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Deadly Choices about vaccination

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

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

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

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Vaccines are a pain: What to do about it

As much as I support vaccines, I see the short term consequences. Vaccines can be painful. Kids don’t like them, and parents don’t like seeing their children suffer. That this transient pain is the most common consequence of gaining  protection from fatal illnesses seems like a fair trade-off to me. But that’s not the case for every parent.

Today’s post isn’t going to focus on the extremes of the anti-vaccination movement. Rather, it’s going to look at ways to make vaccines less painful and more acceptable to children. The pain of vaccines can lead to anxiety, fear, and even nonadherence with vaccination schedules. Fear of needles and injections is not uncommon, it’s estimated that 10% of the population avoids vaccinations for this reason.

The vaccine schedules are intense. Where I live, the public vaccination schedule specifies seventeen injections of six different products over six visits in the first 18 months of life, plus influenza vaccinations and one-offs like H1N1. That’s a lot of visits, and a lot of tears if a child doesn’t handle them well.

In light of what’s known about the prevalence of needle fears, their potential effect on vaccination adherence (that could persist through adult life), and the possible impact on public health because of unvaccinated individuals, it makes sense to do whatever we can to minimize the pain and discomfort of vaccines, increasing their acceptance to children and their parents. But what works? I’ve personally found Smarties (the real ones) and Dora the Explorer stickers are effective distractions and bribes. But I’m not about to call my n=2 trial good science. Nicely, there’s much more evidence to guide our recommendations.

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Posted in: Vaccines

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Be thankful: No anti-vaccine propaganda at the movies this weekend

It’s Thanksgiving Day here in the U.S., and, despite the crappy economy, there are still things to be thankful for. For instance, skeptical activism can still be effective. On Sunday Skepchick Elyse put out the call to Skepchick readers to complain to movie theaters that were reportedly going to be airing a public service announcement from the anti-vaccine group SafeMinds? (Actually, “public service announcement” is a misnomer; it should be called a public disservice announcement.) The entire PSA was a truly disgusting and deceptive bit of misinformation. In response, Elyse urged Skepchic readers to flood the relevant theaters with complaints about showing an anti-vaccine advertisement prior to its movies.

Now here’s what we can be thankful for: It worked. At least with AMC Theaters. Last night the anti-vaccine propaganda blog Age of Autism, which had been teaming up with SafeMinds to raise money to show these ads during the Thanksgiving holiday weekend admitted as much.

At least for now:

SafeMinds was notified late yesterday afternoon that AMC Theaters has decided to block the SafeMinds Public Service Announcement (PSA) on influenza vaccines with mercury. The PSA alerts parents and pregnant women of the presence of mercury in most influenza vaccines and the ample availability of mercury-free alternatives. The CDC has declined to give a preference for the mercury-free versions, so it is important that the public is aware of its options. AMC’s advertising representative had reviewed and approved the PSA to run in AMC cinemas over the Thanksgiving weekend. A small group of vocal vaccine proponents dismissive of mercury concerns learned of the PSA and bombarded the AMC website, leading to the company’s decision to prevent its release. SafeMinds thanks its supporters who viewed the PSA and contributed to its efforts to educate the public to avoid unnecessary mercury exposure. Mercury in all forms is dangerous, especially to the developing fetus and infants, as referenced on the PSA website www.safemindsflu.org. SafeMinds will continue its mission to educate the public on this important healthcare topic.

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Posted in: Public Health, Science and the Media, Vaccines

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Improving Our Response to Anti-Vaccine Sentiment

As Vaccine Awareness Week draws to a close, I thought it might be instructive to step back and look at the tactics, impact, and successes of the anti-vaccine movement. Yesterday, Orac questioned the best approach to counter the anti-vaccine movement. With today’s post, I’ll summarize two pertinent papers on the effectiveness of their tactics, and suggest some possible approaches.

