Articles

The final nail in the coffin for the antivaccine rallying cry “Too many too soon”?

There are some weeks when I know what my topic will be—what it must be. These are weeks in which the universe gives the very appearance of handing to me my topic for the week on the proverbial silver platter with a giant hand descending from the clouds, pointing at it, and saying, “Blog about this, you idiot!” Usually, it’s because a study is released or something happens or a quack writes something that cries out for rebuttal. Whatever it is, it’s big and it’s unavoidable (for me, at least).

This is one of those weeks.

The reason it’s one of those weeks is because just last Friday, as I was driving to work, I heard a news story on NPR about a study that had just been released in the Journal of Pediatrics. The story, as it was reported, noted that the study being discussed looked specifically at a certain antivaccine trope and found for yet the umpteenth time that vaccines are not correlated with an increased risk of autism. Normally the news that a study had once again failed to find a link between vaccines and autism would be as surprising as a study finding that the sun rises in the east and sets in the west, or finding that water boils at 100° C at sea level. At this point, the evidence is so utterly overwhelming that there is not a whiff of a hint of a whisper of a correlation between vaccines and autism that it has become irritating that antivaccine activists keep pressuring scientists to do the same study over and over again, coming up with the same results over and over again, and then seeing antivaccinationists fail to believe those same results over and over again. Apparently, antivaccine activists think that if the same sorts of studies are done enough times, there will be a positive result implicating vaccines as a risk factor for or contributing cause to autism. By sheer random chance alone, this might happen someday, given the definition of statistical significance, but so far there has not been a single large, well-designed epidemiological study by reputable researchers that has found a link.

The final nail in the coffin of “too many too soon”?

Its utterly expected result notwithstanding, what makes the study reported on by NPR interesting is that it looked specifically at a common antivaccine trope that started popping up a lot five or six years ago. To my knowledge, although it had been percolating for a couple of years before that, this trope had its big debut when Jenny McCarthy led an antivaccine “protest” march on Washington, DC in June 2008, coupled with the delightfully Orwellian slogan, “Green our vaccines!” Quite honestly, I had to hand it to the antivaccinationists. “Too many too soon” and “Green our vaccines” were great slogans. They were pithy, simple, and communicated the message that vaccines were toxic and that they shouldn’t be given to young children. From a scientific standpoint they were horribly wrong, but from a propaganda standpoint they were brilliant, not the least of which because “too many too soon” was much more difficult to falsify than other antivaccine tropes, such as the roundly falsified claims that the mercury-containing preservative thimerosal causes or contributes to autism, that vaccines are loaded with “toxins,” and the idea popularized by the now disgraced Andrew Wakefield that the MMR triple vaccine could result in “autistic enterocolitis” and autism itself. This study looks right at the “too many too soon” hypothesis and finds zero evidence to suggest that there is anything to it. As I said, this could be completely predicted beforehand, but antivaccinationists keep forcing scientists to do the same study over and over and over again in different ways. They’re still not convinced, but we can always hope to convince the fence sitters.

The study itself was carried out by Frank DeStefano, Cristofer S. Price, and Eric S. Weintraub, from the CDC and Abt Associates, and the complete study, Increasing Exposure to Antibody-Stimulating Proteins and Polysaccharides in Vaccines Is Not Associated with Risk of Autism is available to all online, which is a lovely thing. It also used publicly available data from a previous study published in 2010 that looked for associations between mercury exposure in thimerosal-containing vaccines and autism. I discussed this study in detail when it originally came out and therefore won’t discuss it further (at least not much) here.

The previous study (Price et al) and this study (DeStefano et al) were both based on the same case control study. A case control study is a type of retrospective study in which subjects with a certain condition (cases) are matched as closely as possible with subjects without the condition under study (controls), and the two groups compared to look for factors that correlate with the condition in the cases. That’s how an earlier study from 2007 that failed to find a link between thimerosal-containing vaccines (Thompson et al) and adverse neurodevelopmental outcomes was performed, and that’s how Price et al and DeStefano et al were also performed. Being retrospective, such a study can never be quite as rigorous as a randomized controlled trial or a prospective cohort study. However, given that thimerosal has already been removed from all infant vaccines other than the flu vaccine (and there is a thimerosal-free alternative) and, more importantly, that it would be unethical to conduct a randomized double blind, placebo-controlled clinical trial, this sort of trial is the best evidence that we will be able to come up with.

I think it’s worth briefly recapping the design of this study, so that you don’t have to spend too much time clicking on previous links:

design

Basically, the two groups that ended up being studied consisted of 256 children with ASD and 752 matched controls. The authors justify the study thusly:

The initial concerns that vaccines may cause autism were related to the measles, mumps, and rubella vaccine and thimerosal-containing vaccines. In 2004, a comprehensive review by the Institute of Medicine concluded that the evidence favors rejection of possible causal associations between each of these vaccine types and autism. Nonetheless, concerns about a possible link between vaccines and autism persist, with the latest concern centering on the number of vaccines administered to infants and young children. A recent survey found that parents’ top vaccine-related concerns included administration of too many vaccines during the first 2 years of life, administration of too many vaccines in a single doctor visit, and a possible link between vaccines and learning disabilities, such as autism. All of the foregoing concerns were reported by 30%-36% of all survey respondents, and were reported by 55%-90% of parents who indicated that their children would receive some, but not all, of the vaccines on the recommended schedule. Another recent survey found that more than 10% of parents of young children refuse or delay vaccinations, with most believing that delaying vaccine doses is safer than providing them in accordance with the Centers for Disease Control and Prevention’s recommended vaccination schedule.

So basically this research was driven not so much by a scientific question as by a social imperative. Scientists have long known that there is no compelling rigorous evidence suggesting that vaccines cause autism or that “too many too soon” can result in or predispose to autism. Sadly, it can’t be repeated too many times (as I’m repeating here) that antivaccinationists force scientists to keep reinventing the wheel in order to try to reassure the parents whose doubts are stoked by the misinformation and pseudoscience promoted by antivaccinationists.

Before I get to the results in detail (you already know the results in general), I’ll also reiterate a point I made when discussing Price et al that this study had the strength that derives from the fact that the case and control populations were collected from three managed care organizations (MCOs) that participate in the Vaccine Safety Datalink, a collaborative effort between the CDC’s Immunization Safety Office and nine MCOs that was established in 1990 to monitor immunization safety and address gaps in scientific knowledge about rare and serious events that can occur after immunization. The VSD uses a large linked database using administrative data sources at each MCO from which data are gathered on vaccination(vaccine type, date of vaccination, concurrent vaccinations), medical outcomes (outpatient visits, inpatient visits, urgent care visits), birth data, and census data. Consequently, because of the detailed records maintained by these MCOs, investigators using VSD data are able to develop a detailed and accurate estimate of vaccine exposure from the computerized databases maintained by the MCOs as well as the medical records of the cases, controls, all supplemented by standardized interviews with the parents. In addition, outcomes have been measured in clinical settings using standardized assessment tools. In Price et al, the most up-to-date standardized assessment tools used to diagnose ASDs were used to identify cases, and the same is true in DeStefano et al. In addition, in order to make sure that the controls did not include children with undiagnosed ASD, which would tend to decrease any apparent differences between the groups, the lifetime form of the Social Communication Questionnaire was administered to controls as part of the interview with each mother for children who had indications of any neurodevelopmental difficulties. Several children were excluded from the control group in this manner. Finally, the detailed medical records and databases maintained by the MCOs allowed for the detailed determination of and control for many potential confounders.

Another major strength of DeStefano et al is how the investigators chose to compare vaccine exposures; basically, they estimated total antigen exposure rather than just counting the number of vaccines. They also looked at total antigen exposures from vaccines administered at single visits as well as the cumulative antigen exposure:

We evaluated antigen exposure for 3 age ranges according to 2 measures: cumulative exposure to antigens within the specified age range and the maximum number of antigens received in a single day within the specified age range. Data were collected on a large number of covariates, including child and family characteristics, maternal exposures during pregnancy, childbirth conditions, early childhood health conditions, and maternal healthcare-seeking behavior (ie, Kotelchuck prenatal care index, cholesterol, and Pap smear screenings).

For those who aren’t familiar with immunology, an antigen is a substance that evokes the production of one or more antibodies. In the case of vaccines, an antigen could be a protein or polysaccharide. In the case of killed vaccines (in which extracts isolated from killed viruses or bacteria are used to provoke the antibody response), there can be dozens, or hundreds, of antigens. An example is the whole cell pertussis vaccine, which is not used anymore. More modern vaccines tend not to be killed organism vaccines anymore, but rather vaccines made of recombinant proteins, protein fragments, or polysaccharides. Such vaccines contain many fewer antigens, but they are the specific antigens that produce an effective immune response against the organism. The vaccines examined in the study ranged from a single antigen per dose (hepatitis B) to 3,004 antigens per dose (DTP-Hib).

Using a strategy similar to the earlier Price et al study, DeStefano et al examined antigen exposure and compared the number of vaccine antigens to which the controls and the cases were exposed. What do you think they found? Yes, I know. I already told you what they found from the beginning: Nada, zip, nothing. No correlation between antigen exposure from vaccines and the risk of developing autism or autism spectrum disorder (ASD)—or even ASD with regression. The results are summarized in Table II from the paper, which shows that there is no correlation between cumulative vaccine antigen exposures and autism outcomes:

Figure2DS

Nor was there a correlation between maximal antigen exposure at one session of being vaccinated and autism outcomes:

Table3DS

This is as negative a study as I have ever seen. There is not even a whiff of a hint of a whisper of an association between the number of antigens to which the cases and the controls were exposed and the subsequent risk of autism. Not only do the confidence intervals for the adjusted odds ratios all overlap 1.0, but they’re very tight. It doesn’t get more negative than this in an epidemiological study, leading the authors to conclude:

We found no evidence indicating an association between exposure to antibody-stimulating proteins and polysaccharides contained in vaccines during the first 2 years of life and the risk of acquiring ASD, AD, or ASD with regression. We also detected no associations when exposures were evaluated as cumulative exposure from birth to 3 months, from birth to 7 months, or from birth to 2 years, or as maximum exposure on a single day during those 3 time periods. These results indicate that parental concerns that their children are receiving too many vaccines in the first 2 years of life or too many vaccines at a single doctor visit are not supported in terms of an increased risk of autism.

They also note:

Considerations of biological mechanisms should be taken into account when evaluating a possible association between autism and immunologic stimulation from vaccines early in life. The infant’s immune system is capable of responding to a large number of immunologic stimuli. Beginning at birth, an infant is exposed to hundreds of viruses and other antigens, and it has been estimated that an infant theoretically could respond to thousands of vaccines at once.15 The possibility that immunologic stimulation from vaccines during the first 1-2 years of life could be related to the development of ASD is not well supported by the known neurobiology of ASD, which tends to be genetically determined with origins in prenatal development,19-22 although possible effects in early infancy cannot be ruled out completely. It can be argued that ASD with regression, in which children usually lose developmental skills during the second year of life, could be related to exposures in infancy, including vaccines; however, we found no association between exposure to antigens from vaccines during infancy and the development of ASD with regression.

In other words, from the standpoint of prior plausibility, there is no compelling reason to suspect that vaccines could cause autism because such a mechanism is not consistent with what we know about the neurobiology of autism. Consistent with this lack of plausibility, the authors failed to find any correlations between exposure to antigens from vaccines and the risk of autism. They sliced and diced the data in a variety of ways looking for correlations and didn’t find any, and their data are in agreement with a study by Smith et al (discussed by my “good bud” Orac here) that failed to find a difference in non-autism neurodevelopmental outcomes between children who received all their recommended vaccines on time and those who were late, or, as I like to view it, “too many too soon” versus “too few too late.”

Yes, there were limitations to DeStefano et al in that it was retrospective. In addition, as the authors discussed, not all antigens are equal in evoking an immune response. Some have more epitopes (areas on the antigen molecule that can trigger an immune response) than others, and the study didn’t weight the antigens for the intensity of the immune response that they evoke. Even so, the antigenic load has fallen dramatically, and this study is based on the vaccine schedule of the 1990s. Indeed, the authors note that the antigen load due to the vaccine schedule has fallen from several thousand in the late 1990s to an estimated 315 in 2012. This is a drop in the bucket compared to the number of antigens infants and children encounter every day, as Emily Willingham notes. Matt Carey and Christine Vara also agree.

