What’s the harm, really?

One thing that anti-vaccine types keep asking over and over is the following:

“If your kid is vaccinated, and if vaccines work as well as you say they do… Why is my kid a threat to your kid?”

It’s an interesting mental game to play with them if you’re so inclined. It probably won’t get you anywhere with the hardcore anti-vaccine activists, the ones that blame everything and anything on vaccines. But the “softer” ones may still be reachable. Here’s how you play the game: Continue reading

The many and the individuals

The thing about public health and public health workers is that we are not healthcare providers in the strictest sense. While some of us may be nurses, physicians, or physician assistants, most of us never even come into direct contact with the people we’re serving. Even those who do “treat” people, e.g. give a vaccine or administer post-exposure antibiotics, are not in charge of the continuing care of the individuals. On the one hand, we’re protecting the health of the people. On the other, it’s not entirely up to us.

This causes some friction, especially when a provider thinks that he or she should be the final arbiter of what to do with their patients. Take, for example, a certain pediatrician to the stars. This pediatrician has said over and over that his decades of experience in medicine and his gut feelings dictate his approach to immunizations. He believes that some vaccines undoubtedly cause bad things, and that vaccines should be spaced out as much as possible, if they are to be given at all.

For his individual patients, that’s fine. It’s really between he and his patients how he is to tend to their healthcare needs, so long as he practices a standard of care that is not negligent and does so in the best interest of his patients. However, for the population at large, this is not a good thing. It’s not good to erode herd immunity against things like measles or mumps. It’s not good under any circumstance.

There was once a kid in a very large university who came down with bacterial meningitis. He had been at a party and allegedly “hooked up” with several young women that night. We did our best to track down those contacts, and everyone else at the party. When we did, we notified them of a possible exposure to bacterial meningitis, and we advices them to go into their local health department to be given antibiotics or to go see the university’s health providers, or to go see their own physician. Well, there was one physician who saw one of the young ladies in question and refused to give her antibiotics. He said that she said that the case and her never really hooked up. They just sat on a bed in a room at the house where the party happened and talked, nothing more. So the physician took her word for it.

This triggered a huge discussion on what to do with her. Would we ask the physician at the local health department to give her the antibiotics anyway? Would we respect her physician’s decision, albeit a questionable decision? What to do?

In the end, the local health department staff reached out to her and explained to her the situation. She was told that she could be in danger if there was any chance that she and the case shared any spit, even incidentally, at the party. (He had fallen most ill about a day after that party, so he was very infectious when he went to it.) She opted not to chance it. Days later, her physician apparently complained about being overruled.

And that’s not the only example I’ve seen or heard of where private practice providers clash with public health practitioners and workers. It seems to be a constant struggle. I don’t see it as a bad thing, though. There must be an interest in providers to take care of their patients, even if jealously so. And the must be a willingness of public health workers to do their due diligence, even if that means stepping on the toes of private practitioners. All as long as we’re all doing it in the best interest of the patient.

So how do we deal with people who refuse vaccines even though they’re licensed healthcare providers who should know better? Or those who refuse to give vaccines and whose action, or inaction, may lead to an outbreak of a serious disease in the community?

I don’t know. It’s above my paygrade to figure out those things. But I have passed this discussion on to a friend who is about to enter a Doctor of Public Health program. I hope his education in that program covers these issues because we need answers. We need guidance. We need to figure out who supersedes whom when it comes to serious disagreements like vaccines, fluoridation, or even antibiotic use.

I’d like to say that evidence supersedes all personal or professional opinions, but the world doesn’t work that way, sadly. In this world, we need to deal with each other, work with each other, and do it all in the best interest of the public and their health.

At what point will someone call Shenanigans? (UPDATED)

I call Shenanigans! Well, not the restaurant, of course. I call shenanigans on this: (It’s a little long, so you can skip it and avoid the headache, or read and get a migraine.)

“My reasons for not vaccinating – what are yours?