There’s overwhelming evidence that vaccines have provided us with tremendous health benefits. Smallpox has been eliminated (except, apparently, for homeopathic nosodes), polio is almost gone, and occurrences of diseases like measles or rubella are now rare. In use for over a century, they are a public health triumph: diseases that terrified us a generation ago are now never seen.  Epidemiologic evidence demonstrates that vaccines have a remarkable safety record, and are exceptionally cost-effective interventions. Yet in spite of this, concerns about vaccine safety seemingly continue to mount.  And as we see time and time again, when vaccination levels drop, diseases reappear. So what’s driving anti-vaccine sentiment, and why is it successful?

The H1N1 pandemic of 2009/10 is now about a year past its peak, and is instructive as a case study on communication on  vaccine safety and efficacy. Remember the H1N1 vaccine? Judging by the anti-vaccine rhetoric of just last year, by now we should all have been rounded up by the army, given forced injections, and if the vaccine didn’t kill us right away, or make us walk backwards, we’d be immunosupressed (from the aluminum adjuvant), or have Gulf War Syndrome (from the squalene). And not only did it not work, it doubled our odds of getting H1N1.  All we needed was vitamin D and a proprietary supplement formula to avoid the flu, they said.

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Posted in: Science and the Media, Vaccines

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Vaccine Wars: the NCCAM Drops the Ball

If you go to the website of the National Center for Complementary and Alternative Medicine (NCCAM), you’ll find that one of its self-identified roles is to “provide information about CAM.” NCCAM Director Josephine Briggs is proud to assert that the website fulfills this expectation. As many readers will recall, three of your bloggers visited the NCCAM last April, after having received an invitation from Dr. Briggs. We differed from her in our opinion of the website: one of our suggestions was that the NCCAM could do a better job providing American citizens with useful and accurate information about “CAM.”

We cited, among several examples, the website offering little response to the dangerous problem of widespread misinformation about childhood immunizations. As Dr. Novella subsequently reported, it seemed that we’d scored a point on that one:

…Dr. Briggs did agree that anti-vaccine sentiments are common in the world of CAM and that the NCCAM can do more to combat this. Information countering anti-vaccine propaganda would be a welcome addition to the NCCAM site.

In anticipation of SBM’s Vaccine Awareness Week, I decided to find out whether such a welcome addition has come to fruition. The short answer: nope.

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Posted in: Chiropractic, Health Fraud, Homeopathy, Legal, Medical Ethics, Naturopathy, Politics and Regulation, Public Health, Science and the Media

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Journal Club Debunks Anti-Vaccine Myths

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

The article presented convincing evidence to debunk 3 myths:

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

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Posted in: Vaccines

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Joe Mercola and Barbara Loe Fisher declare November 1-6, 2010 “Vaccine Awareness Week”? Not so fast!

As I pointed out earlier, a rare thing happened this week, namely I don’t have a full post ready for Science-Based Medicine because I’m at the Lorne Trottier Symposium. Not only have the organizers have packed my day with skeptical and science goodness, but I only have Internet access when I’m back at the hotel, which isn’t very often. I suppose I could pay outrageous international roaming charges by activating international roaming on my iPhone, but why on earth would I do that except in urgent circumstances? Fortunately, David Ramey stepped in with his usual excellent work.

The trials and tribulations of actually trying to do more than be at home, work, and blog aside, I couldn’t let this one pass. The ever-observant Mark Crislip sent his fellow SBM bloggers this little tidbit from the website of that well-known promoter of quackery Joe Mercola. Buried near the bottom of Mercola’s “newsletter” is an announcement of this intriguing (from a blog fodder perspective) initiative:

Mercola.com & NVIC Dedicating November 1-6 Vaccine Awareness Week

In a long-scheduled joint effort to raise public awareness about important vaccination issues during the week of November 1-6, 2010, Mercola.com and NVIC will publish a series of articles and interviews on vaccine topics of interest to Mercola.com newsletter subscribers and NVIC Vaccine E-newsletter readers.

The week-long public awareness program will also raise funds for NVIC, a non-profit charity that has been working for more than two decades to prevent vaccine injuries and deaths through public education and protecting informed consent to vaccination.