The antivaccinationists attack

Not surprisingly, even though this study was released on Good Friday, with a holiday weekend fast approaching, antivaccinationists were sufficiently displeased that they managed to launch a series of broadsides against the study. It’s instructive to look at the bad science and logical fallacies that populate such “criticisms.” For instance, Dr. “Bob” Sears, who is, despite his efforts to appear otherwise, as antivaccine as they come, went to Facebook to rant against the study. His complaints reveal such ignorance about statistical methods and basic epidemiology that it’s worth a quick look:

I pretty much only have one major criticism of this study. You would probably find the exact same results no matter what group of kids you studied. Pretty much all children in any given span of years receive the exact same number of shot antigens. (By the way, an antigen is simply a protein or sugar germ-related ingredient in a vaccine – some vaccines only have a few, some have many.) Virtually all kids WITH autism have had the same shots as kids WITHOUT autism. So, why would it even be useful to study this? You’ll get the same results every time, whether you study 1000 kids or 100,000 kids. They all get the same shots on the same schedule. They would have gotten the same results if they’d studies asthma, cancer, or any other chronic problem. All this study proved is that all the kids in that HMO got about the same vaccines over that 5 year time period. This doesn’t give us any useful data on how vaccines would have or would not have influenced the rate of autism.

Clearly, Dr. Bob doesn’t understand the very concept of a case-control study. Rather amusingly, he says that “virtually all the kids with autism have had the same shots as kids without autism” without realizing that that very conclusion in a case control study would be pretty powerful evidence that vaccine exposure is not a risk factor for autism! In actuality, though, he’s misstating the conclusion of DeStefano et al, anyway. The real conclusion was that the number of antigens from vaccines a child sees (which is a surrogate for vaccine load) has no correlation with that child’s risk of autism, ASD, or ASD with regression.

But if you really want hilarity, take a look at what he proposes as an alternative:

Now, if I were to do a study (and have several million bucks to fund it), here’s how I would look at the question of whether or not an increased number of vaccines relates to an increased risk of autism: I would take a bunch of kids who had all the vaccines on the regular schedule and look at the rate of autism in that group. We know that it’s about 1 in 50 kids. Then I’d take a whole bunch of kids who were only partially vaccinated and look at the rate of autism. I would subdivide the partially vaccinated group into subgroups based on the total number of vaccines given during infancy. I would perhaps have a group that delayed vaccines. And hey, while we’re at it, let’s really go crazy and find a few totally unvaccinated kids just for fun. On the other hand, no. Let’s not. It would be totally unethical to subject a group of totally unvaccinated children to any type of medical research. Ok, back to my study. These data would then give us a true look at autism rates compared to number of vaccines given and the age at which they were given.

Now THAT would be an interesting study. Unfortunately, it’s just too logical. It’s much better to study things in a confusing and illogical manner so you can get some results that the press can really sink their teeth into.

As I said, Dr. Bob’s ignorance is quite striking, because that’s rather what was done in Price et al for autism and Thompson et al for other neurodevelopmental outcomes. One notes that Dr. Bob also doesn’t tell us how he would compare these populations. What sort of study would he do? A case control? Oh, wait, he doesn’t like case control studies, finding them “confusing and illogical.” (No kidding. It’s very clear that he’s confused.) Maybe he would like a cohort study? Actually, that’s what he seems to be suggesting. After all, case control studies starts with the outcome (presence or absence of disease or condition) and then work back to exposure, while cohort studies start with exposure and work towards outcomes. Each study type has its advantages and disadvantages, but I get no sense that Dr. Bob has any clue about when it is best to use one versus the other. One notes, for instance, that Sir Richard Doll used the case control study method to be among the earliest investigators to confirm a link between cigarette smoking and lung cancer, while A. B. Hill used a cohort design. Both produced the same results, just from a different approach. Basically, it’s sour grapes. Dr. Bob just didn’t like the outcome of of DeStefano et al. His criticism of the study demonstrates that he has no understanding of the issues behind case control studies, and his suggestion of an apparent cohort study doesn’t address his rejection of DeStefano et al, specifically the question of why he thinks the results of DeStefano et al are so flawed that a huge new multimillion dollar cohort study is necessary to address the question of whether vaccines increase the risk of autism.

Instead, he retreats to conspiracy mongering and antivaccine fear mongering:

So, is anyone really surprised to see the Journal of Pediatrics study? What were you expecting? CDC researchers to publish as study that actually showed an increased risk of autism related to vaccines? The CDC would NEVER simply publish such a study. I doubt anyone would. Anyone at the CDC who published such a study would be fired faster than they could sell their Pharma stock.

Yawn. The pharma shill gambit. How original.

Of course, the antivaccine crank blog Age of Autism is very unhappy as well, but seems unable to muster any complaints much more coherent than those of Dan Olmsted, who basically mindlessly parrots Dr. Bob Sears’ objections, and Anne Dachel, who could muster nothing more than a call for the usual “vaxed versus unvaxed” study and reinforcing my conclusion that antivaccinationists don’t understand even the basics of clinical trial design, epidemiology, or ethics.

Perhaps the most amusing misunderstanding of basic epidemiology and the nature of a case control study comes from homeopath Heidi Stevenson of Gaia Health, who tries to argue…well, I’ll let you see for yourself:

As initially pointed out, this study was done on the assumption that there is no connection between autism and vaccinations. Therefore, there was no reason to do such a study. Why would you do a study on whether there’s an association between autism and vaccinations before you believe that there’s been a study demonstrating such a connection? If this were legitimate science, then there’d be no reason to do it.

Uh, no. This study was done to see if there was a connection between vaccine and autism detectable as a difference in vaccine antigen exposure between cases and controls. Stevenson digs herself in even deeper in terms of showing how little she understands what a case control study is when she writes:

This study, even if well done, would be meaningless simply because it jumps the gun. It makes no sense to do a study on the relative degree of a potential toxin’s effect on autism when no study has yet been done to determine that there is one. Since no such study has been done that officially implicates vaccines as the cause of autism, as explained earlier, what’s the point in doing a study focused on the relative degree of harm? This is pure duplicity on the part of the CDC.

One notes that Sir Richard Doll’s case control study was done before his and A.B. Hill’s cohort study. Does Stevenson doubt that smoking is an enormous risk factor for lung cancer? No, case control and cohort studies are different methodologies that each have advantages and disadvantages compared to the other. However, if a case control study as well done as DeStefano et al is so completely negative, there is no scientific justification for proceeding to do a cohort study. Yet that’s exactly what Dr. Sears and a homeopath are demanding because they think that a different study methodology will show them what this methodology didn’t. No doubt if someone did a cohort study of the type they want and it was negative, they’d proceed to demand a case control study.

Stevenson also tries to nitpick aspects of the study. For instance, she complains that more controls were eliminated than cases. The reasons for this were explained in both Price et al (in more detail) and in DeStefano et al, namely that they were deemed ineligible because they didn’t meet the protocol requirements. Indeed, in my previous post on Price et al, I reproduced the flowsheet that showed exactly how cases were ascertained and how subjects who fell under various exclusion criteria were eliminated. This study uses the same subjects, so the same flowsheet applies. One wonders whether Stevenson bothered to look up Price et al. Whether she did or not, Stevenson appears not to understand the concept of a case control study and how the cases and controls have to be matched as closely as possible for everything other than the condition that differentiates them.

Then, Stevenson lays down this doozy:

They looked at the number of antigens given to each child, both overall for their first two years and the number given on single days. This presumes that the number of antigens, rather than the number of vaccinations is the issue. It completely ignores adjuvants and other vaccine ingredients, including known toxins such as formaldehyde, mercury, and sorbitol 80, among others.

So which is it? “Too many too soon” or “the toxins“? I can’t tell. I guess it’s whatever argument happens to be convenient that day for the antivaccinationist making it.

The “evolution” of the antivaccinationist

Over the last decade or so, the reasons antivaccinationists advance for their fear and loathing of vaccines as an alleged cause of autism have “evolved” in response to what can be considered the “selective pressure” of scientific studies. It’s not surprising that that evolution has involved a tendency to migrate to hypotheses (I’m being really generous using that word here, I admit) whose main trait is to become more difficult to falsify. For instance, back in the late 1990s and early 2000s, the two predominant ideas were that MMR causes autism (this idea was most common in the U.K., thanks to Andrew Wakefield) or that the mercury in the thimerosal preservative in childhood vaccines caused autism (the favored notion in the U.S.). These were straightforward “hypotheses” that could be falsified using epidemiological studies of relatively simple design. And they were falsified roundly.

Then came the “toxins” gambit, which postulated that vaccines were full of vile substances ranging from antifreeze to formaldehyde to aborted fetal tissue. This one was more difficult conceptually in that there are a number of chemicals in vaccines, but they are all present at doses that are harmless. However, saying that was a harder sell, and the idea behind the “toxins” gambit was to force scientists to have to test each chemical, each adjuvant, each ingredient individually, a difficult enough task given the number of chemicals, and then in various combinations, an impossible task. That the task was impossible was the very point, of course. No matter how many trials scientists did, antivaccinationists could always say, “What about this adjuvant or this combination of adjuvants?”

Which brings us to “too many too soon.” It appeared to be a “hypothesis” that was impossible to falsify, but DeStefano et al came about as close as it’s ethically possible to falsifying the hypothesis. No wonder that all that antivaccinationists are left with are calls for “vaxed versus unvaxed” studies and pharma shill ranting.

Posted in: Epidemiology, Public Health, Vaccines

Leave a Comment (81) ↓

81 thoughts on “The final nail in the coffin for the antivaccine rallying cry “Too many too soon”?

  1. Narad says:

    I think my favorite of the comments on the NPR article is from the woman who touts her affiliation with these guys, who have the most wootastic Web design ever.*

    * The style sheet presents it upside-down in every browser I’ve tried.

  2. Badly Shaved Monkey says:

    The whole approach of the anti-vac movement has become an exercise in reductio ad absurdum. We need to remember that their basic contention is that vaccines cause harm on such a widespread scale that it is ‘obvious’ to casual observation. This is directly analogous to the claims made by homeopaths, though they claim a beneficial effect rather than a harmful effect from their intervention. Supposedly the effect is so large that it can be seen with daily dramatic clinical reliability.

    In both cases, if the advocates of these hypotheses require larger and larger studies, more and more subgroup analysis to detect effects that are deemed to be so subtle and evanescent that even the slightest deviation from an idealised perfect trial set-up causes those effects to disappear into the background noise, then their original hypothesis, their fundamental initial contention, that there is a real and dramatic biological effect has already been disproven. Arguing over the minutiae of another trial means they have lost the argument.

    But like Monty Python’s Black Knight, with a cry of “It’s just a flesh-wound!”, they just will not give up on something that has come to wholly identify their personalities.

  3. mousethatroared says:

    I’m glad this study was featured on NPR and I hope it gets good coverage elsewhere. I hope that it is explained well, to the public, so that laymen can understand the logic behind the approach and the results.

    Of the folks I’ve know with autistic children, (none of them age of autism type radical folk) “too many too soon” seems to be the concern I’ve heard the most often. Particularly my neighbor who’s son has regressive autism. She has never said anything against vaccines, but I think recalling her son’s regression starting awhile after a set of vaccines has bothered her.

  4. Janet says:

    “In other words, from the standpoint of prior plausibility, there is no compelling reason to suspect that vaccines could cause autism because such a mechanism is not consistent with what we know about the neurobiology of autism.”

    This relates back to the theme of your talk in DC posted last week. Alties want to keep studying things that don’t work and at the same time, their ignorance requires us to keep studying things that we already know DO work. What a waste of resources all around.

    @ MTM

    I agree with you–the question I hear most often (even from people who don’t hesitate to get their kids vaxed), is that whiff of concern about “that huge load of stuff” going into the bloodstream of a tiny baby. It’s good to be ready with a reassuring response to the effect that this is a misunderstanding of the process and explain that it’s really insignificant biologically. I then ask them if they really think that the entire scientific community is colluding to harm their children. Only the loons who fell off the fence long ago are paranoid enough to continue the argument at that point.

