http://www.nytimes.com/2008/03/21/us/21vaccine.html
I saw this article in the New York Times recently about a small measles outbreak in San Diego. In some ways that article was a typical pro-vaccine article, using certain techniques in order to give a slightly skewed view of the truth to make a stronger point. For example they cited statistics from around the world (242,000 children die annually from measles) instead of giving us statistics relevant to our lives. If children in third world countries are dying from measles, you could very reasonably conclude that this might not tell you much about what your child’s risk might be. There are obviously differences in circumstances, and at least some of those children might not have access to the healthy food, good sanitation and the excellent palliative care that we generally have available in the US. But there were two parts of the article I found more interesting than the rhetoric: the comment that many pediatricians view people who don’t vaccinate their children as “…parasites, of a sort, benefiting from an otherwise inoculated majority.” I suppose that they got a lot of mileage from calling people parasites instead of free riders, since it’s obviously a more upsetting, pejorative term. The other thing that was interesting was the fact that they got a mother to admit that she was more concerned about her child’s well being than those of other children.
But the most amazing thing about the article was the vitriol contained in the comments by people who think that vaccination should be forced on all children by the government. These people did a lot of name-calling of those who disagree with them, using inflammatory terms like “unscientific”, “poorly educated”, and claiming that non-vaccinators are unable to evaluate validity of reasoning because they don’t share the opinion of the particular comment’s author. It’s an important lesson for all of us to pay very little attention to the authority with which people speak on important matters, but instead to focus on the evidence which they present. This is especially true when the opinion is full of inflammatory, emotional language and is mostly rhetoric rather than evidenced reasoning, as are most of the comments after the article. If I didn’t know better, I would think it was a fervent flame war over religion and not a scientific disagreement.
Let me state my position point-blank, before I go any further: every person making a comment there that makes it seem as though this is a simple problem with an obvious answer (in either direction) does not know what they are talking about. That includes all the physicians and nurses who think that giving people shots for thirty years somehow confers upon them complex, otherwise-unknown scientific truths that have amazingly eluded everyone else. There is a reason that well-educated people around the world disagree in this problem-space: no one knows what the truth is. I maintain that anyone who tells you otherwise hasn’t looked at the problem and the studies very carefully, or has some sort of interest in the conclusion. And that interest may be as benign (and simultaneously malignant) as just assuming that when a lot of credentialed people say something is true, it must be.
Now, let me begin by saying something that I thought would be obvious to everyone: vaccines damage some children. (and this has nothing to do with the recent Hannah Poling case) It is pretty much true that everyone who knows about public health already knows this. This is the reason that vaccine court exists, and the reason that each shot costs a little bit more than it would otherwise; the money gets put into a fund to pay off those that have been hurt by vaccines. Again, it’s called PUBLIC health – it’s not about your child; it’s about the promotion of the healthy well-being of the society at large, knowing that along the way some people will probably be hurt. This is very simple public policy stuff about which it appears lots of people have their heads in the sand.
So far the lesson is that the pro- and anti-vaccine people agree about this general fact, and they’re now arguing about numbers. Pro-vaccine people think that you’re at much higher risk for being injured by illnesses, and the anti-vaccine people think you are at more risk for being harmed by vaccines. The anti-vaccine people are concerned that autoimmune diseases, allergies and autism are caused, at least in part, by vaccines and/or their component parts (meaning live viruses, adjuvants and/or preservatives, mainly) and that many of the illnesses for which we vaccinate are not serious. The pro-vaccine people think that vaccines alone keep us from reverting to the days when hospitals were full of people suffering and dying from diseases that we can now sidestep entirely because effective vaccines have been invented.
I have personally read all of the studies claiming to show that there is no connection between vaccines and autism, and would have read the studies showing that vaccines were evaluated in the long term, had anyone done those sorts of studies. And by that I mean that I have read the studies in their entirety, which means that I did not rely on information that I read about them in Time magazine, I did not have a conversation with someone (an MD or DO, or a medical student – lots of whom commented on the NY Times article) who claimed to have read the study, and lastly (and most importantly) I did not just glance at the abstract and pretend that I read the whole study, considered the methodology carefully and agree that the study actually demonstrates what it claims to show.
