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Nine Questions, Nine Answers.

This is not an easy blog to write.  Doctors Novella and Gorski want the entries to be formal, academic, referenced, with a minimum of snark.
For the most part I comply. But sometimes. Sometimes. It is hard, so hard, to not spiral into sarcastic diatribes over the writings that pass for information on the interwebs. I wish, sometimes, that I could be an irascible computer as well.
What brings on this particular bit of angst is a bit of whimsy on the Internet called “9 Questions That Stump Every Pro-Vaccine Advocate and Their Claims.”  by David Mihalovic, ND. Mr. Mihalovic identifies himself as “a naturopathic medical doctor who specializes in vaccine research.” However, just where the research is published is uncertain as his name yields no publications on pubmed.  BTW. I am a beer researcher.
The nine questions show up frequently on the interwebs, similar to questions on is to ask when you want to stump an evolutionist.  Like the supposed stumpers for evolution, the vaccine questions are grounded in either misinformation or laziness. Let’s go through them one at a time.
1. Could you please provide one double-blind, placebo-controlled study that can prove the safety and effectiveness of vaccines?
One trial? It took me 55 seconds to find 20211953, and that includes time to boot the browser and mis-spell the search terms.  Vaccine efficacy randomized placebo control trial gives 416 pubmed results; add safety to the search term, you 126 returns. The are easily more than one.  Of course, to find them you have to look.
Of course, I am a highly educated adult who constantly searches the web for medical information.  For hoots and giggles, I asked my 12 year old son, whose passions are basketball and filming comedy videos, to find me a reference that met the same criteria and I timed him.
22 seconds to find Randomized, Placebo-Controlled Trial of Inactivated Poliovirus Vaccine in Cuba from the NEJM.
12 yo one,  Mihalovic 0.  Served.
As long as we are on the topic, since he evidently place great store in science, could Mihalovic please provide one double-blind, placebo-controlled study that can prove the safety and effectiveness of naturopathy?  I would be happy at this point to know you could do a pubmed search corruptly just to make me look the fool.
2. Could you please provide scientific evidence on ANY study which can confirm the long-term safety and effectiveness of vaccines?
Long term is vague. What is long term?  Smallpox disappeared in 1976 thanks to the vaccine.  I have not seem a case of smallpox in my medical career, which now on it’s 31st year. No reported long term toxicities and the eradication of smallpox seems to me reasonable evidence for long term effectiveness.
No vaccine is 100% in efficacy, and whether  infected naturally or by way of a vaccine, immunity wanes with time.  In  earlier times  people would be have their immunity boosted by exposure to disease and maintain their antibody levels.  It is not the initial infection that leads to better immunity from natural infections, as posited by some antivaccine people, but the the fact that people were constantly re-exposed to wild type disease.
It is interesting what is happening with shingles.  Everyone used to get chickenpox as a child, and then, as they raised their kids and grand kids, got re-exposed to the virus and boost their immunity. Currently, due to the chickenpox vaccine and a change in the way way children are raised, older adults are not getting exposed naturally to chickenpox, immunity is waning, and there is an increase in shingles in older adults.  Part of why they need the zoster vaccine.  http://www.journals.uchicago.edu/doi/abs/10.1086/651078
Clever conspiracy, huh?
Unless exposed to new infection, immunity, as measured by antibody levels directed against the infecting agent, can wane over time. That is to be expected.  The nice thing about the immune system, unlike water, is that it remembers the infection. It is primed so that if exposed again at a later date, it can almost instantly produce large amounts of antibody to nip an infection in the bud. So rather than prevent infection, in some people far removed in time from the vaccine, may instead have a shorter, less severe illness and be infectious not as long, thereby decreasing spread.
There is a nice review in the NEJM 1798383 on duration of immunity (first search in pubmed using duration of immunity vaccine, results in 17 seconds, including correcting typos.  Seriously, just how hard is it to find this information?  As would be expected, it depends on the disease and the vaccine (live better than killed). They estimated the half life for the varicella zoster virus immunity at 50 years, 200 years for measles and mumps, and 11 years for tetanus.  If you peruse the references, you can find other studies that show variable but sustained response to vaccines,  for example 90% maintain immunity to smallpox up to 75 years after vaccination. 12925846
Long term safety was more difficult, 5 years was the limit of time I could find safety studies, for the Hepatits B.  j med virol  65 2001Most vaccine toxicities are found in the first week after the inoculation and the studies follow most patients for a year.  Probably would not cut it as long term for Mihalovic.
BTW, could you please provide scientific evidence on ANY study which can confirm the long-term safety and effectiveness of naturopathy?
3.  Could you please provide scientific evidence which can prove that disease reduction in any part of the world, at any point in history was attributable to inoculation of populations?
Smallpox? Smallpox? Smallpox? Anyone? Smallpox? Buehler? Buehler?
Again I get back to the whole binary, black and white approach that characterizes many with whom we cross medical swords.  The decrease in infectious diseases has been multifactorial, due to improved nutrition, improved hygienic (lets hear it for the flush toilet) and understanding the epidemiology of diseases.  Knowing how a disease is spread has always been critical in decreasing its spread.  Note that none, none, none of the interventions that have decreased the spread of infections in the last 200 years or so have come from alt med tradition.
The teasing out the effects of vaccines on populations is always fraught with potential controversy. There are always multiple confounders.  The best example of the effects of vaccines was from JAMA http://jama.ama-assn.org/cgi/content/full/298/18/2155
“Objective  To compare morbidity and mortality before and after widespread implementation of national vaccine recommendations for 13 vaccine-preventable diseases for which recommendations were in place prior to 2005.
Design, Setting, and Participants  For the United States, prevaccine baselines were assessed based on representative historical data from primary sources and were compared to the most recent morbidity (2006) and mortality (2004) data for diphtheria, pertussis, tetanus, poliomyelitis, measles, mumps, rubella (including congenital rubella syndrome), invasive Haemophilus influenzae type b (Hib), acute hepatitis B, hepatitis A, varicella, Streptococcus pneumoniae, and smallpox.
Main Outcome Measures  Number of cases, deaths, and hospitalizations for 13 vaccine-preventable diseases. Estimates of the percent reductions from baseline to recent were made without adjustment for factors that could affect vaccine-preventable disease morbidity, mortality, or reporting.
Results  A greater than 92% decline in cases and a 99% or greater decline in deaths due to diseases prevented by vaccines recommended before 1980 were shown for diphtheria, mumps, pertussis, and tetanus. Endemic transmission of poliovirus and measles and rubella viruses has been eliminated in the United States; smallpox has been eradicated worldwide. Declines were 80% or greater for cases and deaths of most vaccine-preventable diseases targeted since 1980 including hepatitis A, acute hepatitis B, Hib, and varicella. Declines in cases and deaths of invasive S pneumoniae were 34% and 25%, respectively.”
Milhalovic,  could you please provide scientific evidence which can prove that disease reduction in any part of the world, at any point in history was attributable to naturopathy?
4. Could you please explain how the safety and mechanism of vaccines in the human body are scientifically proven if their pharmacokinetics (the study of bodily absorption, distribution, metabolism and excretion of ingredients) are never examined or analyzed in any vaccine study?
There is, superficially, some truth in this statement.  Most pharmacokinetics are done prior to the clinical efficacy trials.  That is why there are phase 1 and phase 2 trials. The assumption being that if you exam influenza vaccine pharmacokinetic studies in one group it can be extrapolated to similar populations.  I think that is reasonable. So no, there are no pharmacokinetic studies in the clinical efficacy trials, those were done prior to the efficacy trials.  But it is not hard to find the phase 1 and 2 trials if you are so moved.
Milhalovic, could you please explain how the safety and mechanism of naturopathic nostrums in the human body are scientifically proven if their pharmacokinetics (the study of bodily absorption, distribution, metabolism and excretion of ingredients) are never examined or analyzed in any naturopathic nostrum study?  Is this getting old?  There is something to be said for repetition.
5. Could you please provide scientific justification as to how injecting a human being with a confirmed neurotoxin is beneficial to human health and prevents disease?
I presume the issue is mercury. Maybe aluminum. The latter is not in most vaccines, although as been discussed at length on this blog, the amount of mercury and aluminum found in vaccines is minimal and, at the dosing and formulation, has never been demonstrated to cause neurotoxicity from vaccines.  Of course, I am old school and think there is a dose response, and that a greater amount leads to a greater response.  Most naturopaths receive extensive training in homeopathy, where the less the amount, the greater the response.  So I would presume arguments based on chemistry would have little meaning to an ND, although I would not want my appletini made by a practitioner of homeopathy.
Of course, it is not the ‘neurotoxin’ that is being used to prevent disease, but the antigens of the potential infection. That is assuming that the author of the nine questions does not consider the antigens to be neurotoxins, and to judge from his understanding of disease later in the post, I am notes certain he warrants the benefit of the doubt.
Could you please provide scientific justification as to how applying naturopathy to a human being is beneficial to human health and prevents disease?
6. Can you provide a risk/benefit profile on how the benefits of injecting a known neurotoxin exceeds its risks to human health for the intended goal of preventing disease?
Since there is no more mercury in most vaccines, I will assume, for the sake of argument, it is the aluminum.  Risk from aluminum in the H. influenza type b vaccine, where aluminium is used as a adjuvant: zero.
The benefit from the vaccine: “From eight trials, the protective efficacy of the Hib conjugate vaccine was 84% (OR 0.16; 95%CI 0.08-0.30) against invasive Hib disease, 75% (OR 0.25; 95%CI 0.08-0.84) against meningitis, and 69% (OR 0.31; 95%CI 0.10-0.97) against pneumonia. Serious adverse events were rare.” 16491301
Seems a good trade off. No risk from aluminum, significant decrease in morbidity and mortality.
7. Could you please provide scientific justification on how bypassing the respiratory tract (or mucous membrane) is advantageous and how directly injecting viruses into the bloodstream enhances immune functioning and prevents future infections?
Well, things really get off the rails here.  Vaccines are not injected into the blood stream, they are infected into the soft tissues.   At a simple level, an infection enters to body, the body makes a variety of antibodies to the constituent parts of the infecting organism and next time the patient is exposed, the pre-existing antibody can, if there is a match with new strain, inactivate the new infection.
It doesn’t matter how the antigen is presented to the immune system, the response is the same. Natural influenza, inhaled influenza vaccine, or injected influenza vaccine, the same antibody will be made.
He says later
“All promoters of vaccination fail to realize that the respiratory tract of humans (actually all mammals) contains antibodies which initiates natural immune responses within the respiratory tract mucosa. Bypassing this mucosal aspect of the immune system by directly injecting viruses into the bloodstream leads to a corruption in the immune system itself. As a result, the pathogenic viruses or bacteria cannot be eliminated by the immune system and remain in the body, where they will further grow and/or mutate as the individual is exposed to ever more antigens and toxins in the environment which continue to assault the immune system.”
This is what we call in the trade, gibberish. At least it makes no sense to me.  I will leave to the readers to search, Bible Code style, for truthiness in the above selection.
8. Could you please provide scientific justification on how a vaccine would prevent viruses from mutating?
That is actually a very interesting question. It has nothing to do with why we give vaccines and  I fear our intrepid ND does not have a firm grasp on what he is talking about as he says
“Despite the injection of any type of vaccine, viruses continue circulating through the body, mutating and transforming into other organisms. The ability of a vaccine manufacturer to target the exact viral strain without knowing its mutagenic properties is equivalent to shooting a gun at a fixed target that has already been moved from its location. You would be shooting at what was, not what is!”
Mutating and transforming into other organisms. Sigh.  Either the author is a sloppy writer  (sloppy writing reflects a sloppy mind) or his understanding of microbiology is so profoundly mistaken it boggles the mind that he takes care of patients.  And in Oregon he would allowed by the state to prescribe antibiotics.
If you have a population of viruses and a specific antibody against the virus, then those naturally occurring mutants that are not recognized by the antibody should have a replication advantage.  It is possible that the vaccine can help select for new strains of an infection, but not new organisms.
Vaccines selecting for new mutants has been looked at for the Hepatitis B vaccine, and found not to be a issue 20210630.
In HIV, there is an ongoing interaction between the immune response and the virus driving mutations that escape the immune system and, in some patients leads to a marked increase in HIV replication and a clinical decline decline (9143689). Oh wait, this is a natural infection. That shouldn’t happen.  It is the vaccines that do do this.
There is nothing unique about the vaccine response acting as environmental pressure on the evolution of infections; the response from the natural infections should be the same.  I would wonder, since the response to  a natural infection is broader, with antibodies made to numerous parts of the infection, rather than the few key antibodies provided by the response to the vaccine, whether a natural infection would lead to a faster mutation rate.  As a rule in the microbial world, the more intense the stress, the faster and more varied the mutations.  More antibiotics leads to faster development of resistance in E. coli, not its delay
9. Could you please provide scientific justification as to how a vaccination can target a virus in an infected individual who does not have the exact viral configuration or strain the vaccine was developed for?
Dr. Black and White.  Antibody response is not all or nothing, there is a gradient of response between the developed antibody and the site to which it is directed.  A good example is the H1N1 influenza.  People exposed to the strains from the first half f the century had antibody that was partially protective for the 2009 strain.  The reason http://www.ncbi.nlm.nih.gov/pubmed/20049332?
“The pandemic influenza virus (2009 H1N1) was recently introduced into the human population. The hemagglutinin (HA) gene of 2009 H1N1 is derived from “classical swine H1N1″ virus, which likely shares a common ancestor with the human H1N1 virus that caused the pandemic in 1918, whose descendant viruses are still circulating in the human population with highly altered antigenicity of HA. However, information on the structural basis to compare the HA antigenicity among 2009 H1N1, the 1918 pandemic, and seasonal human H1N1 viruses has been lacking. By homology modeling of the HA structure, here we show that HAs of 2009 H1N1 and the 1918 pandemic virus share a significant number of amino acid residues in known antigenic sites, suggesting the existence of common epitopes for neutralizing antibodies cross-reactive to both HAs. It was noted that the early human H1N1 viruses isolated in the 1930s-1940s still harbored some of the original epitopes that are also found in 2009 H1N1. Interestingly, while 2009 H1N1 HA lacks the multiple N-glycosylations that have been found to be associated with an antigenic change of the human H1N1 virus during the early epidemic of this virus, 2009 H1N1 HA still retains unique three-codon motifs, some of which became N-glycosylation sites via a single nucleotide mutation in the human H1N1 virus. We thus hypothesize that the 2009 H1N1 HA antigenic sites involving the conserved amino acids will soon be targeted by antibody-mediated selection pressure in humans. Indeed, amino acid substitutions predicted here are occurring in the recent 2009 H1N1 variants. The present study suggests that antibodies elicited by natural infection with the 1918 pandemic or its early descendant viruses play a role in specific immunity against 2009 H1N1, and provides an insight into future likely antigenic changes in the evolutionary process of 2009 H1N1 in the human population.”
Oops.  Not simple.
But the result? http://www.ncbi.nlm.nih.gov/pubmed/20059763
” over 75% of confirmed cases of novel H1N1 occurred in persons < or = 30 years old, with peak incidence in the age range 10-19 years. Less than 3% of cases occurred in persons over 65, with a gradation in incidence between ages 20 and 60 years.The sequence data indicates that novel H1N1 is most similar to H1N1 viruses that circulated before 1943. Novel H1N1 lacks glycosylation sites on the globular head of hemagglutinin (HA1) near antigenic regions, a pattern shared with the 1918 pandemic strain and H1N1 viruses that circulated until the early 1940s. Later H1N1 viruses progressively added new glycosylation sites likely to shield antigenic epitopes, while T-cell epitopes were relatively unchanged.
CONCLUSIONS: In this evolutionary context, Original Antigenic Sin exposure should produce an immune response increasingly mismatched to novel H1N1 in progressively younger persons. We suggest that it is this mismatch that produces both the gradation in susceptibility and the unusual toxicity”
The better the antibdy fit for the epitope (where the antibody binds) the better the effect, but it doesn’t have to be all or nothing. He would probably ask, what good is half and eye, why have half a wing. Or had a brain.
He finishes
“I have never encountered one pro-vaccine advocate, whether medically or scientifically qualified, who could answer even 1 let alone all 9 of these questions. One or all of the following will happen when debating any of the above questions:
- They will concede defeat and admit they are stumped.
- They will attempt to discredit unrelated issues that do not pertain to the question.
- They will formulate their response and rebuttal based on historical arguments and scientific studies which have been disproved over and over again. Not one pro-vaccine advocate will ever directly address these questions in an open mainstream venue.”
I am neither stumped not defeated.
My response was not unrelated.
My arguments are bases on modern studies that a 12 year old can find in less than a minute.
SBM is an open mainstream venue.
I do feel like I just had a foot race with a sloth; where is the honor in that?
And people wonder why I question the wisdom of allowing naturopaths to function as primary care providers.