  5. passionlessDrone says:

    In addition, as the authors discussed, not all antigens are equal in evoking an immune response. Some have more epitopes (areas on the antigen molecule that can trigger an immune response) than others, and the study didn’t weight the antigens for the intensity of the immune response that they evoke. Even so, the antigenic load has fallen dramatically, and this study is based on the vaccine schedule of the 1990s.

    In other words, our metric (counting antigens) has no meaningful relationship with the intended outcome (degree of immunological stimulation), but we sure did count it! I mean seriously, who cares if our antigenic load has fallen dramatically if that value has no input on immunological stimulation?

    I wonder why we’ve been putting adjuvants in vaccines all this time since all we need is those antigens and epitopes? After all, those are the things that comprise the immunological stimulation! We really ought to try to stop adding alum to these vaccines, all it does is give the antivaxxers ammunition to claim there is a problem with vaccines; after all, we all know that it is the ‘antigenic load’ that determines the quality and quantity of immune response.

    If anyone wants the barest details on how flawed it is to count antigens and hope to come up with a metric for immunological stimulation, here is a paper where people actually tried to measure it a bit. [Note: I was amazed this paper actually existed.]

    http://www.vaccine-tlc.org/docs/31198987.pdf

    where pre-term infants were vaccinated, either with individual shots or multiple shots, and CRP and cardiorespiratory effects were measured. If you look at table 2, you can see that the shot with the most frequent increase in CRP (70%) is Hib, which has 2 measly antigens. The polio vaccine, which has 15 scary antigens resulted in no cases of increased CRP. Zero indications of immunological stimulation.

    That’s right, we have clinical data indicating that a vaccine with seven times more antigens causing far less immunological stimulation. What does this data do to the idea that you can accurately measure immune stimulation through the proxy of antigen counting? Anything?

    The DTaP was caused a CRP increase to 12.1 in one case out of 41, when children got DTaP, does anyone think CRP increased to 6000 (going from 6 antigens to 3000) at the same ratio? If not, if, of course, this is an absolutely ridiculous idea to hold in your head for a single second, what does this do to the foundation of DeStefano, which at its heart, relies on simple addition of antigens to measure immunological stimulation?

    This is a total joke.

    - pD

  6. David Gorski says:

    Of course, the problem with pD’s retort is his apparent assumption that immune stimulation due to vaccination has anything to do with the development of regressive autism. That has never been established.

  7. cervantes says:

    This is probably too obvious to be worth pointing out, but actually getting the disease is a helluva lot more stimulative of the immune system than getting the vaccine. Ergo, if stimulating the immune system is bad, vaccines are good.

    Just sayin’.

  8. David Gorski says:

    It’s never too obvious to point that out, because it seems to need constant pointing out.

  9. tjohnson_nb says:

    Well, if there is no correlation between numbers of autism cases and vaccinations we are still faced with the fact that “autistic events” seem to be connected time-wise to vaccinations. So is it the case that these children would have become autistic without vaccinations just maybe not right at that moment? So it could be possible that the vaccinations are precipitating an event that would in all likelihood have occurred anyway? You can see how difficult this would be for a parent to accept. To me this indicates that we should be researching ways of strengthening the immune system so that the body may fight off infections when it does encounter them. Perhaps we could then decrease the numbers of autism as well.

  10. tjohnson – that is not a fact. In fact, there is no statistical correlation between the timing of vaccinations and the development of autism, so there is no reason to hypothesize that vaccines are any sort of trigger.

    But – the most effective way to strengthen the immune system to fight off infections is – vaccines. That is exactly what they do. There is simply no connection to autism, however.

  11. tjohnson_nb says:

    @Steven Novella
    “that is not a fact. In fact, there is no statistical correlation between the timing of vaccinations and the development of autism, so there is no reason to hypothesize that vaccines are any sort of trigger.”

    Really? It seems to me that this is why so many people believe vaccinations CAUSE autism? Why else would they suspect that?

    “But – the most effective way to strengthen the immune system to fight off infections is – vaccines.”

    More accurately, this is what most healthcare practitioners believe at present.

  12. elburto says:

    tJohnson – No, it’s a case of correlation not always implying causation. That’s stats 101.

    People need something to blame for things that happen. Crops spoiled in the fields? The gods must be displeased. Children apparently only start showing signs of a neurodevelopmental disorder during the time frame a certain vaccines are given? Vaccines cause ASDs.

    It might seem logical, but it isn’t. If you have toast for breakfast one day, rather than your usual cereal and then crash your car on the way to work, is cereal to blame? “Ha!” You say, “that’s a coincidence!” However, if all drivers involved in RTAs are all asked about what they ate for breakfast that day, and most say it was cereal, then what? Seems plausible enough.

    It’s been disproved over and over again that vaccines cause autism, that “toxins” in vaccines cause autism, that “too many vaccines too soon” cause autism. So the antivax mob keep moving the goalposts, chucking gambits around as if they were tennis balls, and refusing to believe what’s staring them in the face.

  13. elburto says:

    Ugh, typing before medication – I mean “Is toast to blame?” Cereal is innocent, obviously.

  14. weing says:

    ““But – the most effective way to strengthen the immune system to fight off infections is – vaccines.”

    More accurately, this is what most healthcare practitioners believe at present.”

    Only the non-quacks.

  15. David Gorski says:

    Really? It seems to me that this is why so many people believe vaccinations CAUSE autism? Why else would they suspect that?

    “Seems to me” is the key phrase in your comment, just as “‘autistic events’ seem to be connected time-wise to vaccinations” is the key phrase in your previous comment. Correlation is being confused with causation. Because children get a number of vaccines right around the time when the diagnosis of autism is most commonly made (ages 2-4) by random chance alone there will be a fairly large number of children who demonstrate their first noticed symptoms of autism or ASD or receive a diagnosis of ASD within close temporal proximity to a round of vaccinations. That doesn’t mean vaccines have anything to do with autism. All the large well-designed epidemiological studies that have been done have failed to find a correlation between vaccination and the risk of subsequently developing autism.

    Now, as I’ve pointed out time and time again, humans aren’t wired to think in populations. We are wired to observe what we see, and we have a tendency to confuse correlation with causation. To a single parent seeing her child receive vaccinations and then to notice autistic symptoms within a week or two it can seem for all the world as though the vaccines caused the autism, but you can’t make such a conclusion from a single child.

  16. tjohnson_nb says:

    @weing

    At one one time most scientists believed space and time were absolute and unrelated. Don’t confuse science with omni-science.

  17. Sawyer says:

    @ tjohnson_nb

    “Really? It seems to me that this is why so many people believe vaccinations CAUSE autism? Why else would they suspect that?”

    Elburto already gave you a good example of a situation where an artificial correlation does not suggest an actual connection, but it probably sounds too absurd for you to relate it to the vaccine-autism issue. If you don’t trust doctors and medical researchers on this issue I would suggest you instead turn to the psychological research that shows how easy it is for people to misconstrue unrelated events as being connected to one another. This phenomena coupled with the dishonest propaganda coming from people that should know better perfectly explains why the belief persists. It has absolutely nothing to do with a real biological connection.

    There are dozens of accessible pop-sci books about this and thousands of journal articles. If you want a starting point I can suggest “The Invisible Gorilla” by Christopher Chabris. It’s probably not the most in depth coverage but specifically mentions vaccines and autism. Other SBM readers can provide you with a wealth of information on this topic.

  18. mousethatroared says:

    “But – the most effective way to strengthen the immune system to fight off infections is – vaccines.”

    In my experience an overly strong immune system is NOT much fun. I believe the nice thing about vaccines is that they don’t strengthen the immune system over all. They sorta educate the immune system.

  19. Sawyer says:

    Whoops, shouldn’t have given tjohnson the benefit of the doubt. Didn’t realize he was going to play the “antivaxxers are the next Einstein” card while I was typing my response.

  20. tjohnson_nb says:

    @David Gorski

    Correct me if I’m wrong but the studies that have been done show that, roughly speaking, just as many children get autism without vaccinations as those that do. But what if vaccinations are only one factor of several that lead to autism? In that case vaccinations could be acting as “the last straw” in some cases which would explain why some parents notice a drastic change seemingly overnight in their children. I understand that some studies are trying to address this at present.

    “The Childhood Autism Risks From Genetics and the Environment (CHARGE) study is under way at the University of California, Davis. Funded by the National Institute of Environmental Health Sciences and enrolling more than 600 families with autism, this study is looking at the interplay between genetic and a wide range of environmental factors in autism. Vaccines are one of the many environmental factors being analyzed.”

  21. Chris says:

    tjohnson_nb:

    Really? It seems to me that this is why so many people believe vaccinations CAUSE autism? Why else would they suspect that?

    Key word in the first question: “believe.” They do not have facts or evidence, so they go on beliefs.

    As for the second question, it is due to credulous folks who like to say “medicine does not believe in prevention!” Unfortunately they are the ones that like to quote fifty year old studies, mangle anecdotes and cherry pick studies. Many of them do it as a way to transfer money from the parents’ bank account to their own. Examples of these people include Wakefield, the Geiers, Boyd Haley, Bob Sears and Mercola.

    In short: there are people who lie to parents with disabled children in order to extract cash from them.

    If you have a better way to prevent measles, pertussis, tetanus, etc than vaccines, then please present the method with verifiable documentation that it would actually work.

    (History: I gave birth to a baby with medical issues over twenty years ago, and ever since I have witnessed quacks try to take advantage of me, and other parents. The first being Glenn Doman with is book What To With Your Brain Damaged Baby, which turned out to be a book length ad for his “Institute” in Philadelphia. This is where for lots of cash they train parents to give their kids excessive physical therapy, and if it doesn’t work it is the parents’ fault. One parent, Berneen Bratt, wrote about it in No Time for Jello. Dr. Novella also wrote about it. And the list goes on, and I do remember when Boyd Haley switched from charging people to test mercury in teeth to vaccines when we still had a phone modem.)

  22. weing says:

    “At one one time most scientists believed space and time were absolute and unrelated. Don’t confuse science with omni-science.”

    Now they have more evidence and modified their beliefs to suit that evidence. The cranks were wrong then, they are still wrong now. They did not believe what the scientists now believe.

  23. Sawyer says:

    @ weing

    You’ve just been brainwashed by the evil overlords of Big Physics. Einstein was actually superseded by concerned parents that were tired of their children getting hurt by conventional Newtonian physics. They utilized their superior mommy-sense to deduce that kids tripping over rocks were warping space-time as they fell and used this knowledge to develop the equations for general relativity. Their rallying cry was “Too much acceleration too soon!”

    Teach the controversy!

  24. Scott says:

    Correct me if I’m wrong but the studies that have been done show that, roughly speaking, just as many children get autism without vaccinations as those that do. But what if vaccinations are only one factor of several that lead to autism?

    Then there would STILL be a correlation between vaccination and autism – which there isn’t. Your “only one factor” is just as roundly refuted as an “only factor” claim would be.

    In that case vaccinations could be acting as “the last straw” in some cases which would explain why some parents notice a drastic change seemingly overnight in their children.

    On really striking thing about such stories is that the vaccinations involved frequently change… e.g. Jenny McCarthy claimed “the light went out of his eyes” in association with at least three different vaccines at different times. Another really striking thing is that the parents in question never seem to have been concerned at that time. (Indeed, if one takes the stories at face value, one would have to consider said parents grossly negligent in not seeking immediate medical attention for a child whose mental state supposedly drastically changed overnight.) Finally, there are very often indications of autism predating said supposed drastic change. And NEVER has there been a clearly documented case of such drastic change.

    In other words, the parents making such claims seem to be uniformly mistaken. Most likely because they have bought in to the antivax lies, and (as happens to all of us) their memories shift over time to reflect what they now believe must have happened, rather than what actually did.

  25. pmoran says:

    Of course, the problem with pD’s retort is his apparent assumption that immune stimulation due to vaccination has anything to do with the development of regressive autism. That has never been established.

    True, but we are talking about the risk of serious disability here, also potentially terrible public health consequences if we should we ever be suspected of taking the risks of vaccination too lightly. So unfortunately the onus of “proof”, to the degree that that is possible, does rest largely with us.

