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I come across stories about what the press likes to call “vaccine-preventable diseases” rather frequently. There are often warnings about the clusters of illness caused by people who choose not to vaccinate. They point to mini-epidemics of whooping cough, measles and mumps, and lament how all this wreaks havoc even for those who have been vaccinated (since vaccines are not 100% effective). There’s always an outbreak here or there, and if you search the archives of any major newspaper you will get quite a few hits.
But I can’t remember the last time I saw the press covering a severe vaccine reaction, or death. I suspect it has something to do with my observation that when there is a temporal relationship between a vaccine and an illness or death, we are reminded that temporal relationships are not the same thing as causality, and that it is a coincidence that a problem occurred shortly after vaccination. But in the amazingly rare instances that a child dies of a vaccine-preventable illness, like measles, the temporal relationship takes priority, and we are told that the child died of measles, even if the child was taking azathioprine or other immune-suppressive drugs to shut down their immune system due to other ailments or organ transplant.
Whatever the reason, today I can stop complaining about the lack of coverage for vaccine reactions, because I came across a story this morning about a healthy three month old infant who received an MMR vaccine, developed a fever, and seemed generally unsettled, who then died the following day. Of natural causes.
Consultant forensic pathologist, Dr Charles Wilson, told the hearing that he believed the baby had died of pneumonia.
He said: “Kenzie had the early stages of a lung infection, the kind you tend to see with bacteria. It was the earliest stage of pneumonia. It was an entirely natural, tragic and unforeseeable cause of death.”
I’m glad the pathologist mentioned that the pneumonia was the type you tend to see with bacteria. That would (phew!) completely rule out any involvement of the vaccine then, since it is comprised of three live-attenuated viruses. I’m a little surprised though, that he thought the pneumonia was the type that one tends to see with bacteria. Didn’t he check the infected lung tissue? I’m surprised he doesn’t know what pathogen was in the lungs.
I’m going to confess now that I find this a bit odd. Do children who seem fine and healthy often die in the very beginning stages of pneumonia, before anyone knows they are ill? Maybe this is truly so common that there is no need to raise an eyebrow, or to send some lung tissue to histopath.
In order to take this article, and the pathologist, at face value we have to believe: 1) the child was absolutely fine at the healthcare visit where he had received the MMR, and that there was no sign of pneumonia that a clinician should have noticed, even if the child was going to die of it about 30 hours later, 2) the administration of the MMR was strictly coincident in time with the unrelated fatal illness, 3) healthy children die rapidly in the early stages of infections, even when it is sufficiently early that there are no symptoms of any concern, and 4) that #3 happens often enough that no one bothers to send infected tissue for histopathological assessment. Apparently the coroner agrees this is reasonable:
Coroner Jennifer Leeming recorded a verdict of death by natural causes.
For myself, I remain slightly skeptical.
I was rather foolishly unable to keep myself from reading yet another New York Times Op-Ed about mercury and vaccines, this one authored by Paul Offit, well-known vaccine advocate who works for the Children’s Hospital of Philadelphia, and has previously served on the CDC’s Advisory Committee on Immunization Practices (ACIP). He has perhaps more famously consulted for Merck, who gave him a $350,000 grant to develop the RotaTeq rotavirus vaccine which is now recommended by the CDC for infants in the US at 2, 4 and 6 months of age (he shares the patent for this vaccine and therefore financially profits whenever the vaccine is given). Rotavirus was killing about 60 infants a year in the US, but hopefully millions of vaccinations will now lower that figure since Rotateq is allegedly quite effective (98% according to New Scientist).
This latest offering by Offit is entitled “Inoculated Against Facts”, and appeared in the NYT on the of 31st of March in response to the media frenzy surrounding the Hannah Poling vaccine court settlement. Offit is obviously worried that the Poling case is going to have fewer people vaccinating, because he spends a lot of time trying to make it seem as though the decision to settle this case was nonsensical, and that the underlying health problem for Hannah Poling (even though no one knows if it existed before the vaccines or not) is extremely rare. He even goes so far as to as to say the “…vaccine court judges have turned their back on science by dropping preponderance of evidence as a standard.” He complains that now petitioners need only “propose a biologically plausible mechanism” in order to prevail in vaccine court. Thankfully, the Polings (who are a physician, lawyer and nurse between them) seem quite committed to setting the record straight on both medical and legal fronts, and have done so here, as a rebuttal to this op-ed in the New York Times, and in the Atlanta Journal-Constitution, (text at the end of this post).