This is not an easy blog to write.  Doctors Novella and Gorski want the entries to be formal, academic, referenced, with a minimum of snark.

For the most part I comply. But sometimes. Sometimes. It is hard, so hard,  not to spiral into sarcastic diatribes over the writings that pass for information on the interwebs. How should one respond to profound ignorance and misinformation?  I wish, sometimes, that I could be an irascible computer as well.

What brings on this particular bit of angst is a bit of whimsy on the Internet called “9 Questions That Stump Every Pro-Vaccine Advocate and Their Claims.”  by David Mihalovic, ND. Mr. Mihalovic identifies himself as “a naturopathic medical doctor who specializes in vaccine research.” However, just where the research is published is uncertain as his name yields no publications on Pubmed.  BTW. I specialize in  beer research.  Same credentials.

The nine questions show up frequently on the interwebs, similar to questions on what to ask when you want to stump an evolutionist.  Similar to the supposed stumpers for evolution, the vaccine questions are grounded in misinformation, ignorance or laziness.  Let’s go through them one at a time.

1. Could you please provide one double-blind, placebo-controlled study that can prove the safety and effectiveness of vaccines?

One trial? It took me 55 seconds to find  ”Efficacy of 23-valent pneumococcal vaccine in preventing pneumonia and improving survival in nursing home residents: double blind, randomised and placebo controlled trial” and that included time to boot the browser and mis-spell the search terms.  ’Vaccine’, ‘efficacy’,  ’randomized’ and  ’placebo control trial’  results in 416 Pubmed references; add ‘safety’ to the search terms, you get 126 returns. 416 is easily more than one.  Of course, to find them you have to look.

Of course, I am a highly educated adult who constantly searches the web for medical information.  For hoots and giggles, I asked my 12 year old son, whose passions are basketball and filming comedy videos, to find me a reference that met the same criteria and I timed him.

Twenty two seconds, not including boot time,  to find “Randomized, Placebo-Controlled Trial of Inactivated Poliovirus Vaccine in Cuba” from the NEJM.  Can anyone beat my son?

12 yo one,  Mihalovic 0.  Served.

As long as we are on the topic, since he evidently place great store in science, could Mihalovic please provide one double-blind, placebo-controlled study that can prove the safety and effectiveness of naturopathy?  I would be happy at this point to know just to know he was able to do a pubmed search correctly just to make me look the fool.

2. Could you please provide scientific evidence on ANY study which can confirm the long-term safety and effectiveness of vaccines?

Long term is vague. What is long term?  Smallpox disappeared in 1977  thanks to the vaccine.  I have not seem a case of smallpox in my medical career, which now on it’s 31st year. No reported long term toxicities of the smallpox vaccine  and the eradication of smallpox appears to me to represent reasonable evidence for long term safety and effectiveness. But it would.

No vaccine has 100%  efficacy, and whether  infected naturally or by  a vaccine, immunity wanes with time.  In  earlier times, people would have their immunity boosted by exposure to disease and maintain their antibody levels.  It is not the initial infection that leads to better immunity from natural infections, as posited by some antivaccine people, but the the fact that people were constantly re-exposed to wild type disease.

It is interesting what is  occurring with shingles.  Everyone used to get chickenpox as a child, and then, as they raised their kids and grand kids, were re-exposed to the virus and boosted their immunity. Currently, due to the chickenpox vaccine and a change in the  way children are raised, older adults are not getting exposed naturally to chickenpox, immunity is waning, and there is an increase in shingles in older adults.  Part of why they need the zoster vaccine.

Clever conspiracy to increase the use of the zoster vaccine, huh?

Unless exposed to new infection, immunity, as measured by antibody levels directed against the infecting agent, can decline over time. That is to be expected.  The nice thing about the immune system, unlike water, is that it remembers the infection. It is primed so that if exposed again at a later date, it can almost instantly produce large amounts of antibody to nip an infection in the bud. So rather than prevent infection, in some people far removed in time from the vaccine, they may instead have a shorter, less severe illness and be infectious for a shorter period of time, thereby decreasing spread.

There is a nice review in the NEJM on duration of immunity (first search in Pubmed using duration of immunity vaccine, results in 17 seconds, including correcting typos.  Seriously, just how hard is it to find this information?  As would be expected, it depends on the disease and the vaccine (live better than killed). They estimated the half-life for the varicella zoster virus immunity at 50 years, 200 years for measles and mumps, and 11 years for tetanus.  If you peruse the references, you can find other studies that show variable but sustained response to vaccines,  for example 90% maintain immunity to smallpox up to 75 years after vaccination.

Long term safety was more difficult, 5 years was the limit of time I could find  for safety studies of  Hepatits B.  Most vaccine toxicities are found in the first week or two after the inoculation and the studies follow most patients for a year.  Probably would not cut it as long term for Mihalovic.

BTW, could you please provide scientific evidence on ANY study which can confirm the long-term safety and effectiveness of naturopathy?

3.  Could you please provide scientific evidence which can prove that disease reduction in any part of the world, at any point in history was attributable to inoculation of populations?

Smallpox? Smallpox? Smallpox? Anyone? Smallpox? Buehler? Buehler?

Again I get back to the whole binary, black and white approach that characterizes many with whom we cross medical swords.  The decrease in infectious diseases has been multifactorial, due to improved nutrition, improved hygienic (lets hear it for the flush toilet) and understanding the epidemiology of diseases.  Knowing how a disease is spread has always been critical in decreasing its spread.  Note that none, none, none of the interventions that have decreased the spread of infections in the last 200 years or so have come from naturopathic tradition.

The teasing out the effects of vaccines on populations is always fraught with potential controversy. There are always multiple confounders.  The best example of the beneficial effects of vaccines was from JAMA.

“Objective  To compare morbidity and mortality before and after widespread implementation of national vaccine recommendations for 13 vaccine-preventable diseases for which recommendations were in place prior to 2005.

Design, Setting, and Participants  For the United States, prevaccine baselines were assessed based on representative historical data from primary sources and were compared to the most recent morbidity (2006) and mortality (2004) data for diphtheria, pertussis, tetanus, poliomyelitis, measles, mumps, rubella (including congenital rubella syndrome), invasive Haemophilus influenzae type b (Hib), acute hepatitis B, hepatitis A, varicella, Streptococcus pneumoniae, and smallpox.

Main Outcome Measures  Number of cases, deaths, and hospitalizations for 13 vaccine-preventable diseases. Estimates of the percent reductions from baseline to recent were made without adjustment for factors that could affect vaccine-preventable disease morbidity, mortality, or reporting.

Results  A greater than 92% decline in cases and a 99% or greater decline in deaths due to diseases prevented by vaccines recommended before 1980 were shown for diphtheria, mumps, pertussis, and tetanus. Endemic transmission of poliovirus and measles and rubella viruses has been eliminated in the United States; smallpox has been eradicated worldwide. Declines were 80% or greater for cases and deaths of most vaccine-preventable diseases targeted since 1980 including hepatitis A, acute hepatitis B, Hib, and varicella. Declines in cases and deaths of invasive S pneumoniae were 34% and 25%, respectively.”

Milhalovic,  could you please provide scientific evidence which can prove that disease reduction in any part of the world, at any point in history was attributable to naturopathy?

4. Could you please explain how the safety and mechanism of vaccines in the human body are scientifically proven if their pharmacokinetics (the study of bodily absorption, distribution, metabolism and excretion of ingredients) are never examined or analyzed in any vaccine study?

There is, superficially, some truth in this statement.  Most pharmacokinetics are done prior to the clinical efficacy trials.  That is why there are phase 1 and phase 2 trials. The assumption being that if you exam influenza vaccine pharmacokinetic studies in one group it can be extrapolated to similar populations.  I think that is reasonable. So no, there are no pharmacokinetic studies in the clinical efficacy trials, those were done prior to the efficacy trials.  But it is not hard to find the phase 1 and 2 trials if you are so moved.

Milhalovic, could you please explain how the safety and mechanism of naturopathic nostrums in the human body are scientifically proven if their pharmacokinetics (the study of bodily absorption, distribution, metabolism and excretion of ingredients) are never examined or analyzed in any naturopathic nostrum study?

Is this getting old?  There is something to be said for repetition.

5. Could you please provide scientific justification as to how injecting a human being with a confirmed neurotoxin is beneficial to human health and prevents disease?

I presume the issue is mercury. Maybe aluminum. The latter is not in most vaccines, although as been discussed at length on this blog, the amount of mercury and aluminum found in vaccines is minimal and, at the dosing and formulation, has never been demonstrated to cause neurotoxicity from vaccines.  Of course, I am old school and think there is a dose response effect of drugs, and that a greater amount leads to a greater response.  Most naturopaths receive extensive training in homeopathy, where the less the amount, the greater the response.  So I would presume arguments based on chemistry would have little meaning to an ND, although I would not want my appletini made by a practitioner of homeopathy.

Of course, it is not the ‘neurotoxin’ that is being used to prevent disease, but the antigens of the potential infection. That is assuming that the author of the nine questions does not consider the antigens to be neurotoxins, and to judge from his understanding of disease later in the post, I am not so certain he warrants the benefit of the doubt.

Could you please provide scientific justification as to how applying naturopathy to a human being is beneficial to human health and prevents disease?

6. Can you provide a risk/benefit profile on how the benefits of injecting a known neurotoxin exceeds its risks to human health for the intended goal of preventing disease?

Since there is no longer mercury in most vaccines, I will assume, for the sake of argument, he is referring to aluminum.  Risk from aluminum in the H. influenza type b vaccine, where aluminium is used as a adjuvant: zero.

The benefit from the vaccine:

“From eight trials, the protective efficacy of the Hib conjugate vaccine was 84% (OR 0.16; 95%CI 0.08-0.30) against invasive Hib disease, 75% (OR 0.25; 95%CI 0.08-0.84) against meningitis, and 69% (OR 0.31; 95%CI 0.10-0.97) against pneumonia. Serious adverse events were rare.”

Seems a good trade off. No risk from aluminum, significant decrease in morbidity and mortality from disease.

7. Could you please provide scientific justification on how bypassing the respiratory tract (or mucous membrane) is advantageous and how directly injecting viruses into the bloodstream enhances immune functioning and prevents future infections?

Well, things really get off the rails here.  Vaccines are not injected into the blood stream, they are infected into the soft tissues.   At a simple level, an infection enters to body, the body makes a variety of antibodies to the constituent parts of the infecting organism and next time the patient is exposed, the pre-existing antibody can, if there is a match with new strain, inactivate the new infection.

It doesn’t matter how the antigen is presented to the immune system, the response is the same. Natural influenza, inhaled influenza vaccine, or injected influenza vaccine, the same antibody will be made to the proteins.