  26. passionlessDrone says:

    @Dr. Gorski –

    Of course, the problem with pD’s retort is his apparent assumption that immune stimulation due to vaccination has anything to do with the development of regressive autism.

    Who said anything about *regressive* autism? It wasn’t me. Please tell me how you could you tell if a two month old regressed versus had their developmental trajectory altered? I’d love to hear an answer to that.

    In any situation, the problem with your retort is that you fail to provide a single shred of evidence that counting antigens tells us the first thing about the quality or quantity of the immune response. Without said evidence, the underlying idea and conclusions of the study has no meaning. Why not just provide that evidence? In fact, why didn’t DeStefano just provide that evidence as references instead of a flaccid admission that antigens may (do) in fact, have differential effects on the quality and quantity of the immune response? Is it really too much to ask for a literature based defense for the hypothesis that the number of antigens in a vaccine has a meaningful effect on immunological stimulation?

    This study is a joke.

    I notice you didn’t really try argue against that statement, you just made up an argument about *regressive* autism, and put it in my mouth. Wouldn’t *somebody* besides me out there like to see Dr. Gorski actually defend the methodology of this study with some relevant literature? If this is ‘the nail in the coffin’ of anything, this should be an exceedingly simple task.

    It’s never too obvious to point that out, because it seems to need constant pointing out.

    I’ve pointed out repeatedly that there are significant problems with failing to take developmental timeframe into the discussion of immune stimulation. In fact, the last time you responded to my post, you got angry at me for wondering aloud if you understood the difference between a two month old and an eighteen month old; apparently you still haven’t figured out that there is one. Talk about needing to constantly point something out!

    @cervantes –

    This is probably too obvious to be worth pointing out, but actually getting the disease is a helluva lot more stimulative of the immune system than getting the vaccine. Ergo, if stimulating the immune system is bad, vaccines are good.

    Can you tell me how your analysis takes the parameter of developmental timeframe into consideration? If you goto pubmed, type in ‘early life immune activation’, you will quickly find that the animal models consistently find that the prenatal and perinatal period is one of differential susceptibility to immune stimulation wherein the early period can cause persistent modifications to hpa axis metabolism, the neuroimmune environment, the immune system, and ultimately, behaviors. Challenges later in life do not have the same effect.

    If every child got the diseases we vaccinate against at two months, your analysis would be ironclad. Fortunately for all of us, every infant does not get those diseases at two months, thus, we cannot assume equivalency between vaccination at birth, two, four, and six months, and getting a disease sometime in your life.

    - pD

  27. My weeks are more like a big foot coming out of the sky and squishing me while I’m listening to Sousa marches.

    Bob

  28. lilady says:

    Test Post.

  29. lilady says:

    pD states…

    “If anyone wants the barest details on how flawed it is to count antigens and hope to come up with a metric for immunological stimulation, here is a paper where people actually tried to measure it a bit. [Note: I was amazed this paper actually existed.]

    http://www.vaccine-tlc.org/docs/31198987.pdf

    where pre-term infants were vaccinated, either with individual shots or multiple shots, and CRP and cardiorespiratory effects were measured. If you look at table 2, you can see that the shot with the most frequent increase in CRP (70%) is Hib, which has 2 measly antigens. The polio vaccine, which has 15 scary antigens resulted in no cases of increased CRP. Zero indications of immunological stimulation.”

    Well, I was able to locate this article at http://www.pediatriccareonline.org (updated 2013), from a chapter of the AAP Red Book…

    https://www.pediatriccareonline.org/pco/ub/view/RedBook29/612292/0/Atropine__for_anaphylaxis?amod=aapea&login=true&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token

    Preterm and Low Birth Weight Infants
    GENERAL

    Red Book
    Preterm and Low Birth Weight Infants
    GENERAL

    Preterm infants born at less than 37 weeks’ gestation and infants of low birth weight (less than 2500 g) should, with few exceptions, receive all routinely recommended childhood vaccines at the same chronologic age as term infants. Gestational age and birth weight are not limiting factors when deciding whether a clinically stable preterm infant is to be immunized on schedule. Although studies have shown decreased immune responses to several vaccines given to neonates with very low birth weight (less than 1500 g) and neonates of very early gestational age (less than 29 weeks), most preterm infants, including infants who receive dexamethasone for chronic lung disease, produce sufficient vaccine-induced immunity to prevent disease. Vaccine dosages given to term infants should not be reduced or divided when given to preterm or low birth weight infants.

    Preterm and low birth weight infants tolerate most childhood vaccines as well as term infants. Apnea with or without bradycardia was reported to have occurred in some extremely low birth weight (less than 1000 g) infants after use of diphtheria and tetanus toxoids and whole-cell pertussis vaccine (DTP). More recent reports demonstrate that apnea episodes were neither more frequent nor more severe in extremely low birth weight infants immunized with acellular pertussis-containing vaccines (DTaP) compared with matched controls. However, cardiorespiratory events, including apnea and bradycardia with oxygen desaturation, frequently increase in very low birth weight infants given the combination diphtheria and tetanus toxoids and acellular pertussis (DTaP), inactivated poliovirus, hepatitis B, and Haemophilus influenzae b conjugate vaccine. Apnea within 24 hours prior to immunization, younger age, or weight less than 2000 g at the time of immunization and 12-hour Score for Neonatal Acute Physiology II less than 10 have been associated with development of postimmunization apnea, and it may be prudent to observe such infants for 48 hours after immunization. However, these postimmunization cardiorespiratory events generally do not have a detrimental effect on the clinical course of immunized infants…”

  30. Narad says:

    “At one one time most scientists believed space and time were absolute and unrelated. Don’t confuse science with omni-science.”

    Now they have more evidence and modified their beliefs to suit that evidence. The cranks were wrong then, they are still wrong now. They did not believe what the scientists now believe.

    Well, GR preceded the evidence; it was verified because it made testable predictions. A Euclidean universe wasn’t the province of cranks, as it’s perfectly appropriate at the observable scales that were accessible. (It’s not as though relativistic formulations are commonly employed in real-world calculations, in any event, with GPS being perhaps the most ubiquitous example.) But then the Lorentz invariance of Maxwell’s equations was noticed, and we were off to the races.

    So, what tjohnson’s analogy suggests (and which he later reinforced with the “last straw” remark) is that the effect of vaccines on autism is so subtle as to require exquisite untangling. Meanwhile, the antivax crowd is shrieking about an effect that is claimed to have produced a change of nearly 3 orders of magnitude.

  31. passionlessDrone says:

    @Narad –

    So, what tjohnson’s analogy suggests (and which he later reinforced with the last straw remark) is that the effect of vaccines on autism is so subtle as to require exquisite untangling.

    Excepting a very few well characterized, but ultimately rare genetic conditions that provide a very high risk of autism (i.e., Fragile-X, Rett) our observations of genetic or environmental risk (or protective) factors for an autism diagnosis follow a low penetrance model, providing a small nudge in risk (or protection) as opposed to an overwhelming push. If vaccination is involved, I don’t see why it would follow a different pattern than that. The problem is, vaccination casts a wide net.

    I have no problem admitting that the AOA crowd are idiots. I have no problem admitting that there is no ‘epidemic’ of autism that is caused by vaccinations. But those are *very different* statements than saying we have adequately studied the process of vaccination for subtle effects. Studying thimerosal only tells you about thimerosal. Studying the MMR only tells you about the MMR, and for the reasons I outlined to cervantes, is particularly problematic for a vaccine schedule that is heavy in the second, fourth, and sixth months of life. If you look at the early life immune literature in the animal models, you will see that we are just starting to understand how these challenges affect neurodevelopment. Yes, the effects are subtle compared to status epilepticus, encephalitis, or death, but subtle effects are still effects. Food for thought.

    @lilady –

    Unfortunately, at no point in the documents that you provide is there any indication that measuring the number of antigens gives us an indication of the quality or quantity of the immunological stimulation of a vaccine. That was the basis of DeStefano, a paper which, by the way provided a grand total of zero literature references to support the notion that counting antigens is a meaningful proxy for characterization of the immune response.

    See my example above on how a vaccine with 2 antigens caused a greater rise in CRP than a vaccine with 15 antigens as an example of why this methodology is at odds with existing evidence, up and above the fact that the authors provided no literature based support for this idea to start with.

    Your link, while it does exist as a link, provides no support to the idea that ‘number of antigens in vaccine == immune stimulation from vaccines’.

    If you want an additional example of the problems with this type of analysis, try the list of side effects from vaccines from the CDC page: http://www.cdc.gov/vaccines/vac-gen/side-effects.htm

    The varicella vaccine, which according to DeStefano has 69 scary antigens in it; yet it only produces a fever in 1/10 children, while the PCV vaccine, with only 8 antigens in it, caused a fever in 1 in 3. Nearly ten times fewer antigens, but higher incidences of immune mediated side effects. Do you understand the problems that this type of data presents to a model that is founded upon adding antigen values up as a way to measure immunological stimulation? I seriously am not sure that you do.

    Alternatively, take a look at the text from the CDC on the varicella vaccine:

    The first dose of MMRV vaccine has been associated with rash and higher rates of fever than MMR and varicella vaccines given separately. Rash has been reported in about 1 person in 20 and fever in about 1 person in 5. Seizures caused by a fever are also reported more often after MMRV. These usually occur 5-12 days after the first dose.

    How on Earth would this be the case if antigen counting is a valid mechanism for describing the immune response? How? The only way we could observe differential effects from vaccinating against the same diseases is if there are participatory factors other than number of antigens at play. It is so blindingly obvious. Once we admit this, however, we must also admit that this paper is a joke.

    - pD

  32. daedalus2u says:

    pD, the real-world standard for “is a vaccine effective”, is does it prevent epidemics of vaccine preventable diseases.

    There is extremely good data that the current vaccine schedule does prevent a great many vaccine preventable diseases that would otherwise be endemic (as they are in regions that do not vaccinate).

    Measuring antigens might be a useful research tool, but has nothing to do with the reasons that people are vaccinated; to prevent transmission of disease.

    The “vaccines cause autism” idea was started by people trying to win the “legal lottery” by blaming vaccines on their child’s autism and suing vaccine manufacturers. That was what the mercury stuff was about, that is what Wakefield’s fraud was about, that is what the Autism Omnibus was about. It was about trying to scam money from someone with deep pockets. That is still what all the autism quacks are about, trying to scam money from parents with more money than sense.

    That is what Jay Gordon’s new book is all about, trying to scam money from parents with more money than sense.

    Quacks will never abandon the anti-vaccine approach until they run out of people with more money than sense to scam.

    If a child is on a “hair trigger” for autism to be activated by immune system stimulation, then every single disease that vaccines prevent cause a more severe immune system activation that the vaccines that prevent them cause. Children get a zillion colds during childhood.

    Children also respond to many many antigens. We know that children mount an immune response to every single type of bacteria that they are exposed to. If they didn’t mount an immune response to a specific bacteria, then that would be the bacterial infection that would kill them in a few days. How many bacteria is that? thousands? tens of thousands? hundreds of thousands?

    You can’t do challenge testing with disease causing agents in children because of ethical considerations. So they do antigen counting and antibody titers. Not “gold standard”, but if the vaccines were not effective, then there would be epidemics which don’t happen because vaccines are effective.

  33. lilady says:

    pD: I provided you with a link to the AAP Red Book (updated 2013) about the paucity of cardiopulmonary events when low birth weight/preterm babies receive vaccines, according to the CDC Recommended Schedule. You OTH, used a five year old article from the Pediatrics Journal to *claim* cardiopulmonary events occur frequently when low birth weight/preterm babies receive vaccines according to the CDC Recommended Schedule.

    Now, changing the goal posts, you post back at me…

    “Unfortunately, at no point in the documents that you provide is there any indication that measuring the number of antigens gives us an indication of the quality or quantity of the immunological stimulation of a vaccine. That was the basis of DeStefano, a paper which, by the way provided a grand total of zero literature references to support the notion that counting antigens is a meaningful proxy for characterization of the immune response.”

