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Sunday, August 07, 2005

Autism/Vaccine Update

I've written here and here about the claims by some groups that thimerosal, a preservative contained in many childhood vaccines, might have a correlation to autism and related disorders. There was segment on today's Meet the Press regarding this debate. The transcript is here (scroll down to the middle). I personally find Dr. Fineberg, who defends the safety of childhood vacinations, to be more convincing - but I had already formed an opinion before watching this. Tim Russert, the moderator, makes a very interesting point:
Since thimerosal is now out of the vaccine, latest as of 2003, we will know in a few years whether or not there is a connection...
I'm sure that is cold comfort for those whose kids have been and will continue to be diagnosed with these disorders in the future, but it will be interesting to see if the rates drop as precipitously as the claims from those in the anti-thimerosal camp would suggest.

15 Comments:

Blogger Zman Biur said...

(As usual, I'm not a doctor...)

Thimerosal is far from the only issue. There are other substances in vaccines which may be toxic, such as aluminum and formaldehyde.

Furthermore, the theory behind vaccines is that by injecting a virus-derived substance into the blood, the immune system can be stimulated into producing antibodies against the virus. Thus, every vaccination introduces potential toxins into the blood.

Add to that the facts that infants have underdeveloped immune systems to begin with; that most childhood vaccines have not been thoroughly tested on infants; that the long-term effects of the current high-intensity vaccination schedule has never been studied; that no vaccine is more than about 85% effective; and that most vaccines are for diseases that either are exceedingly rare or are nearly always harmless to those who contract them!

In most cases, the likelihood of your child being harmed by a vaccine is much greater than the likelihood of his being similarly harmed by the disease. (For example, for the last few decades the only polio cases in the U.S. were caused by the vaccine!)

Do the research and make up your own mind. You owe it to your kids to be fully informed about any medical decision you have to make for them. Remember, you can always postpone a vaccination, but you can't undo it.

10:30 AM  
Blogger orthomom said...

Thanks, I've done the research as well, and your statement that
"In most cases, the likelihood of your child being harmed by a vaccine is much greater than the likelihood of his being similarly harmed by the disease. (For example, for the last few decades the only polio cases in the U.S. were caused by the vaccine!)"
Is far from the objective truth. The fact that the only polio cases in the US were as a result of the vaccine completely ignores the fact that there were so many more cases of polio a year until the vaccine started being used! It is unfortunate that the polio vaccine used to cause a few cases of polio a year (and I say "used to" because it is no longer the case since they switched from the oral to the injectable vaccine, by the way), but that doesn't change the vast numbers of children protected since the polio vaccine started to be administered. To even consider going back to the days of the unprotected masses of children contracting fatal and maiming diseases makes me close my eyes and thank God that I DO live in the age of immunizations. But thanks for your input.

10:46 AM  
Blogger GoldaLeah said...

Thanks for the level-headed post on this issue. Unfortunately, I live in an area where it's now in vogue not to vaccinate your kids. I wish I could say that most of these parents are making well-informed decisions, but many of them aren't. Last year, at my son's preschool, there was a case of whopping cough brought into the school by an unvaccinated child. These diseases that we thought we had eradicated. Guess what? They're back.

I think every parent who decides to refuse vaccinations should be reruiqred to view a video of the real effects of these diseases. Do most people my age even know how serious diptheria was? Or polio? Or even rubella? We think of them as "things you get and get over," but sometimes the effects are devastating or even fatal.

On the one hand, I'm all for personal liberty and allowing parents to make health care choices for their kids. On the other hand, I'm not very comfortable with parents being allowed to enroll their unvaccinated kids in my kids' schools. Doesn't your personal liberty end when you put my kid at risk?

11:52 AM  
Blogger orthomom said...

I agree, Golda Leah. I controlled myself as best I could, but nothing gets me more annoyed than the points made like the first one in this comment section. Obviously, if the only cases of Polio these days are caused by the vaccine - then it should be clear that the vaccine is doing its job!! Especially now that thimerosal has been removed from the formulations of vaccines, I cannot for the life of me understand the thought process behind withholding your children from something so clearly beneficial.

12:01 PM  
Blogger Zman Biur said...

Thanks, I've done the research as well,

That's the important part. Honest people can disagree about the interpretation.


and your statement...Is far from the objective truth. The fact that the only polio cases in the US were as a result of the vaccine completely ignores the fact that there were so many more cases of polio a year until the vaccine started being used!