Vaccine antigens cause a short term response as measured by antibody count (titer tests). The first problem we encounter is that, when tested after a few weeks those antibodies are, in most people, not present anymore. The next problem is that there is no study proving that a high antibody count actually protects from or prevents disease outside of the lab (real world). The third problem and major issue I have with vaccines is their effect on the immune system. In recent years science has learned that the human immune system is much more complicated than we thought. It is composed of two functional branches or compartments which may work together in a mutually cooperative way or in a mutually antagonistic way depending on the health of the individual.

One branch is the humoral immune system (or Th2 function) which primarily produces antibodies in the blood circulation as a sensing or recognizing function of the immune system to the presence of foreign antigens in the body. The other branch is the cellular or cell-mediated immune system (or Th1 function) which primarily destroys, digests and expels foreign antigens out of the body through the activity of its cells found in the thymus, tonsils, adenoids, spleen, lymph nodes and lymph system throughout the body. This process of destroying, digesting and discharging foreign antigens from the body is known as “the acute inflammatory response” and is often accompanied by the classic signs of inflammation: fever, pain, malaise and discharge of mucus, pus, skin rash or diarrhea.

These two functional branches of the immune system may be compared to the two functions in eating: tasting and recognizing the food on the one hand, and digesting the food and eliminating the food waste on the other hand. In the same way, the humoral or Th2 branch of the immune system “tastes” and recognizes and even remembers foreign antigens and the cellular or Th1 branch of the immune system digests and eliminates the foreign antigens from the body. But just as too much repeated tasting of food will ruin the appetite, so also too much repeated stimulation of the “tasting” humoral immune system by an antigen will inhibit and suppress the digesting and eliminating function of the cellular immune system. In other words, overstimulating antibody production can suppress the acute inflammatory response of the cellular immune system!

This explains the polar opposite relationship between acute discharging inflammations on the one hand and allergies and auto-immune inflammations on the other hand. The more a person has of one, the less he or she will have of the other!

A growing number of scientists believe that the increase in America, Europe, Australia and Japan in allergic and auto-immune diseases (which stimulate the humoral or Th2 branch of the immune system) is caused by the lack of stimulation of the cellular or the Th1 branch of the immune system from the lack of acute inflammatory responses and discharges in childhood. We need to identify the factors which cause this shift in the function of the immune system or which cause allergies and auto-immune diseases in childhood to increase!

If we now return to the original question of the mechanism of action of vaccinations, we find what I believe is the key to the puzzle. A vaccination consists of introducing a disease agent or disease antigen into an individual’s body without causing the disease. If the disease agent provoked the whole immune system into action it wouldcause all the symptoms of the disease! The symptoms of a disease are primarily the symptoms (fever, pain, malaise, loss of function) of the acute inflammatory response to the disease. 

So the trick of a vaccination is to stimulate the immune system just enough so that it makes antibodies and “remembers” the disease antigen but not so much that it provokes an acute inflammatory response by the cellular immune system and makes us sick with the disease we’re trying to prevent! Thus a vaccination works by stimulating very much the antibody production (Th2) and by stimulating very little or not at all the digesting and discharging function of the cellular immune system (Th1).

Vaccine antigens are designed to be “unprovocative” or “indigestible” for the cellular immune system (Th1) and highly stimulating for the antibody-mediated humoral immune system (Th2).

Perhaps it is not difficult to see then why the repeated use of vaccinations would tend to shift the functional balance of the immune system toward the antibody-producing side (Th2) and away from the acute inflammatory discharging side (the cell-mediated side or Th1). This has been confirmed by observation especially in the case of Gulf War Illness: most vaccinations cause a shift in immune function from the Th1 side (acute inflammatory discharging response) to the Th2 side (chronic auto-immune or allergic response).

The outcome of this line of thought is that, contrary to previous belief, vaccinations do not strengthen or “boost” the whole immune system. Instead vaccinations overstimulate the “tasting and remembering” function of the antibody-mediated branch of the immune system (Th2) which simultaneously suppresses the cellular immune system (Th1) thus “preventing” the disease in question. What in reality is prevented is not the disease but the ability of our cellular immune system to manifest, to respond to and overcome the disease. 

Those are my reasons for not vaccinating my children. What are yours?”