    Go back and read the link I provided to see; “…Although studies have shown decreased immune responses to several vaccines given to neonates with very low birth weight (less than 1500 g) and neonates of very early gestational age (less than 29 weeks), most preterm infants, including infants who receive dexamethasone for chronic lung disease, produce sufficient vaccine-induced immunity to prevent disease. Vaccine dosages given to term infants should not be reduced or divided when given to preterm or low birth weight infants.”

    I’m not going to do your research for you pD. Show us any studies to disprove what the AAP Red Book states about vaccines for low birth weight/preterm babies and the evoking of “vaccine-induced immunity to prevent disease”. Make certain you know the difference between low birthweight and very low birthweight as well as preterm (less than 35 weeks gestational age) and very early gestational age (less than 29 weeks gestational age).

    Are you certain you know what a case control study is?

  34. WilliamLawrenceUtridge says:

    You know what? PassionlessDrone has convinced me. Yes, theoretically there might be a tiny increased risk of autism that is undetectable despite many studies. We should stop vaccinating. We would be much better off with millions children born sterile, deaf and mentally disabled due to rubella, permanently crippled and requiring an iron lung to breathe due to polio, or 1/1000 dead due to high fever from measles than we would be with a nigh-undetectable increase in autism rates due to vaccination.

    The argument that “antigens are different” is still worlds away from “antigens cause autism”. Those tiny nudges alluded to, if they exist at all, are so vastly less dangerous than the diseases prevented that even if it were proven through massive, expensive and nigh-impossible trials (i.e. even bigger than the studies involving tens of thousands of children, the kind of numbers where you might actually see tiny increases in autism rates) that vaccination produced minutely higher rates of autism we would still be justified in vaccinating. Unless you think that deaf, sterile, disabled, crippled or dead children are preferred over autistic children.

  35. tjohnson_nb says:

    What about the reports of vaccine-associated paralytic poliomyelitis as reported here?

    http://www.bmj.com/content/344/bmj.e2398/rr/578260

    What do the proponents of Science Based Medicine have to say about this?

  36. WilliamLawrenceUtridge says:

    You’re seriously quoting Viera Scheibner on science-based medicine? You realize her PhD is in microfossils, right? Her conflict of interest statement is wrong as well, she runs a website dedicated to opposing vaccination at all costs. So right off the bat, I wouldn’t listen to anything she says since she is not a disinterested commentor on the scientific literature, she’s more of a blatant liar who consistently misrepresents her own qualifications as well as any peer reviewed journals she touches. I suggest you fact-check all of her claims and sources as a starting point to determine whether they actually say what she suggests they say. Then I would look into the scientific literature more broadly, to see if these issues are agreed to by a consensus of experts, or if they are outliers that can be added to the enormous pile of initially interesting but subsequently unconfirmed study results.

    Live polio viruses are more stable and store better than killed-type viruses, as well as being far more effective at preventing actual polio – requiring fewer doses and achieving higher rates of immunity. As a result, they tend to be the preferred form of vaccination for countries that lack a stable supply chain that can maintain vaccines at a consistently low temperature. However, live attenuated vaccines are also live, meaning they do reproduce once they enter a body, and do mutate as they do so. Attenuated vaccines are passed through numerous nonhuman vectors to the point that they are for the most part not dangerous, but in a small number of cases they do revert to a wild-type that is dangerous. Therefore, when deciding which vaccine to use, one must carefully weigh the risks against the benefits; in most developed countries with excellent supply chain management and easy access to electricity and refrigeration, this means using injected killed vaccines which have zero risk of vaccine-associated paralysis. In most third-world countries (particularly in rural or sparsely-inhabited areas which lack electricity and the means to keep vials cold, and which often are fraught with communication difficulties or even active war making it hard to ensure children can get both doses of the vaccine), the stability and effectiveness of live-virus vaccines present tremendous advantages that for the most part offset their regretable but rare adverse effect of paralysis.

    Yes, it would be nice to have a vaccine that is stable, effective and risk-free. We don’t have that.

    So what do proponents say about vaccine-associated paralytic poliomyelitis? This proponent says the perfect is the enemy of the good, vaccines have enormous benefits but are not risk-free, it’s a complicated question, and only militant zealots present this sort of false dilemma. Scheibner isn’t worth listening to, she is not an expert, and she is dishonest. And finally, you should compare the risk of vaccine-associated paralytic poliomyelitis with the risk of paralysis due to wild-type infection by the polio virus; then you should realize that since you have a computer and ready internet access, that it’s not even a question you will ever have to deal with since you do not live in the backwoods of Nigeria and accordingly will only ever receive the killed virus.

    I hope that is illuminating.

  37. weing says:

    TJ,

    check out http://www.cdc.gov/mmwr/preview/mmwrhtml/00045949.htm

    You’ll see that, prior to vaccination in the US, there were over 2500 cases of paralytic polio per year and 125 cases of VAPP from 1980-1994 and no wild type cases. That is why it is important that polio be eradicated everywhere. Then we can stop the vaccination for it. Just like we did with smallpox.

  38. tjohnson_nb says:

    I am coming to the conclusion that vaccination programs may be very worthwhile in populations with high incidence of disease but as the incidence decreases the benefit/risk ratio becomes suspect.

  39. Scott says:

    That’s why we don’t vaccinate for smallpox anymore.

  40. lilady says:

    During calendar year 2012, there were a total of 223 cases of polio…worldwide:

    http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

    The *endgame* 2013-2018 plan to eradicate polio from the face of the earth:

    http://www.polioeradication.org/Portals/0/Document/Resources/StrategyWork/EndGameStratPlan_20130329_ENG.pdf

  41. WilliamLawrenceUtridge says:

    tjohnson, what do you consider the risks of vaccination to be?

    Also keep in mind that vaccine-preventable diseases preferentially infect the unvaccinated. While some people are “idiot unvaccinators” (i.e. they have spurious or ignorant objections to vaccination) there are genuinely some people who can not be vaccinated (because they have certain types of cancers or immunological conditions which prevent it) or will not benefit from vaccination (the elderly). These people rely on herd immunity to protect themselves from diseases, which requires very high rates of vaccination. However, unfortunately, you can’t hide in the herd. Idiot unvaccinators, the unable and the unresponsive all rely on herd immunity to protect themselves from diseases, but only the latter two groups can claim any reasonable right to that protection.

    There is a fourth group as well, since vaccinations are not 100% effective there are a small number of people who will get the CDC-recommended vaccine schedule but will still not acquire immunity to one or more of the diseases. These people also rely on the herd, but they are not parasitic on it in the same way idiot unvaccinators are. This is why vaccination will never be an absolute panacea and why selfish idiot objections like “you’re safe, you’ve been vaccinated” are not rational responses.

    But what all this essentially comes down to is – until a disease is actually eliminated, it is normally well-worth the incredibly minor risks of vaccination in order to acquire immunity. The risks from diseases are orders of magnitude higher than the risks from vaccination. “Natural” infection is not better at much besides increasing your risk of dying or suffering complications from the disease itself. Without regular vaccination programs, in the modern world with air travel connecting nearly every sizeable population on the planet, vaccination is an absolute necessity because those vaccinations are the only thing preventing us from becoming the “populations with high incidence of disease” you think should be vaccinated.

    Incidentally, the vaccine schedule incorporates risk:benefit ratios in it, the specific vaccines chosen and timing of each dose is rationally discussed by genuine experts in the relevant disciplines, sub-disciplines and sub-sub-disciplines. The committees involved are filled with epidemiologists, pediatric immunologists, infectious disease specialists and the like. The specific vaccines are evaluated for risk and benefit at each renewal of the schedule, which is why the extremely effective but somewhat riskier whole-cell pertussis vaccine was withdrawn and the less effective but less risky acellular pertussis vaccine is used instead. Pertussis aka whooping cough, incidentally, is quite unpleasant but is also lethal – and for those for whom it is lethal, there is no effective treatment whatsoever; you just get to watch your baby die like these people did. There is a specific window in which babies can not be vaccinated against pertussis, and even after that window the vaccine is not very effective. I’ve had my pertussis booster shot but I still refuse to visit any newborns who have not had minimum two doses of the pertussis vaccine – because I don’t want to be the guy who gives his friend’s baby a lethal dose of whooping cough.

    Polio is another example of the risk:benefit decision making that goes into the vaccine schedule. Most developed countries switched to the less effective killed vaccine rather than the more dangerous attenuated live vaccine several decades ago because the risk of infection was generally low. Could have been zero if Nigeria and Afghanistan had participated in the WHO’s vaccination program.

    Influenza is another example of a risk:benefit calculation; it is free, but not mandatory, because it is generally dangerous mostly to the already-ill.

    I recommend any book by Paul Offit, but Arthur Allen’s Vaccine is another good one.

  42. Lauren @ the VEC says:

    The Vaccine Education Center at The Children’s Hospital of Philadelphia has some easily downloadable sheets that discuss the research surrounding vaccine safety concerns including autism (http://bit.ly/VaccinesAndAutism) and too many vaccines (http://bit.ly/TooManyVaccines).

  43. WilliamLawrenceUtridge says:

    Also, before quoting Ms. Scheibner again, perhaps you might want to review this document regarding her and her claims. It’s from 2003, but doubtless little has changed bar sophistry.

  44. Chris says:

    tjohnson_nb:

    I am coming to the conclusion that vaccination programs may be very worthwhile in populations with high incidence of disease but as the incidence decreases the benefit/risk ratio becomes suspect.

    I just knew that someone who said that modern medicine does not believe in prevention would not like vaccines. And it is precious that your level of evidence is a comment by someone whose PhD is in the study of rocks created by teeny tiny fossils (micropaleontology).

    And, yes, the vaccine schedule changes when certain benefit/risk ratios are met. This is why smallpox, yellow fever, typhus and typhoid are not on the American pediatric schedule (though I received them all as a child since I was born and lived in Panama). This is why the American pediatric schedule changed the polio vaccine from OPV to IPV.

    Now do tell us which vaccines on the present American pediatric schedule that you feel are too dangerous. Be sure to provide actual citations in the form of title, journal and dates of PubMed indexed papers. This means no more comments from geologists! I present for you reading pleasure what happened when vaccination was reduced in Japan:

    Impact of anti-vaccine movements on pertussis control: the untold story:

    After two infants died within 24 h of receiving DTP, the Ministry of Health and Welfare eliminated whole-cell pertussis vaccine altogether. They later allowed it only for children older than 2 years. Pertussis coverage for infants fell from nearly 80% in 1974 to 10% in 1976. A pertussis epidemic occurred in 1979 with more than 13 000 cases and 41 deaths.

    Measles vaccine coverage and factors related to uncompleted vaccination among 18-month-old and 36-month-old children in Kyoto, Japan:

    In Japan, measles vaccine coverage has remained low, and either small or moderate outbreaks have occurred repeatedly in communities. According to an infectious disease surveillance (2000), total measles cases were estimated to be from 180,000 to 210,000, and total deaths were estimated to be 88 [11,12]. Measles cases are most frequently observed among non-immunized children, particularly between 12 to 24 months.

    Also, think carefully about which vaccine in the present pediatric schedule you wish to eliminate. My son suffered seizures from dehydration due to rotavirus as a toddler, which may or may not be related to his severe speech/language disability. So really do include those citations showing the vaccines carry more risk than the diseases.

  45. Sawyer says:

    @pD

    Even if your criticisms on antigen response are valid (I’m curious if the papers you cited are the exceptions to the rule instead of the normal trend), doesn’t this still fly in the face of what people like Dr. Sears have been touting for years? I suspect the reason this study is not meeting your standards is because all of the real research on this topic was done a decade ago and we are now testing the ridiculous hypotheses put forward by antivaxxers. Comparing antigen levels doesn’t prove vaccines can’t cause autism. It does prove that everyone touting the “too many too soon” was completely full of it and now they are moving the goalposts for the 700th time.

  46. passionlessDrone says:

    @daedulus2u –

    pD, the real-world standard for “is a vaccine effective”, is does it prevent epidemics of vaccine preventable diseases.

    OK. I won’t disagree with you on any of your statements regarding vaccine efficacy at preventing diseases. I wonder, can you provide a single reference where I have tried to state otherwise? If so, please post it. If you cannot, perhaps I will start to imply that you said vaccines are 100 medically safe, and without any side effects. You have said that, haven’t you?