And even with all this study of the primary literature it’s the case that I still don’t understand what people are talking about when they say that vaccines have been proven to not cause autism. There are some epidemiological studies, but when I learned about biostatistics and scientific studies, population-based studies were used solely to help define more specific questions that could be investigated via experimental research. They are where one begins to define a medical inquiry, and are almost never used to prove/disprove anything (and certainly are not used to approve drugs or medical devices) because they fall prey to too many confounding factors.
The prior objection about the population-based studies doesn’t even begin to raise the questions about the legitimacy of the particular population studies that were done, and cited by the Institute of Medicine. In one case the children in the country where the study was done were administered half the thimerosal as children in the US, but somehow the study is still cited as perfectly applicable to US children. There was another study, done in the US, but it had a minor difficulty in that all the data that was analysed was “lost” (although individuals have testified that they were instructed to destroy the data), which would under any other circumstance result in the study being disregarded. High standards of proof in medicine usually require that the information used is available so that the results of the analysis can be checked and verified by other parties. In fact, the famous Wakefield study (that claimed an association between autism and measles vaccines by isolating measles in the gut of autistic children) is commonly discredited in this way. But somehow this protocol has been eschewed for studies on only one side of this debate. All this makes me feel a bit as though I’m living in the twilight zone; there’s one standard of proof when you’re discussing the claim that vaccines have no relation to autism, and a separate, more stringent standard of proof for the other side of the debate, and everything else.
But in spite of all these difficulties, every day people claim that there is no association between vaccines and autism. Go ahead and go back and count the number of comments after the New York Times article that claimed that the association between autism and vaccines has been disproven (bonus points for how many times this was said by physicians and med school students). These are the standards of proof being used by these commenters. (assuming they’ve read the studies at all and aren’t just relying on press releases or the likes of sciencedaily’s rubbish summaries that bear no relation to the study in question)
I believe that if someone could show people that do not vaccinate that vaccines were actually safe they might well reconsider; I think the uptake rates on vaccines would increase dramatically if people felt that they were safe and effective. So let me share some ideas that I have for things that could be done to get to get non-vaxers to reconsider, instead of using the brute force of law or personal attack, which a lot of the commenters seemed to be advocating.
Admit that no one has done any long-term study of vaccinations, and that certainly NO ONE has done a study to determine what happens when you give the many shots of the US recommended schedule in a short period of time (other than generate a lot of revenue).
Stop pretending that the thousands of families who have had normally developing children who went for a series of vaccines one day, then screamed for 24 hours (a not-uncommon vax side-effect) and then never uttered another word are imagining it. Science at its heart is all about observation, not fancy journals; so when many people tell a very similar story it certainly warrants real scientific investigation instead of a castigation that people are all collectively imagining things, and that it is a coincidence. I find it astounding that the people of medical science expect people to believe this. When you dismiss the reports and the very observational basis of science and instead engage in heated denial, you are simply extending an open invitation to people to wonder about cover-ups and conspiracies.
Acknowledge that vaccines do not seem to provide the same sort of protection that natural immunity does. There are almost no infections that humans routinely get that are not caused through contact with mucosal or digestive surfaces (malaria being the major exception that comes to mind). In lay-speak, our immune systems have various “layers” of immune globulins that have different roles in immunity – when we inject vaccines, we bypass some levels of immune response, and there is a good chance that this big difference is a factor in the shorter duration of protection that vaccines offer. Because vaccinations don’t seem to confer long-lasting immunity there seems to be an emerging trend where illnesses that used to mainly affect children are now affecting older people (sometimes only in their 20s), and the result has been atypical forms of the illness (like measles) that seem to be more virulent than when the illness is typically contracted as a child. A slightly different problem with the short-lived effect of vaccines is the fact that women used to contract rubella as children, and later, when they became pregnant, their immunity to it was practically assured. Now that we vaccinate against rubella, the immunity that waned, or simply never occurred (via vaccine failure) means that more fetuses are at risk of birth defects due to perinatal rubella infections. Stop pretending that these problems are due to non-vaccinators when vaccines and their incomplete, short-lived immunity contribute to the problem as well.
Stop claiming that practically everyone in the world died of chicken pox and measles ten minutes before the vaccines were invented. Go look have a look at the first hand statistics instead of just mindlessly repeating the propaganda.