Mihalovic says later

“All promoters of vaccination fail to realize that the respiratory tract of humans (actually all mammals) contains antibodies which initiates natural immune responses within the respiratory tract mucosa. Bypassing this mucosal aspect of the immune system by directly injecting viruses into the bloodstream leads to a corruption in the immune system itself. As a result, the pathogenic viruses or bacteria cannot be eliminated by the immune system and remain in the body, where they will further grow and/or mutate as the individual is exposed to ever more antigens and toxins in the environment which continue to assault the immune system.”

This is what we call in the trade, gibberish. At least it makes no sense to me.  I will leave to the readers to search, Bible Code style, for truthiness in the above selection.

8. Could you please provide scientific justification on how a vaccine would prevent viruses from mutating?

That is actually a very interesting question. It has nothing to do with why we give vaccines and  I fear our intrepid ND does not have a firm grasp on what he is talking about as he says

“Despite the injection of any type of vaccine, viruses continue circulating through the body, mutating and transforming into other organisms. The ability of a vaccine manufacturer to target the exact viral strain without knowing its mutagenic properties is equivalent to shooting a gun at a fixed target that has already been moved from its location. You would be shooting at what was, not what is!”

Mutating and transforming into other organisms. Sigh.  Either the author is a sloppy writer  (sloppy writing (not typos, but logic and word selection) reflects a sloppy mind) or his understanding of microbiology is so profoundly mistaken it boggles the mind that he takes care of patients.  And in Oregon he would allowed by the state to prescribe antibiotics and other pharmaceuticals.

If you have a population of viruses and a specific antibody against the virus, then those naturally occurring mutants that are not recognized by the antibody should have a replication advantage.  It is possible that the vaccine can help select for new strains of an infection, but not new organisms.

Vaccines selecting for new mutants has been looked at for the Hepatitis B vaccine, and found not to be a issue.

In HIV, there is an ongoing interaction between the immune response and the virus, driving mutations that escape the immune system and, in some patients leads to a marked increase in HIV replication and a clinical decline decline. Oh wait, this is a natural infection. That shouldn’t happen.  It is the vaccines that do this.

There is nothing unique about the vaccine response acting as environmental pressure on the evolution of infections; the response from the natural infections should be the same.  I would wonder, since the response to  a natural infection is broader, with antibodies made to numerous parts of the infection, rather than the few key antibodies provided by the response to the vaccine, whether a natural infection would lead to a faster mutation rate.  As a rule in the microbial world, the more intense the stress, the faster and more varied the mutations.  More antibiotics leads to faster development of resistance in E. coli, not its delay.

9. Could you please provide scientific justification as to how a vaccination can target a virus in an infected individual who does not have the exact viral configuration or strain the vaccine was developed for?

Mr. Black and White.  Antibody response is not all or nothing, there is a gradient of response between the developed antibody and the site to which it is directed.  A good example is the H1N1 influenza.  People exposed to the strains from the first half of the century had antibody that was partially protective for the 2009 strain.  The reason?

“The pandemic influenza virus (2009 H1N1) was recently introduced into the human population. The hemagglutinin (HA) gene of 2009 H1N1 is derived from “classical swine H1N1″ virus, which likely shares a common ancestor with the human H1N1 virus that caused the pandemic in 1918, whose descendant viruses are still circulating in the human population with highly altered antigenicity of HA. However, information on the structural basis to compare the HA antigenicity among 2009 H1N1, the 1918 pandemic, and seasonal human H1N1 viruses has been lacking. By homology modeling of the HA structure, here we show that HAs of 2009 H1N1 and the 1918 pandemic virus share a significant number of amino acid residues in known antigenic sites, suggesting the existence of common epitopes for neutralizing antibodies cross-reactive to both HAs. It was noted that the early human H1N1 viruses isolated in the 1930s-1940s still harbored some of the original epitopes that are also found in 2009 H1N1. Interestingly, while 2009 H1N1 HA lacks the multiple N-glycosylations that have been found to be associated with an antigenic change of the human H1N1 virus during the early epidemic of this virus, 2009 H1N1 HA still retains unique three-codon motifs, some of which became N-glycosylation sites via a single nucleotide mutation in the human H1N1 virus. We thus hypothesize that the 2009 H1N1 HA antigenic sites involving the conserved amino acids will soon be targeted by antibody-mediated selection pressure in humans. Indeed, amino acid substitutions predicted here are occurring in the recent 2009 H1N1 variants. The present study suggests that antibodies elicited by natural infection with the 1918 pandemic or its early descendant viruses play a role in specific immunity against 2009 H1N1, and provides an insight into future likely antigenic changes in the evolutionary process of 2009 H1N1 in the human population.”

Oops.  Not simple.

But the result?

“Over 75% of confirmed cases of novel H1N1 occurred in persons < or = 30 years old, with peak incidence in the age range 10-19 years. Less than 3% of cases occurred in persons over 65, with a gradation in incidence between ages 20 and 60 years.The sequence data indicates that novel H1N1 is most similar to H1N1 viruses that circulated before 1943. Novel H1N1 lacks glycosylation sites on the globular head of hemagglutinin (HA1) near antigenic regions, a pattern shared with the 1918 pandemic strain and H1N1 viruses that circulated until the early 1940s. Later H1N1 viruses progressively added new glycosylation sites likely to shield antigenic epitopes, while T-cell epitopes were relatively unchanged.

CONCLUSIONS: In this evolutionary context, Original Antigenic Sin exposure should produce an immune response increasingly mismatched to novel H1N1 in progressively younger persons. We suggest that it is this mismatch that produces both the gradation in susceptibility and the unusual toxicity”

The better the antibdy fit for the epitope (where the antibody binds) the better the effect, but it doesn’t have to be all or nothing. Mihalovic would probably ask, what good is half an eye, why have half a wing, or half a brain?

He finishes,

“I have never encountered one pro-vaccine advocate, whether medically or scientifically qualified, who could answer even 1 let alone all 9 of these questions. One or all of the following will happen when debating any of the above questions:

- They will concede defeat and admit they are stumped.

- They will attempt to discredit unrelated issues that do not pertain to the question.

- They will formulate their response and rebuttal based on historical arguments and scientific studies which have been disproved over and over again. Not one pro-vaccine advocate will ever directly address these questions in an open mainstream venue.”

I am neither stumped not defeated. I know how to search Pubmed for medical information.

My response directed specifically to the questions.

My arguments are based on modern studies that a 12 year old can find in less than a minute, none of which have been disproved once, much less over and over.

SBM is an open mainstream venue.

I do feel like I just had won Jeopardy playing against Prof. R.J. Gumby; where is the honor in that?

And people wonder why I question the wisdom of allowing naturopaths to function as primary care providers.

ADDENDUM FROM THE EDITOR: Medical Voices has responded to this post by e-mail. We have published our response here.

Posted in: Vaccines

Leave a Comment (234) ↓

234 thoughts on “Nine Questions, Nine Answers.

  1. David Gorski says:

    Doctors Novella and Gorski want the entries to be formal, academic, referenced, with a minimum of snark.

    Not true (entirely). Occasionally snark is absolutely required. This is one example. Well done!

    After all, consider my other blog. Are you saying that snark is not a major part of what I do. I just don’t do it quite as much here.

    In fact, so pleased was I with this post that I sent a copy to the hapless naturopath Mihalovic by sending it to the “contact us” link at Medical Voices. I expect that the “refutation” (if Mihalovic has the guts) will be as clueless and full of misinformation as the first one. He has an open invitation to try to refute your post here in the comments. :-)

    I encourage our readers to do the same here:

    http://www.medicalvoices.org/contactus/mvvic.html

  2. weing says:

    Excellent post. This Mihalovic apparently does science by declaration. What he declares is true. No need to do research.

  3. rork says:

    There’s another post at MedicalVoices with claims about the smallpox vaccine being useless at best. “Smallpox Vaccine: Origins of Vaccine Madness”. I might benefit from expert help to understand where it fails, since lots of it is about history more than 100 years ago. For example if and why large outbreaks occurred after (supposedly) thorough vaccination campaigns.
    I’m not sure it’s worth an expert’s time though.

  4. daijiyobu says:

    I’m looking right now for a bio. on the guy. I’m curious as to which school he attended, just for a sense of his ND-incredentials.

    -r.c.

  5. Hubbub says:

    More Mark Crislip!

    My guess is he will claim that all of your cited studies are “long-discredited”, a status he will define as “I have made a dubious argument on my website based upon fundamental misconceptions that allows me to ignore all studies of this kind”.

  6. Kimbo Jones says:

    I love that he set it up so that any response can be dismissed as a non sequitur or based on “disproved” (so far as he’s concerned) studies. So no one can prove him wrong – not because they don’t have the evidence, but because he decided a priori not to listen to the explanation.

  7. Becca Stareyes says:

    You know, actually I did get my last vaccine (a flu shot, don’t remember if it was the seasonal strain or H1N1) via my mucous membranes in my nose, rather than a soft-tissue injection. I suspect this was more because most people don’t really like being jabbed with needles anyway*, even if it’s delivering something good for you, than any thoughts about ‘shot in your arm to fight a respiratory infection’. After all, humans have this wonderful thing called the circulatory system…

    (* It worked — I, personally, am much more willing to get my flu vaccinations if I don’t have to be poked by a needle, even if the immune response to ‘saline with viral proteins up the nose’ is ‘feel stuffed up for the rest of the day as the immune system does its learning’, while I usually have less of an immune reaction to a shot. Ew, needles…)

  8. Zoe237 says:

    Very interesting! I hadn’t even thought of #4. Another thing that might help is explaining to people the reasons why “organic vaccines” are NOT the same issue as organic food.

    This was no ordinary snark. It was actually funny. :P

    I’d like to see a response to this article below, because honestly, to me spreading out vaccines a little bit for families who WOULDN’T OTHERWISE vaccinate seems prudent to me (and I hadn’t realized that the AAP recommends exactly that, if no other option). Yes, I know, the schedule hasn’t been tested, but I fail to see the harm in giving shots at 2,3,4,5,6, 9,12, 18 months rather than 2,4,6, 12 (besides more shots, more doctor visits). No, there is no good reason to do so, but 39% of parents refusing one or more is a lot bigger percentage than I thought. Most of the moms I know are totally for polio vax, mmr, dtap. They don’t understand gardasil or hep b for newborns.

    http://www.huffingtonpost.com/dr-bob-sears/vaccine-health-what-to-do_b_563334.html

  9. Wicked Lad says:

    > [C]ould Mihalovic please provide one double-blind, placebo-controlled
    >study that can prove the safety and effectiveness of naturopathy?

    …etc. How about, could Mihalovic please provide one falsifiable naturopathic hypothesis?

  10. Scott says:

    The other important point is that, if presented with these arguments on the street or in a bar, most vaccination advocates *wouldn’t* be able to provide citations. It’s entirely unreasonable to expect otherwise, but it gives Mihalovic a fig leaf to point to.

    He, of course, is not familiar with such limitations; those who just make everything up on the spot don’t understand that those who want to make sure they’re right need to do research…

  11. TsuDhoNimh says:

    RORK – In that article, he is confounding variolation (using the vaccine-loaded lymph from true smallpox eruptions) with vaccination (using the vaccine-loaded lymph from cowpox eruptions) … although variolation would scare the crap out of us today, when done by the traditional methods it had a very low death rate.

    Like any “traditional method”, when variolation left its native area and was adopted by others the others screwed it up. It is notable that amateurs who followed the directions had high success rates and low rates of complications – the ones who thought they knew better who were the problem. Instead of quarantining the patients, the Europeans let the patients wander around and start epidemics. Instead of the few, shallow scratches, the eminent physicians decided (with no proof) that deep slashes would be better and weren’t happy until the patient had oozing infections (laudable pus was still ion vogue). Instead of cool rooms and lots of liquids the Europeans prepped the patients by bleeding, purging and kept them in hot rooms … it’s a wonder they didn’t kill more people than they did.

  12. Kerry Maxwell says:

    That was no mere fisking, that was a de-pantsing! I can only hope this pantsless clown shows up here to comment.

  13. Ash says:

    Excellent post, Mark. This is the sort of stuff that keeps bringing me back to SBM – a thorough, rational demolition of unscientific beliefs, with just the right amount of “snark” when needed. You’re setting the bar pretty high for the rest of us science/medical bloggers :)

  14. Martin A. Lessem, J.D. says:

    As an avowed hater of needles, I am sometimes surprised at just how much in favor of medical science I am. I recently began a course of Allergy Vaccinations, which based on what I have been told don’t really work the same way as other vaccines, in that you have to keep getting the shot in increasing strength and dosage on a weekly basis until you reach maintenance levels, and then it is every other week or so. To me this is decidedly not fun, although I guess it is a good way to cure my dislike of needles.

    My point here is that as the son of medical professionals, I usually research treatments before I start them, and while this can involve just asking my Father (M.D., Ph.D., FACC) or in some cases my Mother (R.N.), I also do my research online using PubMed as a starting point, and usually tossing the FDA website in for good measure if it is a specific medicinal treatment I am contemplating. A recent and wonderful example of where this came into play was with my hypertension medication. My insurance has raised the rates of the medication I currently take, a angiotensin II receptor antagonist, so I called them to find out why, and was told it is not an approved brand. They in turn recommended the following; Avapro, Diovan, Toprol-XL or Olmetec.

    I started in the logical place, with my Father, the cardiologist. His instant response was to curse the stupidity of Insurance companies and tell me to swallow the higher cost unless I switch to Olmetec. I was a little bit intrigued by this so I did what “Dr.” Mihalovic apparently does not know how to do, I researched it. Imagine my surprise when I discovered that Olmetec is the only one of the four which uses the same API (Active Pharmaceutical Ingredient) and that Toprol-XL doesn’t even use the same method of action. Remember, these recommendations were given to me based on the fact that they are all Hypertension drugs with little or no knowledge of my specific situation, which is complicated by a controlled asthma. In the UK, Toprol-XL is no longer used as a front-line treatment due to an increased risk of diabetes with Beta blockers.

