One of the things that you hear over and over again from the anti-science crowd is that public policy should not “sacrifice” the life of one person for the good of the population. In the case of vaccines, many of the people who are convinced that vaccines cause autism will tell you that we should not “sacrifice” a child to autism even if it means preventing a whole lot of death and disability from vaccine-preventable diseases. Mind you, autism does not equal death for a child. But such is the mentality of the fanatic.
I wish that I could live in a fantasy world where there were no sacrifices for the good of the population, where no one in the absolute would have a reaction to a vaccine (no matter how mild). Unfortunately, such a world does not exist. However, there is this thing called science, and it prescribes the tools we can use to minimize the amount of suffering in humanity. With it, we’ve been able to cure diseases that used to kill people by the thousands (maybe millions) in centuries past. Sadly, there are those who have not benefited from the science and may have even been hurt by it. But such is life.
It seems cold to say, “Sorry about your luck, Suzy,” when Suzy has an allergic reaction to a medication or a vaccine. But there isn’t really much we can do. In the United States, medicines (including vaccines) are tested over and over and over again on thousands of people before they go to market. In those different phases of testing, we get to know what dose is good enough to reach a desired effect, what dose may be too high and cause injury, and, of course, whether or not the drug does what it’s supposed to do. Without this testing, medications are not allowed to go to market. Or, if they do go to market, they will include the Quack Miranda Warning, telling you that they have not been tested and are not intended to cure, treat, or prevent any disease (although they’re marketed as curing, treating, or preventing diseases).
During those phases, and even after the medication has gone to market, there are those “few” individuals who do get injured. (I write “few” to mean “not everyone who takes the medication”.) This is because those “few” individuals may be genetically predisposed to the bad reaction, or they have become sensitized and have an allergic reaction, or they were taking a medication that interacted with the new medication. It happens, but the rigorous testing regime in the US clinical trials and licensing process makes sure that the damage is minimal.
Still, there are those anti-science people who will say to you that “all medications that have ever been taken off the market were first approved by the FDA.” This is what we in the business call a “truism”. Yes, to be unapproved and taken off the market, the medication had to be first approved and taken to market. It’s like saying that all planes that have crashed were first airborne. It’s true. But it’s a deceptive way of trying to convince you that the FDA process of approving drugs is worthless, compromised, or corrupt. Well, if it’s any of these things, why was the drug taken off the market? I mean, if the conspiracy is deep, why did it not prevent the medication from being withdrawn?
The very fact that drugs are taken off the market is a clear indicator that the system works. It’s also not just FDA that keeps an eye out on medications post-licensure. Researchers in competing companies may want to test the drug to see if their competitor’s product is really as good as the marketing says it is. Other researchers in academic settings may also test it to see if the drug can be used for other conditions. And government researchers may also test it to make sure that the drug is safe in the long term.
It was precisely a combination of these types of post-marketing research that has led to the recall of many drugs that have been shown to not be that safe in the long run, or that were shown to interact with unexpected patient characteristics (e.g. genetics, diets, other medications and other conditions). So, yeah, there may be people hurt by a drug, but the drug was first shown to be of benefit to the overwhelming majority of people who need it. For example, children overdose on acetaminophen, aspirin, and ibuprofen by accident, but this doesn’t mean that these drugs are taken off the market, leaving us without a safe and effective way to treat pain and fever without “harder” drugs like morphine.
Still other anti-science people will point to the experience of “thalidomide” and try to trick you into thinking that the fiasco that happened with this drug was the responsibility of drug-regulating agencies in the United States. Long story short, thalidomide was a medication first licensed in Germany. It was used to treat morning sickness in pregnant women. Soon after it was licensed to be sold over-the-counter in Germany, children began to be born with severe malformations. But this drug never made it to American markets as a medication for pregnant women because an FDA investigator by the name of Frances Kelsey reviewed the evidence of the drug in Europe and on pregnant women and their fetuses. Today, through additional research, thalidomide continues to be used as a drug for other diseases and conditions, but never on pregnant women or women who could become pregnant. In essence, so thalidomide could not cause damage here in the United States, it caused damage over there in Germany.
This is the spot where those of us who work in public health and public health policy find ourselves. On the one hand, we have these phenomenal technologies that will help prevent, treat, or cure diseases and conditions. We have the evidence that they do. We have a robust system of testing them that includes participants other than just the manufacturers themselves and their subsidiaries. On the other hand, there is an inherent danger in any medical intervention, no matter how small. Even a paper cut can get a Staph infection that kills you if you don’t wash it and dress it appropriately. A child with previously unrecognized sensitivity to penicillin may die from the treatment for Strep throat, but more children will die of Scarlet Fever or cardiac sequelae from an untreated Strep throat infection. A woman who is pregnant may have a child with a deformity because she underwent a series of x-rays after a car accident when she was only a few weeks along, but more women will die if their injuries are not identified by radiographic imaging.
This, dear readers, is the world we live in. It’s reality. It’s cold and uncaring.
We have this wonderful technology called the measles-mumps-rubella vaccine (MMR) which has been shown to prevent measles, mumps, and rubella in the overwhelming majority of people who are immunized with it. Because of it, rubella (German Measles) is virtually eradicated from the American Continent. (The whole, entire, goddamned continent.) I told you before what rubella can do to an unborn child. The cases I’ve investigated of Congenital Rubella Syndrome (CRS) are so few that I can count them in one hand, and they were all in babes whose mother went overseas and contracted rubella while pregnant and not vaccinated.
You know where vaccination for rubella is not mandatory, required, or otherwise? Japan. You know where they had 31 cases of CRS in 2013? In Japan. Thirty-one children were born with horrible deformities so the fears and apprehensions and misinformation over vaccination by their mothers could be allayed. Or, if you ask anti-vaccinators, 31 children were sacrificed to CRS instead of being “sacrificed” to autism because the MMR vaccine causes autism, all evidence be damned.
People like Andrew Jeremy Wakefield, Jenny McCarthy, and the rest of the merry band of anti-vaccine
loons wackos who are convinced that vaccines cause autism will likely be hard to find in public, or hard to get an apology from, when CRS makes a comeback in the United States as levels of MMR immunity drop. Because they have a utilitarian view of the world, like I do. Except that their view sees random, rare events as being purposeful, unbelievably common events. Their view sees a “tsunami” of autism and other diseases caused by vaccines, and yet they fail to see that we had more cases of CRS in Japan in 2013 than cases of autism directly attributable to vaccines in the United States.