The November 1-6 Vaccine Awareness Week hosted by Mercola.com and NVIC will follow a month-long vaccine awareness effort in October that was recently announced on Facebook by parents highlighting Gardasil vaccine risks.

The six-week-long focus this fall on vaccine issues will help raise the consciousness of many more Americans, who may be unaware that they can take an active role in helping to prevent vaccine injuries and deaths and defend the legal right to make voluntary vaccination choices.

And remember, you can always visit Vaccines.Mercola.com and NVIC.org for the latest vaccine news updates and other important vaccine information.

“Six week” focus? Methinks Dr. Mercola meant “six days.”
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Posted in: Vaccines

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Using attacks on science by the anti-vaccine movement as a “teachable moment”

Last week, I wrote one of my usual ridiculously detailed posts analyzing a recent study (Price et al) that, if science and reason ruled, would be the last nail in the coffin of the hypothesis connecting autism with the mercury-containing preservative, thimerosal, which used to be in many childhood vaccines but was phased out beginning in 1999 and disappearing in infant vaccines except for the flu vaccine by early 2002. Of course, for at least the last five years, the thimerosal-autism hypothesis has been a notion whose coffin already had so many nails pounded into it that Price et al probably had a hard time finding even a tiny area of virgin wood into which to pound even a tiny nail of a study published in an impact factor one journal, much less the spike that their study in Pediatrics represented.

Unfortunately, as we know, in the anti-vaccine movement unreason rules, and, not unexpectedly, as a result this study has changed little in the debate, the fortuitously ironic happenstance of its being released the day before Mark Blaxill and Dan Olmsted’s anti-mercury screed Age of Autism not withstanding. To physicians and scientists, it is another strong piece of data being added to the confluence of evidence that has shown no link between mercury in vaccines and autism (or vaccines themselves and autism, for that matter). It is yet another confirmation that vaccines are safe. In contrast, to the anti-vaccine movement, it is simply yet another confirmation that the CDC is hopelessly biased, that scientists are in on a conspiracy to suppress The Truth, and that they are the poor persecuted minority, the only ones who know What Is Really Going On.

When I wrote my post last week, I didn’t know whether or not it would be worth my while to comment on the response of anti-vaccine activists to the study. The reason is that, as fun as it is to reveal their responses to be as vacuous as they are, I wasn’t sure that it would be educational. Granted, sometimes educational value takes a back seat to criticism, but sometimes it’s just too easy. In any case, by mid-week, there had been virtually no criticism of the study yet from the usual sources; so I figured it to be a moot point whether or not I would end up writing about this study one last time. Then, on Thursday morning I noted an e-mail in my in box. In order to keep my finger on the pulse of various pseudoscience movements, I subscribe to e-mail lists of various crank organizations, one of which is Generation Rescue and another of which is SafeMinds. SafeMinds, as you may recall, is the organization headed up by Sallie Bernard. As you may also recall, Bernard was originally on the external consulting committee that participated in the design of Price et al, and, before it, Thompson et al, the two of which ultimately made up a one-two punch against the mercury-autism hypothesis. When she saw that the results of Thompson et al were going against her idea and that no link between thimerosal-containing vaccines and neurodevelopmental disorders was showing up in the preliminary analyses, she resigned from the committee and started attacking Thompson et al. What surprised me was that she wasn’t ready with a criticism of Price et al when it was released.
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Posted in: Clinical Trials, Vaccines

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The final nail in the mercury-autism hypothesis?

PROLOGUE: BAD LUCK AND BAD TIMING

Two and a half years ago, very early in the history of this blog, I wrote one of my usual logorrheic (although I prefer the word “comprehensive”) posts entitled Mercury in vaccines as a cause of autism and autism spectrum disorders (ASDs): A failed hypothesis. In that post, I characterized the scientifically discredited notion that the mercury in the thimerosal preservative that used to be in several childhood vaccines was the cause of the “autism epidemic” as “one of the most pernicious medical myths of recent years.” And so it is. I like to characterize the notion that thimerosal-containing vaccines (TCVs) cause autism as the American version of the British myth, popularized by Andrew Wakefield and a sensationalistic British press, that the measles-mumps-rubella (MMR) vaccine causes autism and “autistic enterocolitis.”