    If a child is on a “hair trigger” for autism to be activated by immune system stimulation, then every single disease that vaccines prevent cause a more severe immune system activation that the vaccines that prevent them cause. Children get a zillion colds during childhood.

    How hard is it to understand that there is a qualitative difference between childhood and being two months old? Have you ever seen an infant two months old? Have you ever seen an eight year old? They are quite a bit different. Maybe you and Dr. Gorski should try to get out more or something.

    Children also respond to many many antigens. We know that children mount an immune response to every single type of bacteria that they are exposed to. If they didn’t mount an immune response to a specific bacteria, then that would be the bacterial infection that would kill them in a few days. How many bacteria is that? thousands? tens of thousands? hundreds of thousands?

    Well then, explain why the Hib vaccine, with 2 antigens, caused a meaningful increase in CRP in the study I posted above? If these children were exposed to bunches of antigens with a resultant immune response, there shouldn’t have been a difference in CRP levels pre and post vaccination. But there was. Why? Vaccines only work because the stimulate the immune response over baseline. That is why.

    So they do antigen counting and antibody titers.

    Can you show me one other study where ‘they do’ ‘antigen counting’ and it was used as a metric for the resultant immune response? Why didn’t DeStefano reference it, if this is such a meaningful value? Isn’t some level of biological plausibility sort of a hallmark for this site? Or is that only for ripping on homeopaths?

    @lilady –

    I wasn’t trying to show anything about cardiac events; merely that there were measurable increases in CRP by vaccine, but those increases followed the opposite pattern we would expect if believed in the ‘count the antigen’ idiocy. I was simply taking advantage of one of three pubmed articles that actually measured CRP post vaccination in infants. Use another one that supports DeStefano’s methodology, if you can.

    You link says absolutely nothing toward the utility of ‘counting antigens’ as a metric for characterizing the immune response. Do you understand that? The achivement of ‘immunity’ is qualitatively a different arm of the immune system that the innate immune response.

    Show us any studies to disprove what the AAP Red Book states about vaccines for low birth weight/preterm babies and the evoking of “vaccine-induced immunity to prevent disease”.

    I’m not trying to make the case to disprove your fantasy argument. I am making the case that there is no literature based support for the underlying premise of DeStefano, that counting antigens tells us anything about the immune response.

    You’ve lost it. I am sorry for you.

    @WLU -

    Yes, theoretically there might be a tiny increased risk of autism that is undetectable despite many studies.

    What studies? Please don’t tell me I have to explain to you also that there is a difference between studying thimerosal and studying vaccination. Please don’t tell me I have to explain to you the difference studying the MMR and studying the practice of vaccination. Do you honestly not understand that there is a difference between the two? Really?

    We should stop vaccinating.

    If you can link to an instance where I have made this argument, I will retract it. Generally, when you make up fantasy arguments, assign them to someone else and make them defend it, it is considered a signature of a weak position. Why not just provide some evidence that DeStefano used an appropriate proxy for measuring immune response? Why not just shut me up with some litreature that supports DeStefano’s abstract; measurement of immunological stimulation by counting antigens? If this study is ‘the nail in the coffin’ of anything, this should be easy, easy, easy.

    The argument that ‘antigens are different’ is still worlds away from ‘antigens cause autism’.

    You are technically correct. But I am not making that argument. So what is your point?

    If I made the assertion that ‘WLU says that vaccines are 100% medically safe with no side effects’, I think you’d probably take issue with me for putting a bogus argument in your mouth; why do the same to me?

    Those tiny nudges alluded to, if they exist at all, are so vastly less dangerous than the diseases prevented that even if it were proven through massive, expensive and nigh-impossible trials (i.e. even bigger than the studies involving tens of thousands of children, the kind of numbers where you might actually see tiny increases in autism rates) that vaccination produced minutely higher rates of autism we would still be justified in vaccinating.

    This line of reasoning seems to miss several key points:

    1) The time dependent nature of the developmental programming models regarding early life immune activation. In other words, you don’t have to remain unchallenged forever to escape the effects of ‘early life’ challenge and resultant persistence of effect.

    2) It assumes we cannot understand what comprises a susceptible subgrouop; i.e., the nature of some predispositions to autism (i.e., prenatal elevation of inflammatory markers), or immune biomarkers that might allow us to discern children for whom vaccination should be carefully planned.

    3) It assumes that we cannot find a way to vaccinate and/or introduce immunological memory without inducing the effects seen in animal models.

    Why do you insist that this must be a binary decision point, vaccinate everyone at the current schedule, or terminate the entire vaccine schedule in whole? If you can show us, here, with links, that I have made this argument, I will retract it, and never, ever post on this site again. Start linking.

    Wouldn’t it just be easier to admit that there isn’t any literature support for DeStefano? That’s why they didn’t include any in their paper. That is why Dr. Gorski hasn’t posted any. Making up fake arguments and assigning them to me doesn’t make the case for DeStefano any stronger, it just makes your position look more fragile.

    - pD

  47. passionlessDrone says:

    @Sawyer -

    Even if your criticisms on antigen response are valid (I’m curious if the papers you cited are the exceptions to the rule instead of the normal trend), doesn’t this still fly in the face of what people like Dr. Sears have been touting for years?

    Find some papers that are in line with DeStefano’s line of reasoning if you think mine are the exceptions. Do you really think that the CDC page I linked to showing adverse effects post vaccination are ‘exceptions to the rule’? I predict that what you will find is that we’ve done precious little in terms of measuring the innate immune response in infants post vaccination; that’s why the study was in premies; and relatively small for a program that touches 4 million infants a year. I am willing to be corrected on this point, however, with literature.

    I don’t care about Dr. Sears or what he says. The guy is an idiot. What of it?

    I suspect the reason this study is not meeting your standards is because all of the real research on this topic was done a decade ago and we are now testing the ridiculous hypotheses put forward by antivaxxers

    Well, then, why not have someone post it? Why don’t you post it? Why didn’t Dr. Gorski post this voluminous evidence in his response to me, instead of making up an argument about *regressive* autism and assigning it to me? Why not email him, and ask him to post all of this great evidence, instead of just implying that it exists?

    As far as my standards, the standards of this site involve biological plausibility for claims, at least is usually does. Try to find me something in the literature that tells us ‘number of antigens == immune response’. If you can’t, then maybe you should ask why the standards of SBM seem to have fallen to such a pitiful level.

    Comparing antigen levels doesn’t prove vaccines can’t cause autism.

    You are correct. In fact, it doesn’t prove anything other than the ability to perform addition.

    It does prove that everyone touting the “too many too soon” was completely full of it and now they are moving the goalposts for the 700th time.

    How? We seem to have discovered a distinct lack of interest in showing that ‘antigens == immune response characterization’ from the available data. See my links above for examples of opposite patterns. If our reality based observations are at odds with the models invoked by DeStefano, why should we ask reality to bend? Why not just assume that DeStefano’s model is invalid; especially as it appears to have no support in the literature? Once we do that, however, we must admit that it doesn’t ‘prove’ anything.

    - pD

  48. Sawyer says:

    @pD

    I do not have the expertise to argue with you on the details but I’m lost as to how this completely invalidates the main conclusion of the study. They are comparing antigen exposure levels to autism. That’s all. If the link between antigens and immune response is mischaracterized it’s certainly something worth pointing out, but it hardly makes the study a “joke.”

    As for the previous literature on vaccines and autism just look in the paper we’re discussing. There are several reviews referenced there and this topic has been covered literally hundreds of times in the science-based medicine and skeptic communities. If you’re frustrated that there’s too much focus on Age of Autism or Dr. Bob please help us push them out of the spotlight so we can talk more about actual science.

  49. WilliamLawrenceUtridge says:

    What studies? Please don’t tell me I have to explain to you also that there is a difference between studying thimerosal and studying vaccination. Please don’t tell me I have to explain to you the difference studying the MMR and studying the practice of vaccination. Do you honestly not understand that there is a difference between the two? Really?

    I understand, I think your point is spurious. Given the enormous numbers of subjects in the multitude of studies done, even if one particular ingredient of one particular vaccine genuinely showed a consistent pattern of increasing rates of autism, there would be a signal in the noise. It’s just noise. This is a dead hypothesis maintained only by the unending shrieks of the scientifically ignorant or morally bankrupt.

    I’m really not sure how one could study “the practice of vaccination” without studying “vaccines”.

    If you can link to an instance where I have made this argument, I will retract it.

    Oh, I can’t link to such an instance. I’m undertaking a reductio ad absurdum to make a point. Really, your comments have the substance of concern trolling even if that’s not your goal. You are attempting to invoke the precautionary principle (vaccines might cause autism, based on little more than correlation in time during a developmentally and medically busy age that is easily explained through several cognitive errors in reasoning) which inherently relies upon possible harms, against a well-studied question. If applied, the precautionary principle would require the withdrawal of vaccines, which has clear, lethal consequences. So, like antivaccinationists everywhere, you are pitting a possible but really essentially discredited harm, against an absolute, unwavering, iron-clad real and proven harm. That is the logical outcome of your points, and if you don’t see it, there’s not much point in discussing further.

    Why not just provide some evidence that DeStefano used an appropriate proxy for measuring immune response? Why not just shut me up with some litreature that supports DeStefano’s abstract; measurement of immunological stimulation by counting antigens? If this study is ‘the nail in the coffin’ of anything, this should be easy, easy, easy.

    Why would I do that? I trust the genuine experts to be experts, to know what they are talking about, to interpret the totality of the evidence and to have the prevention of disease to be their primary goal. I’m not about to spend months educating myself to understand just the basic issues when your premises and logic leads to such an untenable outcome. I have to do this, because I don’t have the time, money or energy to acquire a MD/PhD in immunology it would require to debate specific points with you. Instead, I’ll trust the experts and restrict myself to my own tiny area of experience, which is laying out why I think you are wrong.

    You are technically correct. But I am not making that argument. So what is your point?

    Your statement that you did not make such an argument may be technically correct, but falls well within the boundaries of the “just asking questions” approach to argumentation. I suppose that’s my point.

    If I made the assertion that ‘WLU says that vaccines are 100% medically safe with no side effects’, I think you’d probably take issue with me for putting a bogus argument in your mouth; why do the same to me?

    It amuses me.

    Why do you insist that this must be a binary decision point, vaccinate everyone at the current schedule, or terminate the entire vaccine schedule in whole? If you can show us, here, with links, that I have made this argument, I will retract it, and never, ever post on this site again. Start linking.

    Why do you insist that there is something to study here? Why do you insist that scarce research dollars, time and effort be spent re-investigating a hypothesis that has failed both empirically and conceptually not once, but dozens of times? Where on earth do you get the arrogance to believe that somehow you have discovered a loophole that hundreds of researchers and millions of interested parents, administrators, health care professionals and students have missed? This whole “maybe there might be for some children within a specific developmental stage perhaps a risk that vaccines could potentiate the genetic predisposition in a subset of cases” is based on so many chained together qualifiers, none of which seem to be serious areas of concern for study, that it hardly seems convincing. Why not simply accept that maybe vaccines have nothing to do with autism?

    Wouldn’t it just be easier to admit that there isn’t any literature support for DeStefano? That’s why they didn’t include any in their paper. That is why Dr. Gorski hasn’t posted any. Making up fake arguments and assigning them to me doesn’t make the case for DeStefano any stronger, it just makes your position look more fragile.

    The thing is, vaccines have had antigens in them for over a century. Pathogens have been antigens for billions of years. By studying vaccines, you are inherently studying antigens at one step’s remove. If I’m comparing two cars for mileage, I don’t need to know why a car gets better mileage to know if it gets better mileage. We’ve been measuring the risk of vaccines (which inherently contain antigens) causing autism for decades. Why would the risk suddenly increase or be any different when the number of antigens drops?

    Why didn’t Dr. Gorski post this voluminous evidence in his response to me, instead of making up an argument about *regressive* autism and assigning it to me?