    My end point here is that knowing how to do research into medicinal topics is very important, and the old “they admit they are stumped” canard is, at the very best a joke. True, a Doctor may not know all the answers up front, but that doesn’t mean that with a bit of research they can’t figure most things out, especially something for which over 400 studies exist.

    -Martin A. Lessem, J.D.

    *DISCLAIMER* I work for a Pharmaceutical Company in the Regulatory Department. The views expressed in my comments, articles and YouTube Channel are my own unless otherwise noted. I have worked for both Innovator and Generic companies and industry-wide organizations. My degree is in Law with a background in Political Science, and aside from a few college classes on the biology of disease and forensic science (the autopsy was the neatest thing ever!) I have no formal scientific background.

  15. windriven says:

    I am … agog. It is inconceivable to me that any rational being would question the efficacy of vaccination. The Puswhisperer alluded repeatedly to the prima facie evidence: the virtual elimination of smallpox. But one can also consider polio, measles, mumps and tetanus.

    These Luddites must ascribe the decline of these diseases from curse to curiosity to magic crystals or, for the less irrational among them, better handwashing techniques. Oh that we could encourage them to eschew vaccination without endangering herd immunity for the rest of us. Also sprach Darwin.

  16. windriven says:

    And as an aside, I’m all for a little more snark and a little more edge at SBM. Science needn’t be straight-laced to be serious. Admittedly, the line between edgy and over-the-edge can be narrow. But seemingly only some of us in the chorus spend too much time on the wrong side of that line. The SBM bloggers could let their belt buckles out a notch without danger.

    Humor can make people uncomfortable and that is sometimes what it takes to get people to move out of their comfort zones and get them thinking about and questioning long-held positions.

  17. Th1Th2 says:

    Mark Crislip,

    “Vaccines are not injected into the blood stream, they are infected into the soft tissues.”

    That was a sloppy argument. You think vaccine ingredients are never absorbed into the blood stream?

    At least you know that vaccination is equivalent to infection. Most vaccine apologists would disagree with you, I guess.

  18. SkepticalLawyer says:

    Despite the injection of any type of vaccine, viruses continue circulating through the body, mutating and transforming into other organisms.

    I have to thank Mihalovic. My doctor (M.D.) couldn’t explain what happened to me a few months ago, but I think now I understand. I started out with what was a common cold, but it turned into a common dolphin (Delphinus delphis). It was very painful.

  19. weing says:

    Th1,

    As usual, your knowledge is based on a misspelling or a misreading.

  20. Peter Lipson says:

    Even more brilliant than usual, Mark.

  21. squirrelelite says:

    @zoe237:

    Dr Sears’ proposal has been discussed several times on SBM and elsewhere.

    John Snyder discussed Dr Bob Sears’ alternative, delayed schedule here:

    http://www.sciencebasedmedicine.org/?p=512#more-512

    which Dr Gorski called an awesome summary.

    Dr Novella discussed Dr Paul Offit’s response to Dr Sears’ suggested schedule in this blog:

    http://www.sciencebasedmedicine.org/?p=333#more-333

  22. Noe says:

    “And in Oregon he would allowed by the state to prescribe antibiotics and other pharmaceuticals.”

    As an Oregonian, I can only hope he views all real medications as “toxins”.

  23. mikerattlesnake says:

    ““Vaccines are not injected into the blood stream, they are infected into the soft tissues.”

    That was a sloppy argument. You think vaccine ingredients are never absorbed into the blood stream?”

    And where, exactly, do you think the things you breath in or eat end up?

  24. Enkidu says:

    Ugh. I’ve had anti-vaxers ask me questions 1-3 many times, and it gets old answering them. They never bother to see if there is any validity to these questions, and when they ask them they assume them to be unanswerable. *sigh* Why is it that when an anti-vaxer says something to me, I go and look up what they are saying to see if there is any truth to it, but for the most part, they go around parroting what all their buddies say as gospel without checking facts and sources?

    As for question #9, that has got to be one of the dumbest things I’ve ever heard; of course I work with antibodies every day, so I actually, you know, KNOW how they work and bind. *le sigh part 2*

  25. colli037 says:

    Anti-vaxers are just another sort of fundamentalist. Like any fundi they only repeat what their “pastor” (charismatic leader) has told them as the “gospel truth” and have turned off the thinking part of their brain.

    Just like any fundi, they are not interested in a dialog, or learning or hearing your opinion. And like most other fundi’s they tend to magnetically attract other fringe beliefs (Something I’d observed occasionally in the past, but becomes really apparent on the internet)

  26. Zoe237 says:

    Thanks, squirrelelite, I’ve read those, along with Offit’s response to the Sears schedule in “Pediatrics.” I keep hearing that the schedule hasn’t been tested or researched. That it causes more shots and more doctor visits, and that there is a longer gap (which, as far I can tell, is a matter of months) of being vulnerable to infectious disease. But this article in HuffPo presents two new ideas to me 1)AAP recommends spreading out vaccines *IF* that’s the only way mothers will accept them. And 2)39% of parents have refused one or more vaccines.

    Bottom line, everybody here hates Dr. Sears, but his ideas seem reasonable to me since I’ve started reading them within the past few weeks. The fact that countries all around the world have different vaccine schedules, some with 12 shots rather than 26, says to me that there ARE different, safe schedules. The “either you’re for us or against us” mindset is rather strange to me. Now, I don’t have a passion either way on this, my kids are fully vaccinated and 100% healthy. I would hate, however, to see more and more parents refuse because of inflexibility in the “5-6 shots for every baby every two months” rule. Then infectious diseases could come back. The CDC got rid of thimerosol, despite lack of evidence of its danger, so there apparently is some interest in extending the proverbial olive branch.

  27. Prometheus says:

    Can I play?

    7. Could you please provide scientific justification on how bypassing the respiratory tract (or mucous membrane) is advantageous and how directly injecting viruses into the bloodstream enhances immune functioning and prevents future infections?

    Yes! The innate immune responses present at the respiratory and gastrointestinal mucosa would prevent a small amount of antigen (such as that present in a vaccine) from stimulating the adaptive immune system enough to provide any significant degree of immunity to the disease.

    As noted above, vaccines are not injected into the bloodstream – the intent is that the components of the vaccine remain in the subcutaneous tissue, where they can stimulate the immune system best. Injecting them into the bloodstream would actually reduce the immune response to the vaccine, in most cases.

    Placing larger amounts of antigen directly on the mucosa might work, but that would not only be wasteful, it would raise the risk of an adverse reaction (e.g. anaphylaxis) to the vaccination in the event there is a break in the mucosal layer (e.g. scratches from food or tooth injuries to the inside of the mouth).

    Attenuated virus vaccines face the same problem unless they – like the attenuated polio, influenza and rotavirus strains – are able to infect the mucosal cells. There is increasing interest in developing such strains, but there are technical hurdles that have yet to be overcome with some (e.g. measles, mumps and rubella).

    With some attenuated strains – especially for viruses that infect the respiratory epithelium – it may actually be safer to inject the attenuated virus, since even the attenuated virus may be able to cause symptomatic infection if it is placed directly on its “preferred” tissue type.

    8. Could you please provide scientific justification on how a vaccine would prevent viruses from mutating?

    Easy! It doesn’t!

    For that matter, what was there in the pre-vaccination world that kept smallpox, measles, mumps, rubella, hepatitis B and influenza from mutating in order to get a “second chance” at people who had recovered from the disease and were now immune?

    Nothing. It was a trick question. In fact, influenza does mutate enough that immunity to last year’s strain gives you little or no protection from this year’s strain.

    Measles, mumps, rubella and even smallpox mutate much faster than humans, so the fact that those diseases gave their victims life-long immunity from future mutated version of the virus is due to the nature of the antigen that our immune system target in those viruses. As it turns out, there are some proteins that even viruses can’t afford to “mess with”; those proteins (antigens), if they are exposed, make good targets for the adaptive immune system and vaccines.

    The interesting question is why viruses such as smallpox, herpes, measles, mumps, rubella and many others that leave long-term (or life-long) immunity don’t seem to mutate enough to “evade” the immune system while others (influenza, HIV, etc.) do.

    Frankly, if smallpox, measles, etc. didn’t evolve the ability to mutate enough to evade immunity in the 200,000 years of human history before vaccines, I think there is little reason to worry that vaccines will suddenly select for “hyper-mutating” strains. From the virus’ point of view, it’s all the same.

    So, “Dr.” Mihalovic has considerately shown he – and presumably other “naturopaths” – has no more understanding of vaccines, immunology and virology than my cat. One can only hope that “Dr.” Mihalovic is as good at catching mice.

    Prometheus

  28. Versus says:

    Mr. N.D. says:
    “Bypassing this mucosal aspect of the immune system by directly injecting viruses into the bloodstream leads to a corruption in the immune system itself. As a result, the pathogenic viruses or bacteria cannot be eliminated by the immune system and remain in the body, where they will further grow and/or mutate as the individual is exposed to ever more antigens and toxins in the environment which continue to assault the immune system.”

    Does this mean that all the bacteria which entered my body over my lifetime through cuts and scrapes are still in there growing and mutating? Does this mean my immune system is corrupt? Funny, I don’t feel sick.

  29. eve_kendall says:

    Zoe237:

    I think the biggest problem with the suggestion is this:

    1)AAP recommends spreading out vaccines *IF* that’s the only way mothers will accept them.

    I haven’t seen any real evidence to suggest that parents will be more likely to vaccinate their kids if the schedule is spread out more. And (this part is purely my opinion, based on the evidence available to date) it’s not worth the risk of infections that could have been prevented by earlier vaccination to find out.

    This is a difficult thing to get a definitive answer on. Sure, you could ask parents whether they’d be more likely to vaccinate their kids completely if you spread the schedule out, but there’s no way to know that they’ll actually follow through even if they say yes. And the track record of anti-vaccinationists does not inspire confidence here. I suspect that if you did spread the schedule out, they’d simply move on to yet another entry on their massive list of excuses for not vaccinating. “Toxins,” still-undiscovered “long term side effects,” mind control, whatever. Name your poison.

  30. Chris says:

    And Mihalovic proves quite conclusively the “ND” stands for “Not a Doctor”!

    I tried to find out more about through the University of Google, perhaps where he was educated. But what I mostly found was that silly article on the nine questions posted all over the place.

  31. orange lantern says:

    Zoe,

    In the pediatrics world, I think there are two main schools of thought concerning alternate vaccine schedules, and both of them have some merit.

    The first is to not entertain alternate vaccine schedules because they are not based in science. The merit to this is that pediatricians stand by vaccines and are not being wishy-washy about it, which promotes confidence in vaccines. Also, even though some patients will leave the practice, many will ultimately choose to vaccinate because they want to stay with their provider. Overall vaccination rates may be higher with this philosophy.

    The second is to strongly advocate for vaccines but allow patients to use an alternate schedule (or not vaccinate at all) if they would otherwise leave the practice. This is the position held by the AAP, and the vast majority of pediatricians according to a recent poll. 80+ percent of pediatricians will not dismiss a family for vaccine refusal. Some physicians have their patients sign a waiver if they do not follow the recommended schedule, and one is available on the AAP site.

    The merit to this philosophy is that it doesn’t punish the child from a medical care perspective due to the parents’ poor choices, and also spreads out the risk of unvaccinated children (as in, if you funnel undervaccinated children into a small number of care providers you increase the chance of an outbreak). The concern is how well the physician advocates for the safety and efficacy of vaccines before deciding to use an alternate schedule

    Of course there are other schools of thought, but these are the main ones among those who advocate for vaccination.

    The fact that other countries have different vaccination schedules is not a strong argument that alternate schedules in the US are a good idea. Other contries have a variety of financial, cultural, logistical, and epidemiological reasons for selecting their vaccines.

    Also, the 39% refusal statistic doesn’t indicate which vaccines are refused. A lot of them could be flu shots or older child boosters, or HPV, and I doubt many physicians consider dismissing their patients for refusing them.

  32. squirrelelite says:

    @Zoe237,

    Perhaps it might help if you think of the CDC recommended vaccination schedule as a delicate balancing act.

    Some shots, especially the additional booster shots for the same disease, need to be spaced out so that the body has time to respond to the first shot before the booster is given to stimulate additional response.

    Also, from a simple troubleshooting point of view, it is better to limit the number of shots at one visit to only a few (i.e., 3,4, or 5, not 20 for instance). Major bad reactions are rare, but they do happen sometimes and this limits the number of candidate causes to worry about.

    And, it is important to minimize the vulnerable period for the diseases being protected against. Babies may be born exposed to Hepatitis B, so this vaccination is given at birth. Other vaccinations can be postponed a few months till the baby is a little older and a lot bigger! But, in the meantime, the baby is vulnerable. Babies have died from being exposed to pertussis before they were old enough to receive the standard scheduled vaccination. This is where Dr Sears’ schedule really causes problems because it extends this vulnerable period.

    Keep in mind that the Huffington Post and other sites regularly post articles which tell their readers that:

    – vaccines have dangerous side effects (there are side effects, but they are rare and much less common and even in the extremely rare, most severe case of death, they cause far fewer deaths and other long-term side-effects than the wild disease would cause in an unvaccinated population)
    – vaccines are connected to diseases/conditions such as autism
    – the wild diseases aren’t that bad
    – the diseases have almost been eradicated or were going away anyway

    Thus, they are already working to increase the fear and distrust of vaccines.
    Then they note that:

    1) AAP recommends spreading out vaccines *IF* that’s the only way mothers will accept them. All right, later is better than never, but sooner is usually better than later. And why are mothers reluctant to accept the vaccines? Just read the Huffington Post.

    And 2)39% of parents have refused one or more vaccines. At best, this is only an argumentum ad populum. A lot of people don’t want to do it so it must be a bad idea. But, the scientific method is not a popularity contest. It is based on making predictions that can be tested and replicated. For the CDC schedule there is a large, interlocking body of various tests to show that the individual shots work and are safe. Also, it shows that they work and are safe when they are given together as scheduled.