I'm talking about now. You're deciding about vaccinating today, not fifty years ago. Today, there are no polio cases in the US or Israel, and there haven't been for many years. It is not logical to claim that that is solely because of vaccination, since vaccination is only about 85% effective. But there are no cases of polio among the 15% of the population whose vaccination is not effective, either.

Polio has been eradicated in the developed world today. This is probably due largely to improved sanitation - polio is a waterborne illness. If I have to decide between the near-zero risk of polio and the uncertain (but clearly much higher) risk of vaccine injury, I know which I prefer.


(Not to mention that the number of polio cases was already declining sharply before the vaccine came into use. But that's an entirely different discussion.)

12:55 PM  
Blogger Zman Biur said...

Last year, at my son's preschool, there was a case of whopping cough brought into the school by an unvaccinated child. These diseases that we thought we had eradicated.

Anectodal evidence is not science. What matters is the comparative risks of infection versus vaccination.

Whooping cough clearly has not been eradicated. It is, however, usually harmless.


Doesn't your personal liberty end when you put my kid at risk?

How is your kid at risk? You said your kids are vaccinated! What are you worried about?

Besides, if I believe vaccination puts my kid at risk, whose liberty takes precedence? When the long-term effects of loading infants with dozens of immunization shots have been properly studied, we'll have something to talk about.


My nephew in the US just came down with chicken pox, along with most of his kindergarten class. They had all been vaccinated. Lot of good it did them.

1:05 PM  
Blogger Zman Biur said...

Obviously, if the only cases of Polio these days are caused by the vaccine - then it should be clear that the vaccine is doing its job!!

Why is this obvious? There are no cases of smallpox today - is the vaccine doing its job? Oops - we don't vaccinate against smallpox any more, since no one gets the disease! Shouldn't the same logic apply to polio?

There are almost no cases of bubonic plague today. Is the vaccine doing its job? Oops - there is no vaccine for bubonic plague!


I try to make medical decisions based on scientific evidence not "obviousness".

1:09 PM  
Blogger orthomom said...

(Not to mention that the number of polio cases was already declining sharply before the vaccine came into use. But that's an entirely different discussion.)
More than the day-to-day fear of contracting a case of polio, the vaccination prevents against an epidemic similar to the one that hit the U.S. in the 50's. Granted, transmission would not be as rampant as it was in those days of poor sanitation and nutrition, but to say that because the number of yearly cases declined means that the disease was on it's way out without the help of vaccinations is unproveable.

2:20 PM  
Blogger GoldaLeah said...

zman -- why don't I just concede? You're all science and I'm all anecdote? You win. I'll unvaccinate my kids immediately.

Sorry, I've entered these kinds of discussions before and the result is always the same. I could provide you with a stack of scientific evidence as tall as I am and it would make no difference whatsoever.

In lieu of that, I bow out.

10:30 AM  
Anonymous sam said...

The humor here, of course, is that like most of zman biur's "facts," his/her assertion that "there is no bubonic plague vaccine" is just plain wrong. There is an inactivated whole cell vaccine, but its not on the market. But that is just pedantry.
I'm shocked, however, to see the degree of his/her misinformation on some of the other issues. A good example is the ludicrous claim that vaccines are aimed at pathogens that are mostly harmless. Let's see: 1) polio - devastating paralytic disease, no cure. 2) HiB - used to (15 years ago) be the #1 cause of epiglotitis (without immediate (<6hrs) care, you're dead, period), and meningitis (bacterial meningitis - the risks of the LP in the workup are more than the risks of the vaccine, such as they are) in kids. Now we almost never see it. Why? B/c the vaccine worked wonders in 15 years
3) Pneumococcus - a major cause of pneumonia, meningitis and occult bacteremia/sepsis in kids - the heptavalent vaccine has made blood cultures in the febrile toddler nearly unneccessary ( give it a few more years - also, see http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15237067&query_hl=1 )
4) measles, pretty self limited, except for the cases of encephalitis (1/1000 measles patients get it) and chronic encephalitis (1/100000 - rarer, but so much more fatal) and viral pneumonia.
5) rubella - not dangerous for the kids, but ever see a rubella baby - born to a mother with active disease? Its not pretty. The vaccine was introduced to protect your news kids, not the old ones.
6) mumps - ok, ok, one.
7) diptheria is fatal if untreated.
8) pretussis - last month I saw a kid with pertussis at LIJ. He was on a ventilator, and nearly died. Yes, I know, anecdotal. But powerful anyway. The issue with pertussis is that its a very serious disease (which, despite being a bacteria and like many of the viruses above, is more or less untreatable with antibiotics). So you have to intubate and pray, most of the time. Sounds like a blast, where do I sign up?
8) varicella - I'm tired of typing - see http://content.nejm.org/cgi/content/abstract/352/5/450?hits=20&where=fulltext&andorexactfulltext=and&searchterm=varicella&sortspec=Score%2Bdesc%2BPUBDATE_SORTDATE%2Bdesc&excludeflag=TWEEK_element&searchid=1123683719700_3004&FIRSTINDEX=0&journalcode=nejm