Dispense with the arguments from authority such as “I am a physician and I think x.” or “My doctor, who went to Yale, says y.” – people with decades of experience and education have been, and will always continue to be mistaken about things. What matters are the studies and methodologies, and not who said what and what their qualifications are. How many people die each year due to physician error? The Institute of Medicine report from 1999 claimed that the figure is approaching 100,000 people per year. Those people were killed by doctors who made mistakes. Please let’s stop perpetuating the myth that doctors have some extra-human access to anything – they are just people who trade in medicine, and they are sometimes right, and sometimes wrong.
Now let me point out that this debate could be solved with an actual study, devoid of biased funding, done by researchers whose livelihood does not depend on paychecks from the manufacturers of vaccines, investigating the points that I mentioned above. It will be difficult to blind an actual experimental investigation of this sort, because of moral concerns. But there are already plenty of families in the US that do not vaccinate, and comparing rates of the various allergies, ADHD, asthma and autism in children who were and were not vaccinated certainly is a good place to start.
Once some reasonable scientific work has been done in this area, I think we could be on the way to refining our thoughts and concerns. It’s the reluctance to actually discuss the shortcomings and unknowns of vaccination, and instead derail the debate with over-emotionalism and insults that holds both public health and the well being of children back.
And as a private reply to comment #383, B. Pirkle, R.N., San Francisco: Non-vaccinating parents all over will be struck by the irony of your comment. They know all too well that there is no such thing as a free lunch; that’s exactly what they’re trying to get YOU to see. You can’t just inject a bunch of untested stuff into the body, hope it effects the immune system in the way you intend, and assume that there is no cost or downside – that sounds like free lunch idealism at its best. Maybe you should consider taking a little of your own medicine.
10 comments
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March 26, 2008 at 11:35 pm
David
Wow! Thank you for that thoughtful response to the NYTimes article. I have to confess that I have never read a Blog in my life, but after reading the article in the paper (and the numerous responses,) I decided to google vaccines and there was your blog! For the record, I have a 4 year old son who my wife and I decided not to immumize. Yes, we argued, debated, did research, talked to friends and doctors and yes, we are educated. After several and I mean SEVERAL pediatricians refused to even talk about possible risks, we were fortunatly referred to a pediatrician who ultimatly supported our decision not to vaccinate. Why oh why isn’t anyone doing the proper studies??? Are the drug companies that powerful? I don’t get it. My son is now in preschool and is still nursing. He has had a few colds in his short 4 years….and that’s it. (knock on wood…and everything else!) His class is full of children who have allergies, asthma, and are out sick more than they are in. Is his immune system stronger than his classmates? Here’s an idea…let’s do some research!
March 27, 2008 at 2:58 pm
Mary
Go Mary, Go Mary — it’s your birthday. No really, this is an excellent op-ed on a complex issue.
My first two children were injured by vaccines, one life long with Juvenile Rheumatoid (sp) Arthritis and one almost died in the ER room.
I finally woke up and my third child is totally unvaccinated. I am highly educated and I’ve read more books and more studies than most doctors on the subject. No one in my family will ever be vaccinated again.
Research has been done, but it totally refutes the effectiveness of vaccines, therefore, you will never see it on page one of any newspaper or even in a magazine. The Pharma companies pay their way through advertisers dollars and it’s just not going to change – that’s why posts like yours are so important. We have to change it one person at a time!
Kudos.
March 28, 2008 at 3:57 am
pKay
Wow….. Now that’s what I call a blog!
Great read & keep up the grear work!
pKay.
March 28, 2008 at 7:00 pm
hilary
what an amazing article. you said exactly what I wanted to say, and what SO needs to be published.
March 28, 2008 at 10:35 pm
Lisa
Thank you so much for your response to that article. As a parent of 2 wonderful, unvaccinated kids (under 3 years old) many of those comments made me shake my head with sadness and fear for my kids and how they might be treated if classmates and other parents found out. Peer pressure certainly won’t change my mind about the issue, but, to quote a friend, they are passionate in their ignorance.
Thanks again,
Lisa
http://njvaccinationchoice.org
April 1, 2008 at 3:53 am
Mary H.