    For Dr Sears’ delayed schedule, a lot of this work still has to be done. Perhaps Dr Sears should be advocating for money to conduct a large scale prospective randomized controlled study to look at benefits and risks (such as additional unprotected infections) as well as costs and completion success rate. The ethics of such a study may be dubious, but at least they are better than a completely unvaccinated versus vaccinated study.

  33. Joe says:

    Zoe237 on 07 May 2010 at 2:39 pm wrote “… Bottom line, everybody here hates Dr. Sears, but his ideas seem reasonable to me since I’ve started reading them within the past few weeks.”

    We use science to separate the reasonable from the factual. George Washington’s doctors thought they were doing the “reasonable” thing when they bled him to death.

    Zoe237 on 07 May 2010 at 2:39 pm wrote “The fact that countries all around the world have different vaccine schedules, some with 12 shots rather than 26, says to me that there ARE different, safe schedules. “What evidence do you have that the alternate schedules are equally safe and efficacious as the one proposed by the CDC?

  34. Zoe237 says:

    “And 2)39% of parents have refused one or more vaccines. At best, this is only an argumentum ad populum. A lot of people don’t want to do it so it must be a bad idea. But, the scientific method is not a popularity contest. It is based on making predictions that can be tested and replicated. For the CDC schedule there is a large, interlocking body of various tests to show that the individual shots work and are safe. Also, it shows that they work and are safe when they are given together as scheduled”

    No, my (tentative) argument is that if 39% of parents are refusing one or more, then maybe those uninformed parents should be given the option of spacing them out more, and they’ll be likely to at least get all of them, albeit more spread out. There is at least one pedi practice in my town who kicks out patients for being non-vaxers, and another that is willing to spread them out if the parents request it. The latter is getting more and more popular. (I don’t go to either, both too big for me). I have another friend who only goes to a chiropractor now.

    That’s the other rationale I’ve heard for limiting shots to one or two: that you can then tell (within two) which one caused an allergic reaction (if it does) and continue with the others.

    The truth is that the vaccine schedule seems to me to be a matter more of practical concerns- when can we get kids into the doctor to get the job done efficiently? Than safety concerns. Wasn’t the hep b recommended for teenagers for a decade before they decided that wasn’t working because of low vax rates and moved it to newborn?

    The other thing that bothers me is that never ever do I see on these blogs a single criticism of any aspect of vaccinations (currently) in the good ‘ol USA. It reminds me of George Bush denying that he’s ever made a mistake in 8 years. It’s like if you criticise, say the cost of gardasil, you’re kicked out of the good ‘ol boys club. That, and the fact that something like 2/3rds of hcw refuse the flu shot makes me wonder if the blogging world is a little… unrepresentative.
    http://www.nytimes.com/2009/09/21/nyregion/21vaccine.html

    BTW, Dr. Sears schedule recommends pertussis vax at 2, 4 and 6 months. Let me clear: I believe his diatribe about aluminum and other toxins is utter nonsense. But I don’t think it’s gonna kill children if a few give their children hep b vax at six months rather than newborn. It will, however, lead to deaths if a significant minority of parents are kicked out of peds practices for not wanting to give that six shots at the two month appointment, and they opt out of the system altogether at that point rather than be offered an alternative.

  35. Draal says:

    As a rule in the microbial world, the more intense the stress, the faster and more varied the mutations. More antibiotics leads to faster development of resistance in E. coli, not its delay.
    As stated, this is just wrong.

    Mutation rates are, for the most part, constant. Take for example, point mutations. The duplication of DNA or RNA is performed by their respective polymerases, each having a constant error rate, which results in point mutations. Adding antibiotics (for say bacteria) or antibodies (for say viruses) does not change the error rate of mutations. What does change the rate of point mutations is when you add a mutagen, carcinogen or use UV radiation, or the polymerase itself is mutated.

    Since the rate of mutations is fairly constant, what does change is the proliferation of a mutant strain due to selective pressure. The vast majority of mutations are deleterious, resulting in a negative attribute to the strain’s fitness (ability to rapidly duplicate). Without selective pressure, the wildtype has the best fitness and can out compete almost all other mutant strains resulting in the wildtype being the predominant strain that is present in a system.
    When you add a selective pressure, mutant strains now have a chance to become the predominant strain even though they have a lower fitness compared to the wildtype under no selective pressure. The mutant strain may not replicate as fast, but under selective pressure, it can replicate faster than the wildtype whose fitness is now severely decrease by the selective pressure.

    For example, an HIV patient will have a viral load that is predominantly one type (wildtype). Upon treatment with say a Nucleoside/Nucleotide Reverse Transcriptase Inhibitor, the viral load can decrease below a detectable level. But after a few months, the viral load increases again as mutant strains begin to emerge and proliferate; the wildtype is no longer the predominant strain. Upon stopping the treatment of the NRTI, the viral population will revert back to being predominantly wildtype. Starting the NRTI treatment again does not work because the time it takes for the mutant strain to re-establish itself as the dominant strain is a much short time frame than the first treatment because the mutant strain is already part of the viral population.

  36. Mark Crislip says:

    I do not think it is unture as stated, perhaps simplistic.

    In response to nutritional or other stress, bacteria can increase their mutation rates in an attempt to escape (i know, badly phased)

    And there was a study recently which I couldn;’t find but meant to reference (nature? science?) where there exposed e coli to additive, synergistic or antagonistic or neutral combinations of antibiotics and found the synergistic combo bred resistance faster.

    I am going from memory here, but I beleive the details to be correct. I’ll keep looking for the ref.

    And that brings up MRSA, USA 300 strain. I have never understood why this multiple resistant mutant has out competed MSSA in the community when there is no antibiotic ie selective pressure and it should be at a disadvantage.

  37. overshoot says:

    First things first: Dr. Crislip, you are having waaaaaay too much fun.

    Secondly: WRT the efficacy of vaccination programs, I’ve been using the following challenge for the last decade-plus (IIRC first use was 1997).

    You take a disease: polio, measles, mumps, rubella, diphtheria, pertussis, HiB, varicella [1]
    You pick a country — anywhere that has been keeping M&M statistics for the disease in question.
    Find me one instance where the introduction of mass vaccination was not followed by a p<0.05 drop in the morbidity and mortality from the disease, as measured between the ten years before and ten years after mass vaccination.

    From time to time I've offered to put up a few thousand bucks in escrow if the antivaxx spewer would do the same, results to be decided in case of dispute by professional arbiter, costs borne by loser.

    I've never had a taker. The excuses have been priceless.

    [1] The list has been changing over the years, of course.

  38. Zoe237 on alternate vaccine schedules:
    “But I don’t think it’s gonna kill children if a few give their children hep b vax at six months rather than newborn.”

    Why not? Do you think Hep B is never fatal? Or do you think it’s not possible to contract it between 0 and 6 months?

    micheleinmichigan posted a comment referencing the WHO on Hepatitis B recently:

    http://www.sciencebasedmedicine.org/?p=4960#comment-50581

    “The main ways of getting infected with HBV are:

    perinatal (from mother to baby at the birth)
    child-to-child transmission
    unsafe injections and transfusions
    sexual contact.”

    “I think parents need to understand that it is a possibility that a child at daycare, preschool or school or in the neighborhood may have Hep B.”

    What pediatricians are concerned about is exactly that unvaccinated infants are vulnerable to contracting vaccine-preventable diseases. If an infant contracts Heb B they may develop a chronic infection and die of it. Adults are more likely to clear it from their systems in a few months.

    Pediatricians think children will die if they receive vaccines at age 6 months instead of as newborns. On what basis do you disagree?

  39. Prometheus says:

    Dr. Crislip asks:

    “And that brings up MRSA, USA 300 strain. I have never understood why this multiple resistant mutant has out competed MSSA in the community when there is no antibiotic ie selective pressure and it should be at a disadvantage.”

    Two points to consider:

    [1] Has MRSA outcompeted MSSA or is there a selection bias at work?

    Staphylococcal infections are very common in the community, but most of them aren’t cultured because they respond to either home care (and don’t come to a doctor’s attention) or empiric antibiotic therapy.

    Culturing bacterial infections is more likely to occur when “the usual therapy” has failed to treat the infection (or when the infection is serious). This would tend to select for those bacteria that are resistant to “the usual”.

    [2] There is a lot of selection pressure for antibiotic resistance in the environment, where bacteria and fungi routinely secrete antibiotics in order to kill off the competition.

    Despite the current medical microbiology fascination with hospitals as the source of multi-drug-resistance plasmids, the genetic data suggest that those plasmids pre-date the antibiotic era. It was our use of antibiotics that gave bacteria infecting humans the selective pressure to start carrying this environmentally-derived plasmid.

    Prior to antibiotics, bacteria infecting humans only needed to evade the immune system, so there was no benefit to carrying a large parasitic DNA element (plasmid) that was no benefit and only served to slow replication. Now, the costs of carrying the plasmid are less than the benefits.

    The question of why synergistic antibiotic use speeds the development of resistant strains is also answerable in terms of bacterial ecology.

    There are two ways for bacteria to tolerate antibiotics – resistance and persistence.

    Resistance has been recognised for decades and is what most people think about when they look at infections that won’t “go away” when treated with antibiotics.

    Persistence, on the other hand, is a relatively new concept (although an ancient “strategy”). “Persistors” are bacteria that are dormant – with minimal metabolic activity – for prolonged periods. Most strains of bacteria have a certain percentage of persistors at any and they appear to go “dormant” at random (although there is some indication that “stress” can induce dormancy) for variable periods of time.

    Since most antibiotics are only effective on growing, metabolising bacteria, the persistors are able to tolerate pretty much all antibiotics while they are dormant. Those that manage – by random chance – to remain dormant during the time the antibiotic is at a lethal concentration will survive. It may be only a small proportion of the total, but when you’re talking about billions and even trillions of bacteria, a small fraction is still a large number.

    So, treating with one antibiotic will leave you – at the end of therapy – with a mixed population consisting of antibiotic resistant bacteria and persistors that are still sensitive to the antibiotic. When the bacterial population regrows, the antibiotic-sensitive persistors, which are typically in larger numbers, will dominate.

    Treating with two antibiotics – especially if the two have very different pharmacokinetics – will narrow the windows of time when the persistors can grow and replenish their numbers. As a result, at the end of therapy, all you will have are the bacteria resistant to the two antibiotics (and a very small number of extraordinarily long-term persistors).

    The antibiotic-resistant bacteria, starting with an edge in numbers, will rapidly become the dominant members of the population.

    Prometheus

  40. Draal says:

    I do not think it is untrue as stated, perhaps simplistic.

    Being simplistic will often mean it’s not ‘technically’ accurate. That was what I was trying to get at with your explanation. I feel that your audience is scientifically savvy enough to have some statements technically accurate. Everyone here may believe in evolution but I think further explanations on the many, many mechanisms involved should be spelled out better.

    I have never understood why this multiple resistant mutant has out competed MSSA in the community when there is no antibiotic ie selective pressure and it should be at a disadvantage.

    I’m not familiar with what exactly makes MRSA have multiple resistances. Species can transfer genes to each other (called horizontal gene transfer); so one organism can acquire resistance after a resistance gene is laterally transfered from another organism. Mutations to efflux pumps is another example where one mutation can result in multiple drug resistance.

    One other point. Not all mutations are deleterious. Just the majority of them. Mutations that give an organism a fitness advantage can and does occur without any new selective pressures. A mutation that gives a strain the ability to out compete for resources will have an advantage over it’s parents, siblings and peers.

  41. Draal says:

    Prometheus’ example of plasmids is another excellent example how microorganisms can acquire new traits. The millions of bacterial viruses are other vectors in which genes can be acquired from the environment.

  42. manixter says:

    Don’t forget about polio! Eradicated in the US, to the extent that we now use the less effective Salk vaccine, since the risk of being exposed to wild-type polio is no longer worth the risk of Sabin-related polio.
    How about diptheria? Tetanus? Measles? Mumps? Rubella? Rabies? (mostly animals and vets). Chickenpox?
    How about the HIb vaccine? We don’t see epiglotitis anymore (thank GOD!).
    The ability of the body to mount a comprensive immune response to an antigen injected into the skin was first taken advantage of with smallpoz, then polio (before the sabin vaccine). It is a boon in medicine, since we don’t have to bypass the very effective ability of the gut to break down (into smaller than immunogenic components) other compounds.
    And apparently I do a great deal of beer research too…

  43. Draal says:

    And there was a study recently which I couldn;’t find but meant to reference (nature? science?) where there exposed e coli to additive, synergistic or antagonistic or neutral combinations of antibiotics and found the synergistic combo bred resistance faster.

    Wrong again! It’s from PNAS. Ha!. j/k

    Accelerated evolution of resistance in multidrug environments
    Author(s): Hegreness M, Shoresh N, Damian D, et al.
    PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA Volume: 105 Issue: 37 Pages: 13977-13981 Published: SEP 16 2008

    The terminology that the authors use is increase in “rate of adaptation”, not increase in mutation rate.

  44. Mark Crislip says:

    When writing an essay, you always make decisions about what topics you are goring to expound on and what comments are made in passing ie are simplistic. Sometimes the point is the earth is round, but it will always be pointed out that it is an oblate spheroid. As I understand the issue at hand, I think it is accurate at the level of approximation to make the point without digressing from the main topic.

    Never fails that a minor point always becomes a point of contention.

    If the essay were a painting of the forrest someone will always note that the shade of green is off for one of the leaves in that oak over there.

    Thank you draal, this is the reference.