Further distortions of fact - unlike his/her claim that vaccines are only 85% effective, the truth is that seroconversion rates of the licensed vaccines are somewhere between 95 and 99%. You can get the rates of the individual vaccines (I have) in harrisons, nelsons or any other medicine textbook.
As to the issue of whether these diseases exist in our neck of the woods, the answer is either yes, or they may be moving here soon. There's a serious outbreak of polio going on in africa and india - all it takes is one guy getting on a plane and being hired by the restaurant down the block and not washing his hands. Diptheria is prevalent in immigrants from Eastern Europe, both young and old - hey there are none of those around here, right? HiB and Pneumococcus are around, especially in adults (less so Hib, to be honest), who havent really been vaccinated. They're waiting for a chance to jump. Pertussis, is staging a big comeback - b/c the vaccine wears off without boosters, and adults are getting it and passing it on - but the literature is very clear about who is bearing the brunt of the cost - its kids who havent been vaccinated due to misconceptions about the disease's prevalence nowadays. I am too lazy by now to cite the article, but there's a good new england journal article (nejm.org search for it, if you care) on pertussis as a reemerging disease published a few years back (2001?). Ultimately, what is at stake here is whether the pseudoscience of people like zman biur should be tolerated to the point that they endanger their own and OUR children, both born and unborn. The evidence on vaccines is in, theyve been doing studies for decades - and there's no good proof that vaccines as a class have any ill effect. Most are component or inactivated, and are no risk to the immunocompromised babies zman biur is so ludicrously worried about.
I could go on, but I'm out of patience. In short, the arguments in favor of vaccinating are legion, and those against it are specious at best, disingenuous at worst. With most of these diseases, by not vaccinating you're playing russian roulette with your kids' health - and there are 5 loaded chambers, and one empty. Best of luck.

10:38 AM  
Anonymous Anonymous said...

OK, I couldnt resist. Two more points:

1) The law is very clear about parents refusing required medical care for their children on religious grounds. In the Jehovah's Witnesses example where parents refused blood transfusions for their children, the court mandated that a guardian be appointed to ensure that these children get adequate medical care. While you have the right of informed consent as an adult, there is no such right regarding your children. I can't say I see a difference between this case and that. There are REAL and defined (unlike the spurious autism links) risks to blood products too - Hep C, Hep B, HIV, etc, - not to mention losing your immortal soul - but the clear benefit is clearly a legal spur to require accepting the transfusion. Similarly, in the vaccine cases, while the autism link may or may not be real (may not, in the opinion of nearly all reputable medical practitioners) the benefit of vaccines is real and often life saving. So shouldnt this be a legally mandated issue? Personal choice shouldnt enter into it - you can't choose for your kids.

2) "Furthermore, the theory behind vaccines is that by injecting a virus-derived substance into the blood, the immune system can be stimulated into producing antibodies against the virus. Thus, every vaccination introduces potential toxins into the blood." Yes, well, by that logic, don't let your kids take antibiotics - they are toxic to some extent as well (as a professor of mine said - "if a drug doesnt have side effects, it has no effects"). For that matter, if god forbid one's child has leukemia, dont let them take chemo - since the express purpose of chemotherapeutic drugs is to be toxic. The point here is that toxicity is relative - the question is whether there is a benefit that outweighs the risk. And, for that matter, the risk here is not as broad as ZB makes it out to be. Not everything that's immunogenic is also toxic. To stimulate an immune response, you need a foreign protein (or carbohydrate), not a toxic one. So many of the vaccines are inactivated or even acellular and thus completely harmless - and not "potentially toxic."

What's happening with this debate is clear: people are making very poor decisions with inadequate information and frankly, without many of the epidemiological and medical tools and training necessary to process such information. A little knowledge is a dangerous thing.

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