As a parent of two children, I decided several years before they were born not to vaccinate. My main reason was reading a vaccine insert label and deciding based on the neurotoxic, carcinogenic, potentially lethal ingredients that no way, no how was I ever going to allow or give authority to any doctor to inoculate my precious babies. They are now teens and are among the healthiest of children. I made this decision unilaterally w/o the support of my husband who would rather stick his head in the sand, then read the various research articles I had collected. W/my sister-in-law a pharmaceutical rep and well-meaning relatives, I held my ground and am glad I did. I now an advocate for parents who choose not to vaccinate and frequently give testimony at our state capitol on vaccine-related bills. I could fill a book w/my experience and studies in this area, and am glad people are starting to wake up and make their own decisions independent of their doctors and well-meaning friends/relatives. Thank you for this excellent article. BTW, the majority of letters in response to the original NYT article were from those in Pharma and the AMA. I have this on good authority and you will notice the perfect spelling and diction, notwithstanding that they were full of –it!! More of the same propaganda to promote their drugs, vaccines, questionable treatments, etc. Even if vaccines were proven to be safe, which they never will, I would choose not to vaccinate. Natural immunity developed through exposure is the best protection, it goes without saying. I, unfortunately, developed severe allergies and asthma when I was in 1st grade (45 years ago), after a set of vaccines. I also had a delayed reaction to a polio vaccine when I was a young teen and almost died. I know too many families whose children have been damaged and a few whose children have died. This is a silent epidemic and it is estimated that appx. 1 million people a year are affected by vaccines in an adverse manner w/many dying. In 2007, $91 million was compensated to families whose children suffered severe side effects. Since ’86, when the Vaccine Injury Compensation Act was established by Congress to indemnify drug cos. from lawsuits brought by plaintiffs of DTP reactions, close to $2 billion has been paid out. This is just the tip of the iceberg in that only 10% of doctors voluntarily report reactions w/just 1% finding relief through Vaccine Court which makes it extremely difficult to file a report. Just say ‘no’ to vaccines.
April 3, 2008 at 12:05 am
Greg Friedman
I agree that, on its surface, this looks pretty reasonable. However, I’ve seen this kind of thing often enough to note some problems.
First of all, there’s a common rhetorical technique that lunatics use in arguing with scientists to level the playing field. I don’t know if it has a name, but it essentially goes like this: “Well, this is a complicated issue and let’s all be honest – my side doesn’t have all the answers and the other side doesn’t have all the answers. Everyone is guilty of a lot of oversimplifications. So let’s step back, stop listening to authorities, go to the facts, and look at what we do know. Now here’s what I see…” Notice how subtly this serves to undermine the authority of anyone who might have any credentials on the issue. In fact, it automatically turns anyone who might have some credentials into “one of those evil authority figures who’s been trying to fool us with his unsupported scientific claims.” The intelligent design people try this kind of crap all the time.
Then, the speaker goes on with “so lets look at the actual data and not what the experts are feeding us.” The speaker then goes on to rattle off a bunch of claims based on data they never cite either. The self-negation of such arguments is astounding. “Don’t trust doctors who may or may not have read something! Don’t trust your pediatrician who went to Yale, that ivory tower that doesn’t care about you! Trust someone who has read all the studies – trust me instead!” So, um, maybe cite some of those studies you’ve read?
Let’s see, next we have the standard technique of mistaking what the science is actually saying and putting words that a scientist would never say into the mouths of scientists. “I don’t understand these scientists who say that they have proven that vaccines don’t cause autism.” Of course not. Because science can’t prove negatives like this, and no scientist worth his salt would ever say this. They’d give you statistics. They’d cite percentages. They’d assess risk factors. They’d never say never. (Well, just the mathematicians – I can assure you that 1+1 never equals 3.)
Hmm, then there’s an emotional appeal with no evidence to back it up: “my baby screamed for 24 hours and then never uttered a sound again” – no citation.
Finally, we have some critique of the writing style of the NY Times piece, essentially a reverse ad hominem by casting themselves as victims – “Notice how they say ‘parasite’ instead of ‘free rider’! They’re implying that we’re bad.” Well, yes, parasite is the more appropriate term. The difference is that parasites conceivably endanger their hosts, and here the non-vaccinated risk increasing the spread of the disease to everyone, including those who opt for an intermediate option like delayed vaccinations instead of no vaccinations.