    He’s probably fucking sick of answering the same questions again and again, facing the same fallacies again and again, facing the same concern trolling again and again, and above all, seeing those goalposts move again and again. I know I am. There is voluminous evidence on this website alone, feel free to peruse it. Pubmed is another starting point, feel free to go there. The burden of evidence is on the party that proposes the hypothesis.

    The core point of the paper is still that in a well-designed study, no relationship was found between vaccines (specifically antigens) and autism. Hooray!

    I wonder why we’ve been putting adjuvants in vaccines all this time since all we need is those antigens and epitopes?

    This is an old comment, but under the impression that you’re genuinely interested in an answer, I’ll provide one. Adjuvants make it easier for the body to recognize the antigen. They often will thicken the antigen-containing solution (so it stays in one place and doesn’t get dispersed immediately) or irritate the body to produce a greater response than an adjuvant-free vaccine. Fewer antigen particles can be used, more vaccine doses can be prepared with less raw material and the vaccine is more effective, more likely to result in permanent (or at least long-term) protection. That’s why we use adjuvants, each of which is evaluated for safety and efficacy in the human body. They aren’t pulled out of a hat or added out of random pique, the decision to add each is again based on experts I trust to be experts.

  50. David Gorski says:

    He’s probably fucking sick of answering the same questions again and again, facing the same fallacies again and again, facing the same concern trolling again and again, and above all, seeing those goalposts move again and again. I know I am.

    Indeed. I probably shouldn’t have bothered to respond at all, but I did. Then we had our blog crisis with the site being down, and I didn’t think it worth coming back to revisit pD’s blather. Just not worth my effort, because I know he’ll do a bit of the Gish gallop and I’ll never satisfy him because he’s not satisfiable.

    He shouldn’t feel too bad, though. I prefer to spend my time producing material for the blog, rather than diving into the comments in depth. True, occasionally I do delve into the comments when I’m in the mood or when someone raises points that interest me, but if it’s a choice between wasting time arguing with someone like pD and keeping this blog and my not-so-secret other blog stocked with new material, keeping this blog and my not-so-secret other blog stocked with new material will win every time.

  51. Narad says:

    See my example above on how a vaccine with 2 antigens caused a greater rise in CRP than a vaccine with 15 antigens as an example of why this methodology is at odds with existing evidence

    It strikes me as odd that Pourcyrous et al. state that “CRP responses to DTaP and other vaccines have
    not been studied” when that’s just the comparison that their own citation made.

    Moreover, your assertion that “if you look at table 2, you can see that the shot with the most frequent increase in CRP (70%) is Hib, which has 2 measly antigens” isn’t quite accurate. It had the highest number of CRPs over 1.6, but DTaP clearly had the greatest number of detectable values, as well as the highest number of interventions. Unfortunately, I can’t find where they report what the prevaccination CRP values were. And if you’re going to try to play the “maybe you and Dr. Gorski should try to get out more or something” card, perhaps you shouldn’t try to extrapolate this work to anything other than preterm infants.

    In any event, what I’m failing to see here is why you think a transient elevation of CRP is of overarching interest.

  52. pmoran says:

    He’s probably fucking sick of answering the same questions again and again, facing the same fallacies again and again, facing the same concern trolling again and again, and above all, seeing those goalposts move again and again. I know I am.

    PD is scarcely the one responsible for all these exasperations . He seems be testing one consistent theory against the available evidence and it should be our job to aid in that.

    The authors of this study themselves say ” — although possible effects in early infancy cannot be ruled out completely.”

    If it is indeed difficult to exclude an idiosyncratic or rare immunological (or other unknown) reaction to vaccines in the very young as contributing to a few examples of ASD, we should say so and begin trying to put any risk into perspective, as we have always done with other imputed risks from vaccines. We have data which suggests that it must be a very rare factor, if at all.

  53. lilady says:

    There is this article in “Expert Review of Vaccines” 2012;11(10):1199-1209

    Immunogenicity, Safety and Tolerance of Vacinations in Premature Infants (Esposito, Fumagalli and Principe), available through online subscription or single article purchase.

    Or, if you subscribe to Medscape, as I do, it is available in its entirety:

    http://www.expert-reviews.com/doi/abs/10.1586/erv.12.93

    Whenever pD posts, remind me to never post back… :-)

  54. Chris says:

    WLU:

    (vaccines might cause autism, based on little more than correlation in time during a developmentally and medically busy age that is easily explained through several cognitive errors in reasoning) which inherently relies upon possible harms, against a well-studied question. If applied, the precautionary principle would require the withdrawal of vaccines, which has clear, lethal consequences.

    The corollary of this argument is that there is tiny group that is susceptible to vaccines. Yet no one can tell us how you would find these children, and if they would fare better by actually getting the disease. I note that pD often comments on cytokine reactions, ignoring that they would be worse for the disease than the vaccine.

    The latter part is because some of the AoA bunch claim that the diseases are not dangerous, and “natural immunity” is better, doncha know. Despite the evidence that measles is quite harmful, and that none of the three bacterial diseases covered by the DTaP create permanent immunity. And as someone who got mumps a second time during the 1968 mumps epidemic, I can personally vouch for the lack of permanent immunity for mumps.

    So, like antivaccinationists everywhere, you are pitting a possible but really essentially discredited harm, against an absolute, unwavering, iron-clad real and proven harm. That is the logical outcome of your points, and if you don’t see it, there’s not much point in discussing further.

    It is done by getting lost in the minutia, and ignoring the very real epidemiology of the diseases, plus of the research that disproves any vaccine/autism link done in the past fifteen years.

    But I keep wondering, why does it have to be vaccines? Why after so much actual real science showing that is not likely to be any connection, why spend so much energy and anger to make the false premise real?

  55. WilliamLawrenceUtridge says:

    @Chris

    Because vaccines are something that can be controlled, and vaccines are not your fault – both are particularly acute given the genetic component of autism.

    Not to mention the anchoring, need to explain and desire for justice that are fallacies in all humans. We are story-telling apes who project the illusion of a comprehensible world around us. While it is best (i.e. most accurately) comprehended scientifically, it is far from satisfying and strips us of many of our illusions of control. Science tells us that there is nothing you can do to stop an earthquake, that you can’t predict who will suffer and die from a disease, or how we can stay free of cancer. The old forms of comfort, propitiating a god, invoking ancestors, communing and suffering, these are peeled away leaving naught but cold, sharp reality. Science, while powerfully effective and far more reliable than any other method of inquiry, offers little comfort.

    Unless you know something about statistics, and realize that most of the boring advice does a pretty good job of preventing a lot of morbidity.

    “Story-telling apes” is my second-favourite Terry Pratchett line, soon after “humans lie between the falling angel and rising ape.” Such a pity he has Alzheimer’s.

  56. Chris says:

    WLU:

    Because vaccines are something that can be controlled, and vaccines are not your fault – both are particularly acute given the genetic component of autism.

    And they give us a way to deny our own genetics. Cute.

  57. passionlessDrone says:

    @Narad –

    . And if you’re going to try to play the “maybe you and Dr. Gorski should try to get out more or something” card, perhaps you shouldn’t try to extrapolate this work to anything other than preterm infants

    The fact that this study is in pre-term infants is a function of the fact that it hasn’t been seen as meaningful to understand innate immune response post vaccine except in very high risk populations. The idea that transient inflammation, without an actual pathogen, could cause persistent effects is very, very new. If you don’t like the pre-term infant data, the CDC rough data on fever also shows a pattern opposite of what we would expect if DeStefano’s model had a reality basis.

    I would think that you’d like to see Dr. Gorski provide some literature support for DeStefano’s methodology. But maybe not. (?) I cannot prove that the data supporting a ‘counting antigens == immune stimulation’ does not exist; but anyone could prove that it does exist. So far, no one has bothered to do that. I assert it is because there is no such evidence.

    Isn’t it kind of common on this board to be skeptical of claims for which there is no literature support?

    In any event, what I’m failing to see here is why you think a transient elevation of CRP is of overarching interest.

    The basis of DeStefano is that you can count antigens to understand ‘the immunological stimulation of vaccines’. That’s the entire point of the paper. CRP is one measurement of inflammation post vaccination; and the only one I’ve seen measured the infant population post vaccination. It just so happens, the profile you see when measure CRP (or side effects from the CDC site), is the opposite of what you would expect if the model proposed by DeStefano was valid. It is of ‘overarching interest’ because it tells us that there is something wrong with DeStefano’s model, something which *should* have been apparent to a bunch of skeptics when they realized that DeStefano provided zero literature references for the ‘counting antigens==immuological stimulation’ nonsense. It isn’t just that there are no references to support the underlying methodology, there is also evidence to indicate their methodology is flawed.

    If we are truly dedicated to a mindset of skepticism and fidelity to the data, we must accept that algorithm used by DeStefano is at odds with existing evidence, and the authors themselves provided no evidence on why it might be a useful tool.

    @Chris –
    I note that pD often comments on cytokine reactions, ignoring that they would be worse for the disease than the vaccine.

    You are simply exposing that you don’t pay attention to my posts. In fact, here, on this thread, I told cervantes that if all infants got the diseases we vaccinate against *at the time we vaccinate*, that the “Ergo, if stimulating the immune system is bad, vaccines are good.”

    I responded:

    If every child got the diseases we vaccinate against at two months, your analysis would be ironclad.

    I do not subscribe to the idea that ‘natural infection is better’.

    @Dr. Gorksi –

    I don’t feel bad. I actually think it’s pretty funny. What, you’ve written a couple of hundred (more than a thousand?) posts on vaccination and autism, and you still don’t seem to understand that antigens aren’t a meaningful metric for immunological stimulation or the difference between a two month old and an eighteen month old and why time dependencies might be important for a condition neurodevelopmental change that is evidence in infants.

    In you cancer posts, many of which I appreciate greatly, you go to great pains to explain that the old guard of cancer knowledge has given way to one where there are thousands of cancers in one individual, the importance of the tumor microenvironment, individual genomic fingerprints are important only for some, and while the genome project didn’t cure cancer, it has given us a lot of important information. In short, the details are important and the closer we look, the more powerful our filter, the more we realize our underpowered observations of the past were not adequate to understand such a complex condition. We should be taking the same tact with any complicated, heterogeneously manifesting condition; if we do that, however, this means that we need tools more complicated than addition to understand the immune response, we cannot accept false equivalencies between newborn infants and full blown toddlers, and we must apply great skepticism toward telescope level views of a landscape that seems to change every year when the microscopic view looks a lot different.

    @WLU –

    He’s probably fucking sick of answering the same questions again and again, facing the same fallacies again and again, facing the same concern trolling again and again, and above all, seeing those goalposts move again and again. I know I am. There is voluminous evidence on this website alone, feel free to peruse it.

    *cough*

    Yeah, I’m pretty sure there’s a link on here that says chelation cures autism too. It’s on there, somewhere, just go find it.

    Regarding ‘same fallacies again and again’, the ridiculous ‘antigen == immune stimulation’ absurdity has a long life here, and one without any literature support to this day.

    The burden of evidence is on the party that proposes the hypothesis.

    My hypothesisis that DeStefano’s methods are at odds with reality based observations. I have provided that evidence above.

    As for the rest, the kids are up and it was mostly boring. Good luck.

    -pD

  58. David Gorski says:

    How hard is it to understand that there is a qualitative difference between childhood and being two months old? Have you ever seen an infant two months old? Have you ever seen an eight year old? They are quite a bit different. Maybe you and Dr. Gorski should try to get out more or something.

    Oh, goody. I’m being told to “get out more” by someone who obsesses over vaccines as a possible cause of autism. I am amused. Gee, pD, no, I’ve never seen a baby before and obviously must conclude that they are the same as six year old children.

    That’s sarcasm, in case you hadn’t noticed.

    Actually, I am out right now. I’m at the American Association for Cancer Research meeting in Washington, DC soaking in the cancer research science goodness. TTFN.

  59. weing says:

    @passionlessDrone,

    If I understand you correctly, you are claiming that vaccines given at the current schedule cause autism. What is your theory of the pathogenesis of autism? Why have you excluded the consumption of organic foods as the cause?

  60. Davdoodles says:

    “If I understand you correctly, you are claiming that vaccines given at the current schedule cause autism. What is your theory of the pathogenesis of autism? Why have you excluded the consumption of organic foods as the cause?”

    pD will, as always, respond that you misunderstand his claim. Nobody, ever, you see, has been able to understand his claim. A mis-underestimated genius.

