I’ve been noticing that there’s a recent new(ish) complaint against people that are concerned about safety of vaccines.  I’ve seen it in some blog posts, and seen it almost constantly in the online comment sections following various news articles and blog articles about vaccines.

The complaint is that people who question vaccines have been changing the nature of their argument over time.  According to this complaint it started with people being concerned about mercury and thimerosal in vaccines.  Over time, as thimerosal was removed (or reduced, as some critics would say) from vaccines, and as a corresponding decrease in autism was not apparent, the “anti-vaccine” people changed their argument. Now they claim that aluminum, formaldehyde and polysorbate 80, etc. are the basis for concern about vaccines.

Apparently some people find this to be some fatal flaw, and from this it apparently follows that any criticism of vaccines is trumped automatically.  But I don’t see that this point has (or should have) any weight.

First of all, points in scientific discussion and debates change over time.  Not only do they change, they ought to change in response to advances in knowledge and to changes in thinking.  Anyone who stays wedded to the first idea they had is either truly perfect, or is a little too invested in being correct.

Consider the medical quest to treat ulcers.  Physicians and researchers considered excess stomach acid production to be the cause of ulcers for decades.  They even tried crazy things like freezing the lining of the stomach to try and reduce acid production until gastric linings started sloughed off and causing lots of bleeding.  I’m glad no one got in their way and said that they couldn’t change their theory halfway through, or was upset because they modified their position in light of further experience.

Furthermore, at least with regards to asthma, allergies and autism, it is reasonable to have a heightened and continuing sense of concern about vaccines, since they are direct attempts to alter the immune system.  Lots of children with autism seem to have immunological problems, and asthma and allergies are both dysfunctions of the immune system.  I’m not remotely suggesting there is evidence of anything causal because of this, but I do think it means it is well worth thinking about and looking at vaccines carefully, since we’re manipulating the immune system in ways that are not well understood, and we’ve got a lot of children appearing with immune problems.

Secondly, the increases in neurological problems, asthma/allergies, ADD and ADHD, bipolar disorder and autistic spectrum disorders in children ARE happening concomitantly with the increases in the number of vaccines that children get.  This is obviously another concern NOT causative on its face, but why does that then make it somehow crazy to want to examine vaccines more closely, as well as their constituent parts?

And finally, if the concerns about vaccines, and their components are so ridiculous and ill-founded, then why aren’t the easy rebuttals just trotted out instead of crying not fair, they changed the game?  For myself, I’d prefer that to all these pointless charges of fallacious argument, and I’m sure there are lots of others who are listening for that as well.

David Kirby, the famous journalist who had leaked the details of the Hannah Poling case in the media in the US, spoke in the United Kingdom last night, at Regent Hall, Oxford Street, London.

I turned up a bit early: 6:10 for a 6:30 pm start, thinking that I wanted to make sure that I got a seat, expecting the room would be quite full, but I was wrong.

The talk began slightly late at about 6:45 pm, and by that time there were about fifty people there, at most.  I was amazed that in a country where there are higher rates of autism than in most of the US that so few people bothered to turn up to hear what this man had to say.

Kirby gave an excellent talk.

I wasn’t sure what to expect since I had seen his work ridiculed on the some of the pro-vaccinationist websites, although I had never read his book or his work at The Huffington Post.  I suppose to be completely fair, I should point out that they don’t call themselves pro-vaccinationists, they tend to call themselves skeptics, or “science-based” or “evidence-based”, implying of course that people who are skeptical about vaccines and who look at evidence don’t exist, or that it is some sort of oxymoron.  It reminds me a bit of being at university where a scholar would refer to her theory as the ‘rich, complex model’ and the theory of someone who disagreed with her as the ‘impoverished, superficial model’.

When Kirby began his talk, he made it clear that he’s not anti-vaccine, nor is he a crusader and that above all, he is a journalist who leaves the science to the scientists.  He pointed out that when he goes home at night, he forgets all about autism; he has no stake in this game and no children.  Along with this topic, he is also working on a project concerning factory-farming of animals, and is writing a book, and none of it has anything to do with autism.

He further pointed out that he doesn’t care whether it is the vaccines that are causing autism or not.  He says that he began researching this area to figure out what was happening that was causing these huge rises in autism cases, and whether it is vaccines or something else doesn’t matter to him, because he is simply working to try and uncover the cause, hoping once discovered the autism epidemic will be able to be stopped.