You’ll notice, by the way, that this contains absolutely nothing about reasoned middle grounds. Nothing about delayed vaccinations. Oh, and no statistics about just how dangerous measles or rubella or polio might be compared to the vaccination risks. For that matter, no hard facts whatsoever beyond “Hey I went and read some stuff, but I’m not going to tell you what.”
I bet I could change just a few hundred words and turn this into an excellent defense of intelligent design.
April 3, 2008 at 10:16 am
Liber Augest
Nice info.Added to favourites.
April 5, 2008 at 9:02 pm
Mary, Mary, Quite Contrary
Many thanks to all of you that took a moment to write to mention that you enjoyed this response to the New York Times article. I certainly would have posted it there, but unfortunately it was closed to comments very quickly after appearing online (and indeed was already closed when I read the article).
This is certainly a complicated issue, and I think that it is worth it to be able to engage with people who have similar concerns in this area. I hope to put some more of my thoughts down on paper, and thoughtful criticism and suggestions are always welcome.
April 5, 2008 at 9:08 pm
Mary, Mary, Quite Contrary
Greg Friedman: I apologise for the lack of citation for my writing. I can only say in my defense that the point of this short essay was to react (primarily) to the comments following the article I mentioned, and to highlight the many obstacles that I think need to be overcome in order to get people who are hesitant concerning vaccines to reconsider, thereby eliminating the free-rider problem with which the many commenters were upset. It was never my intention to provide an exegetical analysis of the medical literature in this area, although I may do so in the future, probably in small sections, as time allows.
But I have some other items from your comment that I wish to address:
Your commentary takes, in general, a form of the straw man fallacy, whereby one abstracts the argument being made (“…there’s a common rhetorical technique that lunatics use…”), then embellishes it a bit to make it a bit easier to attack (but at the same time, because of the abstraction, it’s not quite being attributed to the instant author) and then excitedly attacks it, thereby somehow casting aspersions on the original argument.
Let me pick out one or two of the several claims that you abstracted and hyperbolised, that I never actually made, just to give a sense of this to anyone lurking, so that they may weight your comments appropriately:
“…trust me, instead [of the experts].” I did not intend to acquire acolytes, nor do I even desire anyone “trusting me”. The only advocacy I engage in is that of thinking for one’s self, without a credentialed or non-credentialed middleman/authority-figure making the errors on your behalf. If you re-read what I wrote, you will see that my very simple claim was that physicians and medical researchers are sometimes right, and sometimes wrong. Obviously, you’re very welcome to go back and attack the actual claim that I made.
I am well aware that science is not in the business of proving negative claims. Science doesn’t actually prove positive claims either, for the record. All it does is propose hypotheses, which people then attempt to experimentally falsify. I am very well acquainted with the work of Popper. If (again) you re-read what I wrote you will find that I said “…I still don’t understand what people are talking about when they say that vaccines have been proven to not cause autism.” This means that a) I am referring to the many comments left after the New York Times article in which people said that it has been demonstrated that vaccines do not cause autism, and b) I did not make the claim that vaccines cause autism, nor did I claim that they do not. Please in the future be kind and conscientious enough to direct your criticisms to the appropriate party(ies).
On another matter, may I re-direct you back to the paragraph where I mentioned the children screaming after the shots, you will notice that I said that this was a common anecdote, and that many parents with autistic children claim that their child was developing normally when they began a bout of high-pitched screaming shortly after a series of vaccines, and then never recovered. I said that when lots of people report a similar anecdote like this that medical science should take it seriously and investigate it and not write it off as a group hallucination. So obviously I don’t have a citation for you, as I was complaining about the very lack of study. I’m sorry if that doesn’t meet your needs for evidence, but you can always join some yahoo groups where autism is discussed and you will see lots of parents telling very similar stories like this. You can also see this symptom in the VAERS database, although it is not a reliable source for the frequency with which such symptoms appear because it is only based on voluntary reporting.
Finally, as a point of interest, I am very well aware of delayed and/or selective vaccination, but again, such a discussion was well beyond my aim in this essay; I do intend to write about this is in the future, as I think it is a more difficult area than many others apparently do.
I’m sorry that you didn’t find what you were looking for in my essay, and wish you good luck in your future searches.