As usual, there is some (junk) food for thought in the comments, courtesy of the New York Times faithful, intelligent, well-educated readers. I’m getting a little hardened to all the tedious rhetoric in those comments, by people who clearly just repeat the propaganda, with very little understanding of what it means. But the best one is this one, from JJ, from Boulder, Colorado. Here’s a partial quote:
It’s called “public health” for a reason: the health of the public is put first, and for good reason. I say this as a parent of a 3 yr old who has received all shots on time; I asked appropriate questions about those shots as they came up (re. thimerosal, etc.) but never questioned whether I would vaccinate, because I believe in something called civic responsibility.
I was absolutely gobsmacked. Do you think that if JJ had gotten his/her child vaccinated, and s/he stopped speaking and lost all eye contact within a week, that they’d be together at pro-vaccine demonstrations these days, with their kid in an over-sized, disabled child’s stroller, with a big sign proclaiming the pride in the sacrifice of their child for the benefit of everyone else? The only persons confident enough to moralize about people not risking their children’s well-being for the greater good are those who have already made the “sacrifice” and emerged unscathed. Those who are not so lucky have a very different perspective.
_____________________h
By Jon S. Poling
For the Atlanta Journal-Constitution
Published on: 04/11/08
Autism in the U.S. has reached epidemic levels, at 1 in 150 children. Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, has recently upgraded autism to “an urgent health threat.” The most contentious issue of the autism debate is the link to routine childhood vaccines. My daughter’s case, Hannah Poling v. U.S. Department of Health and Human Services, has changed this debate forever. Hannah has pointed us in a new and promising direction —- the mitochondria. On Nov. 9, 2007, HHS medical experts conceded through the Department of Justice that Hannah’s autism was triggered by nine childhood vaccinations administered when she was 19 months of age. This concession was granted without any courtroom proceedings or expert testimony, effectively preventing any public hearing discussing what happened to Hannah and why. Contrary to some reports, the Special Masters, “judges” who preside over the “vaccine court,” did not issue a decision. Four months later, on March 6, with trepidation my wife, Terry, and I stepped forward to announce this news —- providing hope and awareness to other families. The HHS expert documents that led to this concession and accompanying court documents remain sealed, though our family has already permitted release of Hannah’s records to those representing the almost 5, 000 other autistic children awaiting their day in vaccine court. Mitochondria key To understand Hannah’s case, it is important to understand mitochondria, which act like batteries in our cells to produce energy critical for normal function. Because the government’s concession hinged on the presence of Hannah’s underlying medical condition, mitochondrial dysfunction, some claim the decision is relevant to very few other children with autism. As a neurologist, scientist and father, I disagree. Emerging evidence suggests that mitochondrial dysfunction may not be rare at all among children with autism. In the only population-based study of its kind, Portuguese researchers confirmed that at least 7.2 percent, and perhaps as many as 20 percent, of autistic children exhibit mitochondrial dysfunction. While we do not yet know a precise U.S. rate, 7.2 percent to 20 percent of children does not qualify as “rare.” In fact, mitochondrial dysfunction may be the most common medical condition associated with autism. Biological markers Although unlikely, if the Portuguese studies are incorrect and mitochondrial dysfunction were found to be a rarity occurring in less than 1 percent of all autism, it would still impact up to 10,000 children (250,000 worldwide), based on current estimates that 1 million people in the U.S. (25 million worldwide) have autism. If, on the other hand, the research showing that 7.2 percent to 20 percent of children with autism have mitochondrial dysfunction is correct, then the implications are both staggering and urgent. Autism researchers do not currently understand whether mitochondrial dysfunction causes autism or is simply a secondary biological marker. Autism clearly has many different causes, and should really be separated into multiple autism(s). I propose that we clearly identify and research the subpopulation term of “mitochondrial autism,” which is distinguished by its unique biological, but not genetic, markers. Based on what we know now, it is time to follow the prestigious Institute of Medicine 2004 report regarding autism and vaccines: “Determining a specific cause (for autism) in the individual is impossible unless the etiology is known and there is a biological marker. Determining causality with population-based methods requires either a well-defined at-risk population or a large effect in the general population.” A paradigm shift When the IOM report was published, mitochondrial dysfunction defining an autistic subpopulation was not firmly established. Today there is no doubt that mitochondrial dysfunction represents a distinct autism subpopulation biological marker. I urge health officials and the IOM to embrace their own report and pursue this breakthrough in the science of autism. National public health leaders, including those at CDC, must now recognize the paradigm shift caused by this biological marker with regard to their current position of dispelling a vaccine-autism link. In light of the Hannah Poling concession, science must determine more precisely how large the mitochondrial autism subpopulation is: 1 percent, 7.2 percent, 20 percent? Based on the 2004 IOM