Kirby began by considering facts and studies that supported the idea that vaccines and autism were not related, and then he turned to those that did suggest a relationship.  He discussed the major studies that are generally considered to be evidence that vaccines are safe, and pointed out all the areas in which these epidemiological studies had methodological problems that directly called the results of the study into question – in many cases by the authors of the studies themselves.  I had already read all the studies he discussed, so I didn’t hear a lot that I didn’t already know, but it was very interesting to have all the information from these studies presented back-to-back so that one could see that as a body of evidence it wasn’t terribly convincing.

But the most amazing part of this talk was that there was no one from the press there.

Well, there was one woman, who said she was a journalist, and that she tried to get someone to commission her to attend the event and write about it, but no one was willing, so she came out of her own interest.  She  pointed out that a notification about the talk had been disseminated among the usual channels in the journalistic community, and that she was certain that the lack of press had nothing to do with people not being aware of the talk.

Meanwhile Hannah Poling is big news in the states and people are now realising that many more children seem to have the markers of mitochondrial dysfunction than the US government originally claimed.   In spite of initial comments by the government health offices that Hannah had an extremely rare inherited condition (in fact Kirby said that the test case intended to replace the Hannah Poling case turned out to have all the same markers and condition as Hannah did, although I haven’t yet confirmed this myself) that the settlement did not mean that the government believed that vaccines cause autism.

But in the midst of this big news that lots of parents are following very closely online, things in the press here are strangely, almost bizarrely silent on this matter.  David Kirby even mentioned that he had a BBC interview scheduled which was canceled, and The Daily Mail commissioned him to write a piece on this subject, which he did, which they then decided not to print.

The Daily Mail did however choose to publish this poorly researched article by Barney Calman about biomedical interventions for autism.  Calman is a journalist who seems to have unfortunately joined forces with Michael Fitzpatrick, a GP who repeatedly and zealously denies that vaccines do any harm or that they have any link to autism.  Fitzpatrick has a son with autism (a teenager who is institutionalised), which he takes special care to mention whenever he speaks or writes, as if this somehow makes his claims weightier.  In fact, Fitzpatrick was at the Kirby talk yesterday, and after Kirby presented his material and then asked for questions, Fitzpatrick hurried not to make any substantive rebuttal of anything Kirby presented, but instead to ask how it could be the case that vaccines contributed to autism when there weren’t any GPs, paediatricians or pediatric gastroenterologists who believed it.

So it would seem that the press in the UK is only willing to publish pieces that are pro-vaccine, and against biomedical treatment for autism.  It doesn’t seem to matter if those articles are even remotely factually correct, or if the primary proponents make sophomoric claims from authority that something must be true because a bunch of doctors think it’s true.

Surely if work like that is worthy of any journalistic effort, then Hannah Poling deserves her own newspaper – and yet she gets nothing in this country.  For myself, I find the silence of the press completely deafening, and I am happy to see people around the country taking notice.

“…my brother’s story also taught me about the loneliness of the visionary, the selfishness of our culture, and the arrogance that blinds many scientists.” – Christina Odone

Lorenzo Odone was a boy diagnosed at age 6 with the rare genetic disorder adrenoleukodystrophy (ALD), where an accumulation of fatty acids occurs in the body due to a missing transporter protein. This results in damage to the myelin sheaths that insulate the axons of nerve cells in the body, and signals can no longer be sent via these axons, resulting in increasing disability, such as losses of sight, hearing and movement.

Soon after his diagnosis, Lorenzo’s parents, Augusto and Michaela, were told by physicians that their son would soon be dead, and that there was nothing to be done.

But the Odones instead set about researching Lorenzo’s disease, and came upon a combination of acids (Lorenzo’s Oil) could stop the production of the fatty acids that were causing the problem. Once given to Lorenzo, the oils worked, and although they could not re-myelinate his already damaged cells, they greatly slowed the progression of the disease.

The Odones created an organization aimed at accelerating and supporting research into the repair of myelin and treatment of leukodystrophies and demyelinating disorders: The Myelin Project.