  45. Zoe237 says:

    Why not? Do you think Hep B is never fatal? Or do you think it’s not possible to contract it between 0 and 6 months?

    micheleinmichigan posted a comment referencing the WHO on Hepatitis B recently:

    http://www.sciencebasedmedicine.org/?p=4960#comment-50581

    “The main ways of getting infected with HBV are:

    perinatal (from mother to baby at the birth)
    child-to-child transmission
    unsafe injections and transfusions
    sexual contact.”

    Alison, my sixth month old isn’t even playing with other kids or in other care besides mine, hubby, or grandparent. Considering I don’t have hep b, yes, I think it basically impossible. If there was some chance that my married for 25 years mother had hep b and didn’t know it (and all 3 of us are vaxed for it), I’d consider it one in a million, maybe one in ten million.

  46. Chris says:

    Zoe, do you plan to let your child interact with any other children in the next few years? Anyway, do be prepared for fluid passage from one child to another:
    http://pkids.org/pdf/phr/02-07mcdonaldsstory.pdf

  47. JMB says:

    Nice entertaining article.

    “5. Could you please provide scientific justification as to how injecting a human being with a confirmed neurotoxin is beneficial to human health and prevents disease?”

    Do naturopaths warn their patients about Botox injections? Will naturopaths lose their license if they have a Botox injection? Can an antivaxxer keep a straight face warning about neurotoxins in vaccines when they have had a Botox injection? Answer — Yes, if they were careful to overdue their last Botox injection.

    “7. Could you please provide scientific justification on how bypassing the respiratory tract (or mucous membrane) is advantageous and how directly injecting viruses into the bloodstream enhances immune functioning and prevents future infections?”

    Do naturopaths know the difference between the lymph stream and the bloodstream? Do naturopaths know the difference between intradermal, subcutaneous, intramuscular, intravenous, and intraarterial injections?

  48. Zoe237 on alternate vaccine schedules:
    “But I don’t think it’s gonna kill children if a few give their children hep b vax at six months rather than newborn.”

    “[M]y sixth month old isn’t even playing with other kids or in other care besides mine, hubby, or grandparent. Considering I don’t have hep b, yes, I think it basically impossible.”

    Zoe, I interpreted your first comment as saying you didn’t think any children could die from being left vulnerable to HepB for their first six months of life. I see that you meant your child wouldn’t, especially given the hindsight that the first six months have already been achieved without any extraordinary event that would cause your child to have contact with other children or with improperly-tested blood products. That is a different statement, and I agree, if you happen to know that your child could not have been exposed to HepB then your child does not have HepB. Especially given that they are vaccinated! :)

  49. Harriet Hall says:

    Zoe is absolutely sure her child is not at risk from the virus. I’m not so confident. One of the reasons for early vaccination for everyone is that lab tests are not 100% reliable at detecting which individuals are at risk. Even knowing my own status, I would be worried about lab error, unanticipated factors, unforeseeable accidental exposures, etc. and I would want my child vaccinated just in case. I want the best insurance for my child. I don’t omit the car seat just because I am a safe driver and have a relatively crash-proof car.

  50. Enkidu says:

    Being the parent of a baby born 3 months premature, people often ask me if I delayed her vaccinations.

    No way Jose! She is at high risk for complications from disease, and I’ll do anything to try to minimize that. She got all her vaxes on time, starting with the HepB and the recommended 2 month shot series at an adjusted age of -1 months old. So parents that are afraid to give their “fragile” babies more than 1 vaccine at a time, or none at all until they are past toddlerhood, my preemie is made of sterner stuff. :)

  51. TsuDhoNimh says:

    Zoe237 – The fact that countries all around the world have different vaccine schedules, some with 12 shots rather than 26, says to me that there ARE different, safe schedules.

    Yes, but the schedules are based on what diseases are prevalent in THAT country. If you like the Swedish schedule better than the American one, remember to take the child to live in Sweden until they reach adulthood.

    my sixth month old isn’t even playing with other kids or in other care besides mine, hubby, or grandparent. Considering I don’t have hep b, yes, I think it basically impossible.

    Ever consider that you, your husband or her granny might come into contact with a chronic carrier, develop the illness and pass the virus to your daughter with love and slobbery kisses? Or have you been tested and vaccinated?

  52. Zoe237 says:

    Zoe, I interpreted your first comment as saying you didn’t think any children could die from being left vulnerable to HepB for their first six months of life. I see that you meant your child wouldn’t, especially given the hindsight that the first six months have already been achieved without any extraordinary event that would cause your child to have contact with other children or with improperly-tested blood products. That is a different statement, and I agree, if you happen to know that your child could not have been exposed to HepB then your child does not have HepB. Especially given that they are vaccinated!

    My argument is that if Dr. Snyder or whoever encounters a parent in his office who wants to delay the hepatitis b vaccine until six months, it is not a completely ridiculous request for which the parent should be kicked out of the practice and possibly never receive another vaccination. With two parents who are vaccinated for hepatitis b, have been tested for hepatitis b, and the baby is not in daycare, the risk of hbv in infancy in developed countries is virtually zero, whether it’s my infant or somebody’s else’s. I was using my own situation as an example. My personal feeling is that while the risk of hepatitis b infection for my child is low, the risk from the vaccine is even lower. Infants don’t share toothbrushes or run around on playgrounds, and even at its worst, in the U.S., the rate was around 1 in 100,000. Hopefully now it can be cut to zero. But I don’t see that happening unless pediatricians allow some flexibility in when the vaccines are given. At its core, public health and herd immunity is a confidence game and it doesn’t work unless most mothers are onboard. And apparently, they’re not if 40% of them are refusing a vaccine. And 60% of HCW don’t receive a flu vaccine. What needs to change about the approach?

    I looked up the numbers for my county, and there has been, in the past five years, one case (chronic) reported to the health department of an hbv infection for an under ten year old. Population 250,000. Babies who aren’t even crawling aren’t going to be playing with other kids at McDonald’s playlands. Now, I don’t have the prevax numbers, but the MMWR/CDC place the case rates at 1 in 100,000 kids infected prevax and .36/100,000 post. An infant would not only have to encouter this child at all, they would also have to have some mutual mucus or blood contact. Possible, yes, barely. But not even remotely likely. How many of these children were infected at McDonald’s playplaces? One? Two? The anaphylaxis rate from the vaccine is about one in a million.

    I guess what I’m asking for is a numerical risk (even hypothetical) to an infant for child to child horizontal transmission in the U.S. There are a smattering of cases (anecdotes) in the literature of documented cases (maybe less than ten) in decades, not even enough to quantify. People keep bringing up this scenario as justification, but I’m just not convinced without some quantification of the risk.

    Btw, this link states that only 46% of newborns receive their hep b vaccine.
    http://www.cdc.gov/mmwr/PDF/rr/rr5416.pdf

    http://pediatrics.aappublications.org/cgi/content/full/112/4/815

    Transmission

    Common modes of transmission in developing countries are:

    •perinatal (from mother to baby at birth)
    •early childhood infections (inapparent infection through close interpersonal contact with infected household contacts)
    •unsafe injections practices
    •blood transfusions
    •sexual contact
    In many developed countries (e.g. those in western Europe and North America), patterns of transmission are different than those mentioned above. Today, the majority of infections in these countries are transmitted during young adulthood by sexual activity and injecting drug use. HBV is a major infectious occupational hazard of health workers.

    http://www.who.int/mediacentre/factsheets/fs204/en/

    Dr. Hall, given that analogy, you shouldn’t drive at all, even with a carseat. My county had an average of 8 child deaths/year from motor vehicle driving accidents, far greater than the number diagnosed with hepatitis b (assuming even pre vax). I’m doubtful that all of them were improperly restrained. It’s certainly riskier than delaying hep b vaccine from newborn to month 6 in an infant born to a hep b negative mother. Of course, the benefits of driving are greater than the miniscule risk of the vaccine too.

    I’m supposed to be at a friend’s birth any day now and she’s thinking about refusing the birth dose, which is why I’m playing devil’s advocate a bit. What I’ve told her is that while I think the benefits in low risk babies are fairly small, they are large for a lifetime, and the risks to the vaccine are almost none. Her child will be in daycare after 3 months. I wonder if I should push harder. Unfortunately, she doesn’t read sites like SBM. ;-)

  53. aaronupnorth says:

    I remember learning about measles as a medical student ‘This is something you want to read up on if you work in the third world’ the lecturer said. I never thought I’d see a case.
    Now we have a measles outbreak in British Columbia. We have a lot of naturopaths (who are allowed to prescribe any drug they like) and a huge population of unvaccinated children, and now I’m seeing Koplik spots in the emergency department…ridiculous…

  54. Zoe237 says:

    “Zoe237 – The fact that countries all around the world have different vaccine schedules, some with 12 shots rather than 26, says to me that there ARE different, safe schedules.

    Yes, but the schedules are based on what diseases are prevalent in THAT country. If you like the Swedish schedule better than the American one, remember to take the child to live in Sweden until they reach adulthood.”

    Ah yes, I haven’t heard that one in a 1001 political “debates” on fox news. ;-)

    I guess if I wanted to keep my hypothetical child super safe, I would, considering their child mortality rates are better than ours, and roads safer. I do rather like it around the U.S. though.

  55. The Dicklomat says:

    If SBM didn’t mind the posts being snarky & informal, they would not have invited Crislip to the fold. Even if they do wish to maintain an air of formality in general (to maintain a professional front), then I suppose SBM letting Crislip do his thing is like Dr. Evil pushing the buttons for those trick chairs in his meeting room. What fun!

    BTW – Mark, your son is STILL only 12 after all these years? (just kidding)

  56. daijiyobu says:

    The huge aspect of all this that is so PATHETIC is the utter silence of naturopathy.

    They simply lurk, license themselves in these back-office legislative sessions, and keep their actual content masked from the public.

    I’m looking forward to the new textbook that supposedly will be North America-wide.

    Here’s that homepage, where they’re discussing “the vis:”

    http://www.foundationsproject.com/

    Look at the sponsors, and budget!

    There’ll be much to read and analyze soon [a couple of years!].

    -r.c.

  57. Stroh says:

    For those interested the Swedish vaccination schedule actually consists of a full 23 shots (boosters included). They are however delivered at 10 instances which, to those without insight, may give the schedule the appearance of having fewer vaccinations than the US schedule.

    For more information, the Swedish CDC has information i English.

  58. Stroh says:

    @ Zoe237: It’s not that either schedule is superior but rather that they are optimized for the regions in which they are used. Sweden simply has a different pathogen flora than the US and hence a slightly different vaccination schedule. It’s no different than people in hot climates wearing different clothes than those in cold.

    Sweden’s really nice by the way, I think you’d really like it here. Forgetting what the sun looks like is not as traumatic as you would think.

  59. Todd W. says:

    Dr. Crislip,

    Excellent post. I had actually started working on answers to these questions about a month ago, but got side-tracked. My approach was a non-science trained/non-medicine trained layperson’s perspective.

    Mind if I link to this over at antiantivax.flurf.net?

  60. Chris says:

    The Vaccination Schedule looks very familiar:

    Birth

    * Hepatitis B (hepB) [See footnote a]

    2 months

    * Hepatitis B (hepB) [See footnote b]
    * Diphtheria, tetanus and whooping cough (acellular pertussis) (DTPa)
    * Haemophilus influenzae type b (Hib) [See footnotes c & d]
    * Polio (inactivated poliomyelitis IPV)
    * Pneumococcal conjugate (7vPCV)
    * Rotavirus

    4 months

    * Hepatitis B (hepB) [See footnote b]
    * Diphtheria, tetanus and whooping cough (acellular pertussis (DTPa)
    * Haemophilus influenzae type b (Hib) [See footnotes c & d]
    * Polio (inactivated poliomyelitis IPV)
    * Pneumococcal conjugate (7vPCV)
    * Rotavirus

    6 months

    * Hepatitis B (hepB) [See footnote b]
    * Diphtheria, tetanus and whooping cough (acellular pertussis (DTPa)
    * Haemophilus influenzae type b (Hib) [See footnote c]
    * Polio (inactivated poliomyelitis) (IPV)
    * Pneumococcal conjugate (7vPCV) [See footnote e]
    * Rotavirus [See footnote j]

    12 months

    * Hepatitis B (hepB) [See footnote b]
    * Haemophilus influenzae type b (Hib) [See footnote d]
    * Measles, mumps and rubella (MMR)
    * Meningococcal C (MenCCV)

    12-24 months

    * Hepatitis A (Aboriginal and Torres Strait Islander children in high risk areas) [See footnote f]

    18 months

    * Chickenpox (varicella) (VZV)

    18-24 months

    * Pneumococcal polysaccharide (23vPPV) (Aboriginal and Torres Strait Islander children in high risk areas) [See footnote g]
    * Hepatitis A (Aboriginal and Torres Strait Islander children in high risk areas)

    …………………………………………..

    Japan does have a different vaccine schedule. The part that is identical to the USA is the DTaP (which was developed in Japan). The rest varies with the inclusion of Japanese Encephalitis and TB, and I don’t think they have switched to the IPV instead of OPV (the online schedule is from 2005, but if you read the links from their infectious disease surveillance reports, you’ll see there have been some changes).

    They stopped using their version of the MMR (biggest difference was the mumps strain used), and have had issues with measles ever since (and no drop in autism diagnoses!). Even after making a form of a measles vaccine mandatory (first it was separate measles and rubella, now they are combined into an MR vaccine). This is a report of measles notifications for this year.

    Mumps vaccination is voluntary in Japan, with expected results:

    Deafness is a rare but important complication of mumps virus infection. Its incidence has been estimated at 0.5 to 5.0 per 100,000 cases of mumps, but recent reports from Japan, where mumps is endemic, suggest that the incidence might be higher.