    As near as I care to figure, he is claiming that fevers cause (or some slipperier concept like it “triggers”) autism. Vaccines sometimes cause fevers, and fevers “trigger” (or whatever) autism. Ergo vaccines something-something autism. A “plausible mechanism crank” basically. His theory wobbles about on conflations of “fever” with “encaephalitis”, and “encaephalitis” with “brain damage” and, in turn, “brain damage” with “autism”.

    Doubtless I’ve “misunderstood” his claim too. But that hardly matters. Science has demonstrated, once again, that vaccines are not linked to autism. All he can do is keep jumping his empty, sciencey claims around, like a duck on a stovetop, to the vague discomfort of largely disinterested passers-by.
    .

  61. Chris says:

    Davdoodles:

    As near as I care to figure, he is claiming that fevers cause (or some slipperier concept like it “triggers”) autism.

    And yet, the fevers from the diseases would not?

  62. Davdoodles says:

    @Chris: “And yet, the fevers from the diseases would not?”

    Best not shine the light of sensible, plain english, questions on the dreadful, wobbly mess.

    It makes him zig-zag nauseatingly.

    I prefer ridicule. Sure, it makes him seeth and gnash, but at least he remains roughly motionless!
    .

  63. norrisL says:

    I am an Australian veterinarian. There is a “lady” in the state of South Australia who claims that 100,000 dogs die every year as a result of being vaccinated. I have been in mixed practice (ie: dogs, cats, horses cows etc) for 10 years and for 17 years in exclusively small animal practice) How many dogs and cats have I seen die shortly after being vaccinated? Well, obviously there are some who decide to turn up their toes within a short time of having been vaccinated. However, if we look closely at death rates for all dogs and cats we would expect to find that the number of deaths in recently vaccinated pets (say vaccinated in the last month) is no different from any other month over the following year. This of course indicates that there may be some dogs and cats who do indeed have a severe reaction and die. But the number is incredibly small. If 100 000 dogs die every year from vaccination, where are all of these dogs going to. Obviously not to my practice!

    I started off by saying “I am an Australian veterinarian.” Well, I was a vet until 6 months ago when I was diagnosed with left frontal lobe focal epilepsy and unfortunately also early onset of dementia. I am 49 years old. Man, does that suck or what? Steve Novella, Help!

    Stuart

  64. passionlessDrone says:

    @Weing –

    You do not understand correctly.

    I am claiming that they *could* participate in autism pathogenesis in *some* infants. I am claiming that our existing research suite is insufficiently designed to detect for this, the fury and nonsense of counting antigens aside. Doesn’t the utter lack of evidence for a reality based reason for ‘counting antigens == immune stimulation from vaccines’ tell you a little bit about the state of our existing research?

    My theory on the pathogensis of autism involves a complicated mix of low penetrant effects. Genetics plays a part, the maternal in utero environment plays a big part, environmental conditions after birth *may* play a part.

    Regarding organic foods, I have not seen any animal models that involve consumption of organic food and consequent physiological or behavioral outcomes similar to autism. Do you know of any?

    The same cannot be said regarding early life immune challenges, of which, there are a great number of salient studies.

    Two that came out detailing this type of interaction which were published in the last month include:

    Functional Programming of the Autonomic Nervous System by Early Life Immune Exposure: Implications for Anxiety (PLoS One. 2013; 8(3): e57700)

    Programming of neuroendocrine function by early-life experience: A critical role for the immune system (Horm Behav. 2013 Mar 6. pii: S0018-506X(13)00052-4. doi: 10.101)

    There are many, many more, and they have a consistent theme; there are critical developmental timeframes during which immune insults are capable of persistent changes to the organism, while the same insult at a later timeframe does not have the same capacity for long term persistence.

    Vaccines stimulate the immune system during infancy, though utilizing mechanisms with far more nuance than the additive properties of their antigen counts. Further, the immunological analysis in the autism cohort reveals a population predisposed to dysregulation of the immune response and increased production of inflammatory cytokines to some agents.

    @Davdoodles –

    Please try evaluating the studies above for a literature based defense of the idea that early life immune challenges can result in persistent alterations to the hpa-axis, neuroimmune, and peripheral immune systems, and ultimately, behavior. If you read some of these papers, you might come to understand my position more clearly.

    @Chris –

    I’ve stated to you, many times, that challenge from disease could have the same effect, if it occurred in infancy. The difference is, very few two month olds get the diseases we vaccinate against, but very many children are vaccinated at that timeframe. Your continued inability to grasp the concept speaks volumes, but not in the way you’d like.

    - pD

  65. lilady says:

    @ Stuart: Not *content* to undermine our human public health system, I’ve seen posts on anti-vaccine blogs that refer to the tens of thousands/hundreds of thousands of deaths of our pets, due to vaccinations. From the pig farmer’s website…

    http://www.whale.to/vaccine/driscoll1.html

    Yeah, that’s a bummer about your medical condition…but now you’ll have more time to post here.

    Welcome aboard. :-)

  66. Narad says:

    BTW, pD, I heard back from Brugha yesterday. He said he’d have McManus get back to me. It will be at the NSSOB when I have something.

  67. mousethatroared says:

    @Stuart – I’ve enjoyed the comments I’ve seen from you in the past. Glad to see you back. Sorry to hear about your health condition. If you need such as refuge, I have found SBM to be one of the few places in the world that one can occasionally gripe about a health condition without receiving unrequested “helpful” dietary, lifestyle, vitamin, positive thinking, advice.

  68. pmoran says:

    I am glad you responded further, PD. You might have gone off in one of those “this is just too beneath me” kinds of huff as soon as the going got rough, as per regular practice on this blog.

    Despite relentless and somewhat ill-directed ad hominem attacks you have shown considerable forebearance, producing only minor retaliatory insults and putting a theory out there for critical analysis by anyone who thinks they have the expertise to do so (which I don’t, but I can follow an argument and understand the limitations of most relevant kinds of evidence).

  69. norrisL says:

    @lilady and @mousethatroared

    Thanks for your sentiments. Not severely affected right now, although not being allowed to drive a car sucks. My mate, David Dawe (I must point out that in Australia, mate means your friend) who went through vet school with me said he would take me surfing and if I had an epileptic seizure he said he would swim down and bring me back up. :)

    Of course I know that the time will come when things are an awful lot worse, but, we’ll just have to deal with that if and when it comes. I love reading and so, since I was put off work on October 15 last year, I have read over 25 books. Normally I would only get to read a few books over Christmas.

    I am eating plenty of farmed smoked salmon from Tasmania, partly because I like it and also in the hope that the omega 3 FA’s will have some effect on my brain health.

    Thanks again

    Stuart

  70. passionlessDrone says:

    @pmoran –

    Thank you. I’ve been putting a lot of work into reigning in my natural sarcastic side with limited results. I do still have work to do.

    @narad –

    OK. Sounds good. The idiots @ ScienceBlogs with their insistence that you post a comment with a device in order to see the latest comment stream on that device means that unless I am actively engaging in a discussion, I rarely can keep track of threads from a while ago. That, and, I’m *trying* to limit my time spent online arguing with people, and focus a bit more on other pursuits means I may not spot a response in the RI thread. If you hear something of interest, try emailing me, passionlessdrone at yahoo, if you’d like.

    - pD

  71. DugganSC says:

    *sigh* I tried to invoke this study with someone I went to high school with, who was publishing on Facebook graphics that indicated that vaccines are causing autism. She thanked me for the fact that I had well-researched sources, but also told me that “until you have a kid with autism, you just don’t understand how much they don’t tell you”.

  72. WilliamLawrenceUtridge says:

    So is conspiracy the first, or the last bastion of defence?

  73. Liz Ditz says:

    norrisL — sorry to read about the lousy health news all around.

    Do you know the novelist Terry Pratchett? (One of my all-time favorites…)

    http://www.terrypratchettbooks.com/

    He was diagnosed with dementia in 2007. Here’s the first of a series of interviews with him.

    http://www.youtube.com/watch?v=H0HIqfMV2cU

  74. weing says:

    @pD,

    So you think the pathogenesis is similar to the case with PKU? What causes you to exclude similar dietary factors in favor of vaccines? We are colonized with bacteria right after birth and are exposed to numerous micro-organisms constantly afterwards. What is your basis for excluding them as culprits?

  75. passionlessDrone says:

    @weing –

    So you think the pathogenesis is similar to the case with PKU?

    I stated previously in this thread that my thoughts include a mixture of low penetract impacts, including genetics, and environmental forces. I am not tied to any particular model of pathogenesis; it is a big tent with lots of unknowns. I’m not really sure what, exactly, you are getting at here, so I would ask that you phrase your question with a little more clarity. Please bear with me, I am but a simple drone.

    What causes you to exclude similar dietary factors in favor of vaccines?

    What has caused *you* to conclude that I have excluded this? It is an interesting idea, but as I stated previously, not one that I’d seen much literature support for. If you have some references that might be useful in such a discussion, maybe you could post them instead of implying I am ignoring them. (?)

    I *also* mentioned previously, the fact that there *are* a great many references regarding early life immune challenge with subsequent changes to neurodevelopment has caused me to question with great skepticism the comprehensiveness of our vaccine analysis in this regard (see ‘lack of evidence for antigen counting == immunological stimulation’ as an example of this).

    In case you wanted some additional references that form my concerns regarding vaccinations, here are a few more you might want to consider regarding early life immune challenge and subsequent persistent alterations:

    Neonatal programming of innate immune functio (Am J Physiol Endocrinol Metab. 2011 Jan;300(1):E11-8. doi: 10.1152) [review paper]

    Celecoxib reduces brain dopaminergic neuronaldysfunction, and improves sensorimotor behavioral performance in neonatal rats exposed to systemic lipopolysaccharide (Journal of Neuroinflammation 2013, 10:45 doi:10.1186/1742-2094-10-45) [shows a resuce effect via mitigating the innate immune response]

    If you want more references, just ask, or follow some of the references in these papers. There are a great number of them.

    We are colonized with bacteria right after birth and are exposed to numerous micro-organisms constantly afterwards. What is your basis for excluding them as culprits?

    Again, I am forced to wonder aloud what has caused you to conclude that I have excluded changes in the microbiota as a player in autism? Can you provide some reference where I have stated something along these lines? Generally, this is a forum where presuming a position of the person you are debating, and then demanding that they support that phantom position is considered a sign of weak debating style or, alternatively, a lack of substance. I might as well ask you, what is your basis for the belief that vaccines are 100% without side effects? That is your position, right?

    If you are *actually* interested in changes in the microbiota of *some children* with autism, the following references might be of interest to you:

    Impaired carbohydrate digestion and transport and mucosal dysbiosis in the intestines of children with autism and gastrointestinal disturbances (PLoS One. 2011;6(9):e24585. doi: 10.1371/journal.pone.0024585)

    Or

    Application of novel PCR-based methods for detection, quantitation, and phylogenetic characterization of Sutterella species in intestinal biopsy samples from children with autism and gastrointestinal disturbances (MBio. 2012 Jan 10;3(1). pii: e00261-11. doi: 10.1128)

    Both of which indicate distinct microbial populations in children with autism and severe GI disturbances compared to children without autism that also have severe GI problems. There are others, if you are interested.

    Finally, I would ask, if you have any literature regarding models for a microbiota based mechanism of action that you could submit? Our ignorance in this area is certainly vast, and the more I read, the more I am convinced that the interconnectedness of our various *systems can lead to black swan style changes that are difficult to predict.

    - pD

  76. goodnightirene says:

    This is a bit late to post but the NY Times Sunday Magazine (4/14, I think) has one of those ridiculously edited, brief quip type of interviews with Temple Grandin where she states boldly that she has some doubts about vaccine safety having talked to five or six parents of sudden onset autistic children. Eeek. The comments (happily) were full of good solid scientific responses, but also lots of “listen to the mommies”, “too much too soon”, and the ever-present “why or why will they not study vax vs. non-vax”. It seemed, on balance, that most people understood the real science, but the hold-outs are never to be convinced.

Comments are closed.