Lorenzo died just a couple of days ago, the 30th of May 2008, the day after his 30th birthday: 22 years later than the physicians predicted. And it was only in 2005 that research on the Odones’ patented Lorenzo’s Oil showed that young boys who had yet to display symptoms of ALD, who has the oils added to their diet, had a statistically lower chance of developing signs of the disease. And more research is being done.

It’s a lucky thing for Lorenzo that his parents persevered, and weren’t satisfied with the best answers that medical science had to offer. Today skeptical parents engage in similar acts of love and dedication to their children when they demand unbiased studies addressing the safety of the vaccine schedule, or they biomedically treat the medical problems borne by their autistic children, when physicians everywhere assure the public that yes, everything is safe, or no, nothing can be done, and anyone who says otherwise is a quack or a parent-in-denial. In spite of the “arrogance of scientists” that Lorenzo’s sister Christina Odone refers to in The Daily Mail, parents all over the world act against the advice of the medical establishment that said nothing could be done for Lorenzo.

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.

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.

Somehow lately, at every turn I find myself seeing references to medical and dental studies that claim to not only exonerate mercury as a toxic substance, but even go so far as to make it seem as though the stuff might even be someone’s guardian angel (see http://pediatrics.aappublications.org/cgi/content/full/114/3/584).

There are some scientifically uncontroversial facts about mercury (but if you accept them, you’re considered a mercury fanatic): 1) it’s extremely toxic stuff, whether in its elemental, organic or inorganic forms, 2) amalgam releases mercury vapor into the mouth, typically from its occlusal surfaces whilst eating or brushing teeth, and also in response to heat and galvanic current from the presence of dissimilar metals in other dental restorations, 3) mercury is lipophilic and concentrates in tissues in the body, especially fatty tissues such as the brain, the kidneys, endocrine glands and liver, and 4) mercury crosses the placenta and lodges in fetal tissue (some studies show in higher proportion than in maternal tissue, which seems to make it more toxic to fetuses and children).

The real point of controversy is whether the amount of mercury released by amalgams, or whether the amount of mercury contained in flu vaccines is enough to do any damage (even when combined with the enormous air pollution of mercury coming to the US from China now, as well as the exposures to aluminum and lead, which are myriad, and act to potentiate the effects of mercury).

And there are lots of good studies that give us reason to question whether mercury even in its common uses is truly safe. Have a look at Thomas Burbacher’s 2005 study using infant macaques, where he finds a lot of inorganic mercury deposits in brain tissues that have half-lives from 227-540 days as well as increases in microglia and brain inflammation that resemble that of autistic persons and Alzheimer’s patients. And all this fun from a little bit of mercury in vaccines. (see http://www.ehponline.org/members/2005/7712/7712.html)

No one has been able to show conclusively that this chronic mercury exposure is safe. Sure, perhaps over time frames of 5-7 years, maybe we only see loss of three IQ points (which is still not negligible) – but what happens when someone’s seven amalgams leak mercury into their brain for 20 years? Or 50 years? Here’s the totally honest answer that no one else wants to tell you: we don’t know (but we’re concerned). As Hume pointed out long ago, there is no way that one can SEE causality – and it seems that as time marches on, potential causal relationships seem increasingly more outrageous, until we eventually find ourselves in a position where people who find mercury at all suspect are the objects of ridicule by all under the state-sanctioned Scientism that teaches us that everything that is printed in a peer-reviewed medical journal is true.

My question is: knowing what we do about mercury toxicity, in matters of public health, why would we expose people to it at all unless we were using it carefully under stringent cost-benefit analysis to further truly vital objectives, or because it was unavoidable? I can’t imagine what the answer to this is.

Of course, in the meanwhile, I wouldn’t take out my couple of amalgams, not because I am not an alarmist, but mostly because I’m waiting for the new extra-strength, super-safe plutonium fillings to come into use here in the UK.

There’s been a lot of buzz in the last month or so concerning this latest study by Michael Pichichero et al. from the University of Rochester which was purportedly published in the February issue of the medical journal Pediatrics a month ahead of schedule in order to combat what was thought to be unscientific autism-is-caused-by-vaccines rhetoric in a fictional television courtroom drama called Eli Stone.

And the media didn’t disappoint, there were lots of reports that latched right onto the “findings” of the study. Here are some examples from The Washington Post, Science Daily and Reuters.