    According to this the Hib is not on the Japanese schedule. It was not even reportable until May 2002. But that does not mean it will not be added in the future, considering this paragraph in the report:

    In nine months from May 2009 to January 2010, 103 medical facilities registered total 200 cases. Of these, 84% were 0-2-year-olds (36% for 0-year, 31% for 1-year, and 17% for 2-year), and among 0-year-old children 70% were older than 7 months of age. The most frequent was meningitis (128 cases) followed by bacteremia (77 cases), septicemia (26 cases), pneumonia (20 cases) and acute pharyngitis (12 cases), etc. There were five cases with severe sequelae, such as developmental, mental and motor disturbances and six cases with impaired otological function. There were three fatal cases and the case-fatality rate was 1.5% among the registered cases.

  61. Chris says:

    Oops, left out the word “Australian” in my first sentence (I think I lost it when I put in the hyperlink).

    By the way, many times you will hear the anti-vax argument that Japan stopped vaccination for pertussis and then SIDS was not a problem any more.

    That is a lie.

    What happened is that they did suspend the DTP for a while. But SIDS still happened. It is just you can’t blame a vaccine that a child did not get. And pertussis increased with a result of more infant deaths. It is noted in this paper:
    Expert Rev Vaccines. 2005 Apr;4(2):173-84.
    Acellular pertussis vaccines in Japan: past, present and future.
    Watanabe M, Nagai M.

    Which says:

    An antivaccine movement developed in Japan as a consequence of increasing numbers of adverse reactions to whole-cell pertussis vaccines in the mid-1970s. After two infants died within 24 h of the vaccination from 1974 to 1975, the Japanese government temporarily suspended vaccinations. Subsequently, the public and the government witnessed the re-emergence of whooping cough, with 41 deaths in 1979. This series of unfortunate events revealed to the public that the vaccine had, in fact, been beneficial.

    Which kind of answers Mihalovic Stupid Question Number 3.

  62. Chris says:

    Another stupid typo mistake… Hib was not reportable in Japan until May 2009.

    I think I’ll go get more coffee. Then clear my mind by stripping and refinishing a chair in the garage.

  63. JMB says:

    @ToddW

    Very nice website. One thing I might add, the disadvantage of natural immunity is that you must suffer the disease to develop the immunity that is either equivalent or stronger than the immunity developed by the vaccination.

  64. Zoe237 says:

    @Stroh:
    “For those interested the Swedish vaccination schedule actually consists of a full 23 shots (boosters included). They are however delivered at 10 instances which, to those without insight, may give the schedule the appearance of having fewer vaccinations than the US schedule.

    For more information, the Swedish CDC has information i English.”

    Sweden definitely has less shots, which I think makes sense because they have less disease. Sweden has 21 shots (unless I’m missing one) against 10 diseases. USA has 32 (not counting flu, counting hpv) against 14 diseases. As far as I can tell, Sweden doesn’t routinely recommend hep a, hep b, chicken pox, or rotavirus. Out of curiosity, I looked up the schedule for Ontario, 13 diseases, 30 shots. However, varicella vaccine is listed for “suspectible” children. Ontario doesn’t have hep a or rota. And hepatitis b vaccines are given to those in grade 7, not newborns. Varicella and mmr are also not given together, but separated. How different are disease rates in Ontario versus Michigan? I realize that the CDC recommends for the whole country, but it seems occasional exceptions (slight delays) could be made for low risk children FOR THE SOLE reason to get them to vaccinate at all.

    I live in rural Michigan, not inner city LA, so it still seems to me that it’s reasonable for some moms around here to delay the birth dose of hep b vaccine, as they do in Ontario, and Sweden, and probably many other countries.

    http://www.cdc.gov/vaccines/recs/schedules/downloads/child/2010/10_0-6yrs-schedule-pr.pdf

    http://www.health.gov.on.ca/english/providers/program/immun/pdf/schedule.pdf

    http://www.smittskyddsinstitutet.se/in-english/activities/the-swedish-vaccination-program

  65. Joe says:

    Zoe237 on 08 May 2010 at 3:10 pm wrote “I live in rural Michigan, not inner city LA, so it still seems to me that it’s reasonable for some moms around here to delay the birth dose of hep b vaccine …”

    I repeat, it seemed reasonable to George Washington’s doctors to keep bleeding him till he died. What you lack is science on your side.

  66. Zoe237 says:

    “I repeat, it seemed reasonable to George Washington’s doctors to keep bleeding him till he died. What you lack is science on your side.”

    Dear Joe, science doesn’t tell us whether a vaccine *should* be offered at any age, only possible results of multiple scenarios. What many people offer in the vaccine debate is value judgements (not necessarily a bad thing) and confusing them with science. You specifically have failed to offer any evidence; I read your comment the first time. What I am arguing is not strictly a matter of where the facts lie, but what would be prudent to do to further public confidence in the vaccine program. I greatly fear the outcome of refusals of vaccines such as MMR, DTaP, and polio.

  67. weing says:

    “I greatly fear the outcome of refusals of vaccines such as MMR, DTaP, and polio.”

    As well you should. All the more reason to expeditiously vaccinate yourself and your family.

  68. Sorry if this point is redundant, my patience is barely above nil this evening, so I only got through 1/3 of the questions before I couldn’t stand it anymore.

    This may be a nonsequitor, but regarding a vaccine shot vs inhaled/nasal, I wanted to point out that in the h1n1 vaccine the shot was recommended over the nasal spray for asthma suffers. I believe this was due to concerns that the nasal spray method for this particular vacinne might trigger asthma symptoms.

    Why would one assume that inhaled is better than injected?

    Now, I am going to watch the Doc Martin season 2 DVD I just received in the mail. It’s better than House.

  69. Stroh says:

    Zoe237: True, many US states do indeed recommend noticeably more shots than Sweden. Still: when many compare the US schedule to the rest of the world they choose to present other schedules (like Sweden’s) as consisting of a mere handful of shots, in order to suggest how “extreme” the US schedule supposedly is.

    That was the main point with me presenting the data. Personally I also do not consider 30 shots to be all that more than 23 shots considering the more heterogeneous population of the US.

    Now, I understand why you would consider the Hep B virus redundant considering your personal situation. But I’m still curious: considering this is a loss-gain calculation, what precisely is it that you consider enough of a loss that you would opt out of that particular vaccine?

  70. Zoe237 says:

    “Now, I understand why you would consider the Hep B virus redundant considering your personal situation. But I’m still curious: considering this is a loss-gain calculation, what precisely is it that you consider enough of a loss that you would opt out of that particular vaccine?”

    Thanks. I don’t consider it a loss at all, since it offers lifetime protection with a minimum of risk. Like I said, my friend is considering delaying the hep b shot (for no scientific reason) but I hardly think she’s endangering her baby considering her hbv status and the area we live in.

  71. Th1Th2 says:

    JMJ,
    “Very nice website. One thing I might add, the disadvantage of natural immunity is that you must suffer the disease to develop the immunity that is either equivalent or stronger than the immunity developed by the vaccination.”

    Who told you that children must be exposed to diseases to develop natural immunity? Where did you hear that superstitious belief?

  72. Chris says:

    Th1Th2:

    Who told you that children must be exposed to diseases to develop natural immunity? Where did you hear that superstitious belief?

    True, a vaccine is much better. Though it is also true that even exposure to the real disease may not confer immunity. Sometimes having the disease does not make one immune.

    Some of us can never become immune to diseases like mumps due to from funky genetics. We depend on herd immunity. So please make sure that it stays intacts.

  73. halincoh says:

    SNARK! SNARK! SNARK! Woo hoo!

  74. JMB says:

    Th1Th2:

    “Who told you that children must be exposed to diseases to develop natural immunity? Where did you hear that superstitious belief?”

    Actually, I was more interested in the discussion about whether vaccination injections end up in the lymphatic system or bloodstream. But you decided to talk about natural immunity… you sidestepped my careful wording to avoid another descent into arguments about natural immunity. Even though we inherit some types of immunity, it must be exercised to achieve a more rapid effective response. Vaccination in the majority of cases facilitates a more rapid response of the immune system that effectively mutes the disease effects. The more rapid acceleration of immune response facilitated by the vaccination reduces the disease effects, and possible consequent complications, from developing, even when the nonspecific barriers are breached. Complications from the infectious disease are more likely with a slower response of the nonvaccinated immune system, or specific defects in the immune system as mentioned by Chris. While supportive care may diminish complications and mortality, vaccination is even more effective (and cost effective) for achieving a greater reduction in morbidity and mortality. For individuals with specific immune deficits, only herd immunity can protect them (as mentioned by Chris).

    You can choose the car sitting ready on the starting line of the drag strip, or choose the car sitting in the garage waiting to be put together. If you want to win the drag race, the choice is obvious. If you lose the drag race, you will have to deal with an exponentially greater number of infectious organisms.

    I will let others carry on this discussion, unless you have some scientific study about what percentage of dermal injections that end up in the bloodstream.

  75. Joe says:

    @Zoe237 on 08 May 2010 at 4:45 pm wrote “Dear Joe, science doesn’t tell us whether a vaccine *should* be offered at any age, only possible results of multiple scenarios.”

    You are about 40 years late to be explaining science to me. Considering that day 1 vs. 6 months is a HUGE difference, I think your powers of reason are failing you.

  76. Th1Th2 says:

    JMB,

    “Actually, I was more interested in the discussion about whether vaccination injections end up in the lymphatic system or bloodstream.”

    So you are still uncertain whether a needle stick injury containing HbsAg would end up into the lymphatics or the blood stream? How about percutaneous vaccination like the smallpox vaccine. You are aware that in order to be ‘successful’, the inoculee MUST exhibit a pus-filled blister in the injection site, aren’t you?

    “Even though we inherit some types of immunity, it must be exercised to achieve a more rapid effective response.”

    By what means? By breaking the innate physiologic barrier to achieve secondary immune response? Such as by naturally exposing a naive child to chicken pox, measles, or through direct inoculation of disease antigens?

    “Vaccination in the majority of cases facilitates a more rapid response of the immune system that effectively mutes the disease effects. The more rapid acceleration of immune response facilitated by the vaccination reduces the disease effects, and possible consequent complications, from developing, even when the nonspecific barriers are breached”

    Vaccination is an alternative to natural infection. So having acquired the disease or infection naturally or through vaccination does not make someone ‘immuned’ to the disease. Hence, the term adaptive immune response.

    “Complications from the infectious disease are more likely with a slower response of the nonvaccinated immune system, or specific defects in the immune system as mentioned by Chris. While supportive care may diminish complications and mortality, vaccination is even more effective (and cost effective) for achieving a greater reduction in morbidity and mortality. ”

    Common childhood diseases generally are benign and self-limited. Complications arise when children become patients in the hospital in the hands of allopathic doctors, a complete contrast to supportive care.

    “I will let others carry on this discussion, unless you have some scientific study about what percentage of dermal injections that end up in the bloodstream.”

    Tuberculin (PPD), being a parenteral injection, is absorbed intradermally through the skin into the lymphatics and blood stream. Will it also end up being absorbed into the blood stream if given otherwise, such as through the veins, the muscle or subcutaneous tissues? I guess that is not too difficult for you to answer after all.

  77. weing says:

    “Common childhood diseases generally are benign and self-limited.”

    Common now or common 60 years ago?

  78. “Common childhood diseases generally are benign and self-limited.”

    Whooping cough is never benign. When measles and polio are not benign and self-limited, then what?

    “Complications arise when children become patients in the hospital in the hands of allopathic doctors, a complete contrast to supportive care.”

    Explain, with supporting evidence, please.

  79. The Blind Watchmaker says:

    I think the phrase, “Not even wrong”, applies to several of the 9 questions.

  80. Th1Th2 says:

    Chris,

    “True, a vaccine is much better. Though it is also true that even exposure to the real disease may not confer immunity. Sometimes having the disease does not make one immune. ”

    Of course not and more so with vaccination. Both of them will not confer immunity; they provoke the disease. What makes you think that exposure to chicken pox for example, will confer ‘immunity’ to someone who has never been exposed? That’s is just as ridiculous as spreading and intensifying the mode of transmission of chicken pox. And what’s more absurd, if everyone else is inoculated with the disease antigen itself.

  81. Harriet Hall says:

    “Complications arise when children become patients in the hospital in the hands of allopathic doctors, a complete contrast to supportive care.”

    This statement is demonstrably false. Children developed complications long before we even had hospitals. Children are hospitalized only after they develop complications at home with supportive care.

  82. Th1Th2 says:

    Harriet Hall,

    “This statement is demonstrably false. Children developed complications long before we even had hospitals. Children are hospitalized only after they develop complications at home with supportive care.”

    Not so true. Our homes have become an extension of the hospital. Just check your medicine cabinet. Parents act as the primary caregiver in the absence of the physician. They can administer medications, not because they know the pharmacokinetics let alone side-effects, but rather because they are instructed to do so based on the putative practice of home medication regime at an early stage of symptom manifestation. In supportive care, there are neither medical nor pharmacologic interventions.

  83. Harriet Hall says:

    Th1Th2,

    That’s a bit of a stretch, equating homes with hospitals just because parents might administer Tylenol! Do you have any evidence that children who are given medications are more likely to suffer complications?

  84. David Gorski says:

    I think the phrase, “Not even wrong”, applies to several of the 9 questions.

    Indeed, and I note that our intrepid naturopath has not answered my challenge to him to respond.

  85. Th1Th2 says:

    Alison Cummins,

    “Whooping cough is never benign. When measles and polio are not benign and self-limited, then what?”

    The poliomyelitis virus is so virulent, like many vaccine apologists would use as scare tactic, that 95% of cases are asymptomatic and only less than 0.1% will actually lead to paralysis. How come?

    You know that pertussis can be diagnosed without the ‘whooping-cough’ and so is measles in the absence of Koplik spots, don’t you? (hint: asymptomatic infection). As benign as they are, they only get worse when they are treated unnecessarily.

  86. Th1Th2,

    Saying something doesn’t make it true. Explain and provide supporting evidence, please.

  87. Th1Th2 says:

    Harriet Hall,

    “That’s a bit of a stretch, equating homes with hospitals just because parents might administer Tylenol! Do you have any evidence that children who are given medications are more likely to suffer complications?”

