idiot’s ravings and put the Maginot line of innate immunity protecting against Germ(an)s in its proper perspective.

    That is a beautiful visual, I must say.

    Regarding the original article, I have just one quibble:

    Autism is not an autoimmune disease.

    It would be more correct to say there is no evidence that autism is an autoimmune disease. Given the very wide variation in presentation, it is hard to exclude all possibilities. After all, there is a good chance autism is not a monolithic entity.

  66. Th1Th2 says:

    They say “People Who Live In Glass Houses Should Not Throw Stones”. I would say people who deny the Germ Theory should not throw stones.

    Attention SBM.

  67. dt says:

    @windriven

    How is it that the same species that can tease out the physics of the early universe, divine the majestic scaffolding that is evolution, produce artists like Saint-Saens and Cezanne, can also produce individuals of such refractory ignorance?

    It’s a female too. That shocks me even more.

  68. Zetetic says:

    Let’s all offer to write a glowing letter of recommendation for Th1Th2 to attend a naturopathy program. He/she/it would fit right in there, probably be asked to stay on as faculty!

  69. windriven says:

    @Zetetic

    I’m more likely to pony up for a Haldol prescription for Th1Th2.

  70. dedicated lurker says:

    Little thing: look up severe combined immunodeficiency. Then explain why people with the condition die.

  71. Th1Th2 says:

    dedicated lurker,

    “Little thing: look up severe combined immunodeficiency. Then explain why people with the condition die.”

    Complications. Even vaccines could kill them much faster. So what’s the point?

  72. dedicated lurker says:

    My point was they have all those things that you say protect against disease, and they still die of infectious disease. Ones that wouldn’t kill a person normally.

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