You can begin to understand why the hubbub erupted after you look at the misleading abstract:

“The blood half-life of intramuscular ethyl mercury from thimerosal in vaccines in infants is substantially shorter that that of oral methyl mercury in adults.”

This sounds like great news, telling us that the mercury preservative in vaccines (still currently in most of the recommended children’s flu shots) is cleared from the blood of children much more quickly than the mercury found in seafood eaten by adults is cleared from their blood. “Maybe thimerosal IS safe,” you might think, if you didn’t actually bother to read the study, “and those people who were worried about injecting mercury into the bloodstream were alarmists.”

Of course, there are some relevant bits of information that were omitted from the abstract, such as where all the mercury cleared from the vaccinated children’s blood WENT. Pichichero doesn’t actually know, as his stated aim was to evaluate the similarity of methyl (fish) and ethyl (vaxes) mercury in order to determine whether current EPA guidelines that suggest maximum exposure to methyl mercury found in fish is suitable for application to ethyl mercury in some vaccinations. He analyzed urine, blood and feces, and so therefore can only report those findings; some inorganic mercury was excreted via a one-time fecal sample from the study subjects, which seems to indicate that at least some of mercury contained in the shots was excreted in this manner, but he doesn’t know how much of the mercury that was injected was excreted via feces. There was no significant excretion of mercury via urine.

Fortunately, Thomas Burbacher, et al. can make a good guess as to where some of the mercury from the injected infants went: their brains. Burbacher’s study reached a very similar result as Pichichero’s in that the half-life of ethyl mercury in the blood was significantly shorter than that of the methyl mercury. The difference is that Burbacher also examined the amount of mercury in the brains of infant macaques that had received either ethyl or methyl mercury, and found that blood mercury levels were not good indicators of brain mercury levels. Furthermore, while Burbacher’s results are similar to those of Pichichero’s in that there does not seem to be any accumulation of mercury in the blood after thimerosal exposure, there are concerns about the accumulation of mercury in the brain.

Burbacher found that absolute inorganic mercury concentrations in the brain were approximately twice as high in the thimerosal-exposed macaques than those exposed to methyl mercury in the diet. Inorganic mercury has a very long half-life in the brain, between 227 to 540 days, depending on which region of the brain in which the mercury is deposited.

When I read the Pichichero study, I couldn’t help but wonder why he so strenuously avoided any reference to the work Burbacher et al. had done; he had, in fact, cited that same study when he noted that “…ethyl mercury readily transports to all tissues but that it has a shorter half-life.” But then when interviewed by reporters concerning his recent study, as in the Reuters article linked above, he made claims such as “Now it’s obvious that ethyl mercury’s short half-life prevents toxic build-up from occurring. It’s just gone too fast.” Burbacher didn’t find it was gone too fast. He found it was going to the brain, and there was nothing in the Pichichero study that demonstrated that he knows where the mercury went when it left the blood. He knows it did not appear in the random urine sample, and that some of it appeared in a random fecal sample, but as far as he knows, a whole bunch of it might be sitting in some tissue in the body. So it is difficult to see his statement as anything more than pure conjecture, and unrelated to anything he knows to be true, in the usual scientific understanding of the word true, and certainly unrelated to anything he demonstrated in his study.

Burbacher and Pichichero did agree that the EPA guidelines for maximum exposure to methyl mercury should not be applicable to ethyl mercury, because both substances seem to be handled differently by the body. But they seem to be parting company on what this means. Burbacher recalls that inorganic mercury in the brain is associated with an increase in microglia and notes that a study has shown an increase in brain inflammatory processes including a large proliferation of microglia in the brains of autistic patients. Whereas Pichichero seems to be holding out hope when in the conclusion of the recent study he states: “Our results suggest that a new risk assessment regarding exposure to thimerosal…should be conducted in light of the demonstrated short half-life of ethyl mercury following vaccination.”

As always, I would gently suggest that you are as informed as possible before you inject substances into your children or yourself. And I further advocate the exercise of caution and extreme critical analysis when a person whose interests might be contrary to yours advocates that you do something based on purported research findings, particularly when the findings are actually outside the purview of the study. (It is interesting to have a look at the “Research Focus” heading here).

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