    Are you saying that children who were given the same Tylenol q4-6 hours around the clock are less likely to suffer from complications if administered in the hospital rather than home?

  88. Harriet Hall says:

    Th1Th2,

    No, I’m asking if you have any evidence that children who are given Tylenol are more likely to develop complications.

  89. WilliamLawrenceUtridge says:

    Everything comes down to risks versus benefit, and evidence.

    Vaccines:
    * Minimal risk
    * Low to extreme benefit (depending on region, disease, and person)
    * Lots of evidence

    Opposition to vaccination:
    * Moderate risk (due to herd immunity, hospitals, sanitation, etc.)
    * Minimal benefit (possible life-long or stronger immunity, though any vaccinated child exposed to a wild-type virus will get that anyway)
    * No evidence

    Opposition to vaccination comes down to “something might happen, some time, somewhere”. I’ve been following vaccination topics for a while, and aside from the side effects listed in the product inserts, I’ve not seen any evidence-based reason not to vaccinate. “Big Pharma” isn’t a reason. “Side effects” isn’t a rational reason. “Toxins” doesn’t even make sense. Fear, and a series of heuristics (natural is good, companies are bad, don’t trust the government, if it’s too complicated for me to understand it must be wrong) seem to be what guides decisions about vaccination.

    Th1Th2′s pathetic arguments cling to the “God of the Gaps” argued by Creationists – we don’t know everything, therefore we must do nothing (alternatively, that I am now justified in making whatever irrational decision I wanted to make before seeing the evidence). That’s nonsense, and is completely oblivious to the fact that even an illness that is benign in 97% of cases is worth vaccinating against when you only see significant reactions to vaccines in 0.1% of cases. The risk to benefit ratio is clear, and antivaccinationists are capitalizing on the possibility of unknown risks as an excuse to reject all vaccination. We know a lot. We know in most cases children will survive many of these illnesses given modern medical treatment. We can even be reasonably sure that my child will be OK. But that doesn’t excuse the fact that some children will get sick, will develop life-long health issues, and will die. This is inevitable, but 99.99% vaccination brings that number down to single digits. Everything has risks, it’s a matter of reducing the risks using the best evidence available. And that means vaccinating.

  90. squirrelelite says:

    @Th1Th2-2:28,

    You stated:

    “The poliomyelitis virus is so virulent, like many vaccine apologists would use as scare tactic, that 95% of cases are asymptomatic and only less than 0.1% will actually lead to paralysis. How come? ”

    That means there are 1000 times as many people (in an unvaccinated population) carrying the virus with the potential to infect someone else who may be the unlucky 1 in a 1000 who winds up paralyzed or even in an iron lung.

    Since Prometheus gave a very nice summary of paralytic cases of polio in the 50′s and early 60′s before and shortly after the introduction of the 2 vaccines.

    http://scienceblogs.com/insolence/2010/04/poor_poor_pitiful_me_jenny_mccarthy_and.php#c2500587

    I will take the liberty of quoting extensively so readers don’t have to scroll past over 300 comments to get to it.

    “It’s not about belief, it’s about the data.

    And before “Sid” goes on with the “whale.to” candard about “Polio was declining before the vaccine.”, here are the numbers for the years around the introduction of the Salk vaccine:

    1951 ….. 10,037
    1952 ….. 21,269
    1953 ….. 15,648
    1954 ….. 18,308
    1955 ….. 13,850 (Salk vaccine introduced)
    1956 …… 7,911
    1957 …… 2,499
    1958 …… 3,697
    1959 …… 6,289
    1960 …… 2,525
    1961 …….. 988 (Sabin vaccine introduced)
    1962 …….. 792
    1963 …….. 396
    1964 …….. 106
    1965 ……… 61

    [Note: prior to 1951, the CDC records combine paralytic and non-paralytic cases of polio - this may be the source of the "Polio was declining before the vaccine." canard. The numbers above are for paralytic cases only, but the non-paralytic cases declined in parallel.]

    What’s harder to believe, that the Salk vaccine reduced the US incidence of polio by almost 82% in five years (1955 – 1960) or that “hygiene”, “sanitation” or “nutrition” in the US improved so much in the same time period that the incidence of polio dropped by 92% “naturally”?”

    If you have some evidence that some other cause was responsible for this drop in paralytic polio cases, what is the evidence and where is it published? (peer-reviewed journals, please)

    And, thanks Prometheus!!!

  91. kill3rTcell says:

    Draal: “I have never understood why this multiple resistant mutant has out competed MSSA in the community when there is no antibiotic ie selective pressure and it should be at a disadvantage.

    I’m not familiar with what exactly makes MRSA have multiple resistances. Species can transfer genes to each other (called horizontal gene transfer); so one organism can acquire resistance after a resistance gene is laterally transfered from another organism.”

    Staph. aureus is incredibly competent – it excels at taking up foreign DNA. As a result, it can pick up antibiotic resistance genes from all over the place at a much higher frequency than other species. Also, in biofilms bacteria literally excrete DNA into the surrounding EPS, and S. aureus loves forming biofilms, especially in hospitals.

  92. Dawn says:

    @Chris: funky genetics, yes. I HAD mumps and measles, got the MMR (twice as a child and once as an adult) and STILL have no immunity to them. Gotta love it. I also had chicken pox. Fortunately, none of my scars are where most of the public will ever see them. My children also had chicken pox. My eldest was so miserable and in so much pain we ended up giving her codeine (it broke my heart to have to give my 5 year old a narcotic, but NOTHING else was working)

    @Zoe237: since my kids were born before the Hep B at birth series (it was optional, not recommended), I delayed the vaccine until they were in late elementary school. Turns out they were very fortunate; one of their friends when they were in daycare developed chronic Hep B from another child who was in the daycare with them (no one knew the kid had it since the parents claim they didn’t know the family member could give it to the child…after all, the family member was not having sex or sharing needles with the child…but there were some instances of family member caring for child and obviously not practicing good handwashing after using the toilet him/herself. I don’t know how this was all discovered since we moved out of town before the whole story came out.) I would never be able to forgive myself if they had chronic hepatitis because I didn’t see the need for it.

    @Th1Th2: So children didn’t die at home from childhood diseases? I’ll have to tell my mom that. Her best friend must not have died from measles in Big City with Modern Sanitation and good home care, she must have died from other causes (funny…the doctor blamed the measles..). I’ll also tell a good friend of mine that her deafness from mumps is because her parents took her to the hospital when she was so sick. They should have kept her home and cared for her, then she wouldn’t have been deaf! After all, if she’d died at home she wouldn’t have become deaf. Damn those doctors for saving her life! And all my books printed in the 1800s that had measles, scarlet fever, mumps, diptheria and pertussis causing great fear because of the death rate associated with them must ALL be because they didn’t have good sanitation, good diet and all that. Yeah, that’s the ticket. Blame everything and everyone except the disease for causing the deaths. Disease is good.

  93. Draal says:

    Exactly, biofilms are an incredible defense against antibiotics. Any drug must diffuse into the film creating a concentration gradient. Cells near the surface of the biofilm can die due to high concentration of a drug, but the cells nestled deep down are protected. Once the antibiotic is no longer being administered, the biofilm can resume growing. It also allows cells to adapt to concentrations near the MIC value of a drug and presto, an antibiotic resistant organism.

  94. Th1Th2 says:

    WilliamLawrenceUtridge,

    “Th1Th2’s pathetic arguments cling to the “God of the Gaps” argued by Creationists – we don’t know everything, therefore we must do nothing (alternatively, that I am now justified in making whatever irrational decision I wanted to make before seeing the evidence).”

    The medical community knows no evidence of harm when they continue to shoot in the dark amidst the writings on the wall. They are blind guides leading the blind. They are so blind that they do not even know what a healthy newborn looks like. How pathetic. They are so ignorant that they tend to label non-Hep B newborns (anti-Hbs negative) as susceptible if they do not receive vaccination! Who wants HbsAg anyway, anyone? Only fools would do that to their child.

    “That’s nonsense, and is completely oblivious to the fact that even an illness that is benign in 97% of cases is worth vaccinating against when you only see significant reactions to vaccines in 0.1% of cases.”

    That 0.1% of the cases leading to paralytic polio is due to the ‘virulent’ wild-type virus and not a reaction from the vaccine. So a person who have not acquired poliovirus from the vaccine is insignificant?

    “The risk to benefit ratio is clear, and antivaccinationists are capitalizing on the possibility of unknown risks as an excuse to reject all vaccination. ”

    Surely, risks are inevitable but preventable. Obviously, vaccination does not play a role whatsoever in prevention since it is inherently a physiologic threat, not a need. Reject? Absolutely.

    “We can even be reasonably sure that my child will be OK.”

    Only the faithful will say that.

    “We know a lot. We know in most cases children will survive many of these illnesses given modern medical treatment. ”

    It is just right to fix whatever you have destroyed (intentionally).

    “But that doesn’t excuse the fact that some children will get sick, will develop life-long health issues, and will die. This is inevitable, but 99.99% vaccination brings that number down to single digits. Everything has risks, it’s a matter of reducing the risks using the best evidence available. And that means vaccinating.”

    The risk of a healthy newborn getting HbsAg at the moment of birth is nil. The risk of the same newborn acquiring HbsAg from the vaccine before discharge is 100% unless of course if the parents are wise enough to reject it.

  95. weing says:

    “The risk of a healthy newborn getting HbsAg at the moment of birth is nil. The risk of the same newborn acquiring HbsAg from the vaccine before discharge is 100% unless of course if the parents are wise enough to reject it.”

    Claims full of crap. No evidence, only delusions to back them up.

  96. Prometheus says:

    Th1Th2 claims:

    The poliomyelitis virus is so virulent, like many vaccine apologists would use as scare tactic, that 95% of cases are asymptomatic and only less than 0.1% will actually lead to paralysis. How come?

    According to “The Pink Book” (http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/polio.pdf), less than 1% of all polio infections result in paralytic polio, with a range of 0.1% to 2% in estimates.

    Th1Th2 – as is his habit – chose the lowest estimate for the ratio of paralytic to inapparent polio infections (1:1000), while the source suggests that 1:200 is more typical. At any rate, the true ratio is hard to know.

    However, a high ratio of inapparent to paralytic polio is not reassuring. This means that polio could circulate widely (as it has in the past, even in the US) and quarantine measures would be useless (we already tried that in the past – it didn’t work). Vaccination is the only protection against the return of epidemic polio.

    And please, Th1Th2, don’t try the old “sanitation” canard – it was sanitation that got us into the problem of paralytic polio (polio virus is excreted in the feces). Polio infections in infancy cause a modest diarrheal illness; it is only in later childhood (and adulthood), that there is a significant risk of paralytic polio.

    In short, it is only when your water and food supply is clean enough that you aren’t exposed the community’s feces from birth that there is a risk of paralytic polio. Sanitation isn’t the solution.

    I do find it amusing that someone – like Th1Th2 – who is usually such a strong proponent of the “precautionary principle” (i.e. that we must assume danger until safety is proven) would so blithely gloss over the fact that, at the very least, 0.1% of polio infections lead to paralytic polio, with all of its attendant complications.

    If we knew that a vaccine (to pick a random example) caused paralysis and life-long complications in 0.1% of the people receiving it, I’m sure that Th1Th2 would be screaming to have it banned (for that matter, so would I). Yet, a virus that is known to be highly infectious and causes between 0.1% and 2% of its victims to become paralyzed (many with permanent paralysis and all with the risk of post-polio syndrome) elicits minimal concern.

    Well, I suppose that’s because the virus is natural.

    Of course, all of us who are “regulars” at SBM are familiar with Th1Th2′s lack of understanding in matters of medicine, biology, epidemiology, statistics etc. For those who are not, don’t expect facts and reason to win him over – his mind is made up and he’s always the smartest person in the room (a legend in his own mind, you might say).

    Prometheus

  97. Th1Th2 says:

    Archangl508,

    “I forget, how is it that the immune system works in your reality? Be sure to back it up with some evidence.”

    You provided links that all discussed the immune system’s adaptive response towards exposure and upon re-exposure to natural infections and disease antigens like vaccines. Certainly, that is NOT the primary and ultimate function of the immune system. Adaptive immune response plays secondary role when a breach of the innate immune system occurs. And it does not always happen unless the breach is intentional such as exposing a naive child to pox (party) or vaccines. Vaccines do NOT confer any protective immunity whatsover. Protective immunity has been established even before a baby is born. And the immune system (innate and adaptive) will work as it is without vaccines. Therefore, vaccines, just like exposure to natural infections, will create nothing but trouble and havoc.

  98. Ok, so if “[p]rotective immunity has been established even before a baby is born,” how could a pox party breach it?

  99. Cloud says:

    @Zoe237- If you’re still reading: I’ve been in situations like you are with your friend. The commenters who think that alternative schedules don’t reach some parents who would otherwise not vaccinate need to hang out with more new parents.

    Anyway, I would concentrate on trying to convince your friend to get her baby vaccinated before the baby starts day care, as that is when the risk will really go up.

    However, I’m with Harriet Hall- I don’t really know my status beyond any doubt (although I have been vaccinated for Hep B). I also know that accidents happen, even in hospitals and doctor’s offices. Since the risk associated with the vaccine is vanishingly small, and the risk of an accidental infection, though small, is not vanishing… I chose to vaccinate both of my babies as recommended.

    I think some parents really need to feel like they are finding “the middle road” or doing their own research and deciding for themselves what is best. If you combine that with a lack of scientific background, you often get a parent who chooses some sort of alternative schedule.

    As a mother who nervously watched a measles outbreak circulate in her community when her baby was 11 months old…. I don’t get it. I want the vaccines as soon as possible, please. But I know quite a few parents who have gone with an alternative schedule. I try to point out the risks when I can, but really, I’m just glad they are vaccinating.

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