analysis, if the mitochondrial autism subpopulation is found to be relatively uncommon, then all conclusions from prior epidemiological studies refuting an autism-vaccination link must be discarded. New studies then need to be performed exclusively with the mitochondrial subpopulation. If mitochondrial autism turns out to be common, then we could re-analyze the data from prior studies to determine if these studies were powered sufficiently based on a predicted effect size. If not powered appropriately, the conclusion refuting an autism-vaccine link would again have to be rejected. These statistical concepts are basic. The current vaccine schedule, co-sponsored by the CDC and the American Academy of Pediatrics, injures a small but significant minority of children, my daughter unfortunately being one of those victims. Every day, more parents and some pediatricians reject the current vaccine schedule. In an abundance of caution, meaningful reform must be performed urgently to prevent the re-emergence of serious diseases like polio or measles. Need for research As a neurologist, I have cared for those afflicted with SSPE (a rare but dreaded neurological complication of measles), paralytic polio and tetanus. If these serious vaccine-preventable diseases again become commonplace, the fault will rest solely on the shoulders of public health leaders and policymakers who have failed to heed the writing on the wall (scribbled by my 9-year old daughter). The mitochondrial autism scenario that my daughter has so eloquently painted has the CDC and public health experts logically cornered. Denial and fear tactics won’t close Pandora’s Box. Whether we find that mitochondrial autism is rare or common, there is urgent research left to be done to fully understand the interrelationship of vaccines, autism and mitochondria. Reform of the vaccine schedule will be an important part of the solution, whether vaccines play a major or minor role in autism. Our public health agencies and programs need a reconstruction plan. Day one of the reconstruction hopefully starts at the Vaccine Safety Advisory Committee’s Working Group, to be held at HHS headquarters today in Washington. > Dr. Jon S. Poling is a practicing neurologist in Athens and clinical assistant professor at the Medical College of Georgia.
After I began writing down some of my thinking about the whole anti-vaccine issue contained in some of my earlier posts here, I had a tiny bit of a panic attack. What if everything I wrote wasn’t absolutely, positively up-to-date, or if I had misunderstood something I’d read in a study or if there was a study I didn’t know about or some extra-scientific, political debate circling out there that had some bearing on what I had to say such that it wasn’t all unassailably accurate by anyone’s interpretation?
In the face of these thoughts I did what I do when I am not sure that I’m right (pretty much all the time, actually) which is to do even more reading, and so I skipped around a bit at some of the sites of the more erudite critics of people who are against vaccines.
The reading I did caused me to question things some more – I had to go back and look over a few relevant parts of studies, and I kept stopping to think things through in my mind. Then suddenly I read something that let me completely relax and stop worrying about the comments made by those people at the end of the New York Times article, who were so outspoken about the apparent simplicity of the vaccine controversy.
It was the way in which one critic, after ridiculing anti-vaccine people for thinking that the CDC might be biased or were trying to promote a particular agenda, dismissed a study that could be interpreted as strongly anti-thimerosal for exactly the same sort of reason (being funded by a group with apparent interests). It reminded me that these people will go as far as they need to (arguing with a researcher’s choice of spectrographic tests to determine whether there is mercury contained in a tissue sample, if they don’t like the study’s conclusion, whereas an epidemiological study where the data was lost and so cannot be verified is fine if it shows their desired result). And the anti-vaccine crowd is often the same.
But the most striking moment came for me later, as I considered my personal trail of thoughts about this whole vaccine business. I wondered about my wavering fear concerning the strength of my beliefs and thinking somehow it meant that maybe my position was uncertain. Does it somehow make my stance less tenable if I feel that it can be shaken?
And I’ve thought about this a lot since this first occurred to me, and my answer is an unqualified: no.
I think that being committed to a position for its own sake plays a part in the problems in these sorts of long-enduring debates, where intelligent people disagree. People become extremely personally invested in being correct, especially once their decision has been implemented with regards to the well-being of their children, or when they become publicly committed to it (even if only by authoring a bit of writing on the web). Then nothing you show them can change their mind or shake their commitment to their position. They are forever reading studies and articles, looking for the smallest shred of evidence that supports their position, and happily discarding anything that doesn’t.
So the wavering, for me, was just a sign that maybe I am still the kind of thinker that I hope to be: always open to some new bit of evidence, some new well-constructed study that would cause me to begin to question the beliefs that I currently hold, and someday perhaps, some evidence that completely topples them. I’d like to see this all over the vaccine debate, instead of all the made-up minds, the complicated machinations to defend one’s position, and the double standards for evidence that supports or denies one’s position. I hope I can live up to this myself; I think it’s a worthy aim.