Both notions were based on confusing correlation with causation, aided and abetted by some truly bad science, and both notions have been painfully difficult to dislodge. Indeed, in the case of Wakefield, only now that Wakefield was stripped of his license to practice in the U.K. by its General Medical Council, leading to The Lancet finally doing what it should have done six years ago and retracting Wakefield’s 1998 study that sparked the MMR frenzy in the U.K. and arguably kickstarted the modern anti-vaccine movement, do I sense that journalists are finally “getting” that science does not support the idea that the MMR vaccine causes autism. Andrew Wakefield may be trying to fight back with his book Callous Disregard after his disgrace was complete, basking in the glow of admiration of die-hard anti-vaccine groups, but, for now, at least, Wakefield and his MMR fear mongering are yesterday’s news, and that’s a very good thing indeed–at least for as long as it lasts.

Perhaps it is the fall of Andy Wakefield that has led to an apparent resurgence of the concept that mercury in TCVs somehow causes autism, after having faded into the background after the CDC and AAP recommended that thimerosal be removed from all childhood vaccines in 1999 and the last TCV having expired towards the end of 2001. After all, if the hypothesis that TCVs cause autism had been correct, we should have expected to see a marked decrease in the incidence of autism and autism spectrum disorders (ASDs) within about 5 years of 2002, given that the vast majority of cases of ASDs are diagnosed between the ages of 2 and 5. We have not, and, even though its adherents have kept moving the goalposts back regarding the date that we should start to see a leveling off and drop in the incidence of ASDs, starting with 2005, then 2007, and now, apparently, 2011 (which is only less than four months away, by the way), even Jenny McCarthy’s anti-vaccine organization originally founded by J.B. Handley and his wife, namely Generation Rescue, began demphasizing mercury in 2007, after having stated flatly on its website that autism is a “misdiagnosis for mercury poisoning” for so long. Since then, “too many, too soon” has been the favored propaganda talking point.

Of course, not every crank is ready to abandon the myth that TCVs cause autism. Indeed, tomorrow two mercury militia “heavy hitters” and bloggers for the anti-vaccine propaganda blog Age of Autism, Mark Blaxill and Dan Olmsted, will be releasing a book entitled Age of Autism: Mercury, Medicine, and a Manmade Epidemic. In anticipation, four weeks ago I actually e-mailed the publicist to send me a review copy of Age of Autism. I have yet to receive the book. I wonder why. Be that as it may, it amuses me that the official release of the release of the not-so-dynamic duo of the mercury militia’s book actually will one day after a study that is arguably the last nail in the coffin of the very dead hypothesis that TCVs cause autism was released. Either the great pharma conspiracy is far more conniving and effective than even J.B. Handley thinks, or Blaxill and Olmsted’s luck is just that bad. As I anticipate the conspiracy mongering posts about this bad timing aside, let’s just take a look at this last coffin nail, which is a study by Price et al that was released today in the journal Pediatrics entitled Prenatal and Infant Exposure to Thimerosal From Vaccines and Immunoglobulins and Risk of Autism.
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Posted in: Neuroscience/Mental Health, Vaccines

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A pox on your bank account: failure to vaccinate and its legal consequences

Here’s a question anti-vaxers may want to consider:

Can the parents of an unvaccinated child be held liable if their child becomes infected with a vaccine-preventable disease which then spreads from their child to another child or children?

Yes, they can.

In fact, for over 125 years, courts in this country have recognized a cause of action for negligent transmission of an infectious disease. In the first reported case (New York, 1884) the defendant infected the plaintiff with whooping cough. Cases since then have run the gamut: smallpox, tuberculosis, unspecified “venereal disease,” typhoid fever, scarlet fever, diphtheria, hepatitis, herpes, gonorrhea, HIV. If your favorite infectious disease is not on this list, don’t worry. The disease may vary, but the legal principles remain the same.
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Posted in: Legal, Medical Ethics, Public Health, Vaccines

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