This is the guy I told you about before, the one who thinks that his daughter’s type I diabetes was caused by the hepatitis B vaccine she received months earlier, the one who thinks he did “academic research” in writing his book. He claims that he’s not anti-vaccine and that he just wants to inform the public so that the public can make their own decisions. “Inform,” I don’t believe that word means what he thinks it means because that whole bunch of drivel up there, all that stuff, it’s chock-full of misinformation.

“Vaccine antigens cause a short term response as measured by antibody count (titer tests). The first problem we encounter is that, when tested after a few weeks those antibodies are, in most people, not present anymore.”

Not so! Pregnant women are checked for immunity by testing their blood for antibodies (titer tests), measuring the immunoglobulin G levels. Immunoglobulin G (IgG) lasts for a very long time. If I take some blood from you now and do a protein electrophoresis on it (separation of proteins by weight), it will look just like this:

From left to right: Albumin, Alpha 1, Alpha 2, Beta, and Gamma globulins (proteins)
See the gamma globulins all the way on the right? They’re your antibodies. They’ll always be there unless you get sick, in which case you get an infusion of antibodies from a donor to keep you safe from infections. This guy is outright lying when he says that antibodies disappear. They don’t, and that’s why so many vaccines will give you long-lasting immunity.
He then dives into the whole “Th1 vs. Th2” thing, but he gets it completely wrong. Here’s what that system is all about: Th1 is about intracellular pathogens, like viruses. Th2 is about extracellular pathogens, like bacteria and fungi. But anti-vaccine people read that “Mercury depletes glutathione and polarizes toward Th2 dominance” and they went nuts over that. Mercury will do that to people. But there are reasons why this isn’t the case with vaccines.
First, the amount of mercury in vaccines was negligible before manufacturers removed all thimerosal (a mercury-containing compound much like salt is a chlorine-containing compound). Even when we do get thimerosal from a vaccine (usually the flu vaccine nowadays), the amount is negligible, and our bodies are really good at dealing with it. Again, it’s all in the chemistry. But, true to anti-vax ideology, this guy swallows the lie hook, line, and sinker, and it seems to me that he wants you to do the same.
But, hey, if you want to believe him, go ahead and spend hundreds of dollars on a lab test you probably don’t need.

“A growing number of scientists believe that the increase in America, Europe, Australia and Japan in allergic and auto-immune diseases (which stimulate the humoral or Th2 branch of the immune system) is caused by the lack of stimulation of the cellular or the Th1 branch of the immune system from the lack of acute inflammatory responses and discharges in childhood.”

I’d really like to meet these scientists and explain to them that the Th1 component really is being stimulated all the time because we’re under constant bombardment by viruses and other intracellular pathogens. Then again, I don’t think these scientists are a “growing number” of them. Rather, I suspect they are the few anti-vaccine “scientists” who like to claim things that aren’t.

“Thus a vaccination works by stimulating very much the antibody production (Th2) and by stimulating very little or not at all the digesting and discharging function of the cellular immune system (Th1).”

This is how I know this guy knows absolutely nothing about immunology. See, when an antigen is introduced into your body — an antigen that shouldn’t be there — macrophages eat that antigen and then present it to your T helper (the “Th”) cells. So, as you can see, the immune system is involved in everything from antigen response through absorption, digestion, and presentation to T helper cells; to B cells, cells that are not even part of the Th system. It is complex, and that’s why he’s getting it all wrong… All of it! It’s as if he can’t read Wikipedia or something.

“Vaccine antigens are designed to be “unprovocative” or “indigestible” for the cellular immune system (Th1) and highly stimulating for the antibody-mediated humoral immune system (Th2).”

What?! Read this and pay attention to this part on the first page:

“Most antigens and vaccines trigger both B and T cell responses, such that there is no rationale in opposing antibody production (‘humoral immunity’) and T cell responses (‘cellular immunity’). In addition, CD4+ T cells are required for most antibody responses, while antibodies exert significant influences on T cell responses to intracellular pathogens.”

The more he posts on his Facebook page, the more I’m convinced he’s one chicken McNugget short of a Happy Meal®.

UPDATE: A reader of the blog asked me to correct/clarify some things. So I did. I’ve bolded them. Also, he posted this on Facebook to counter the anti-vaccine activist’s rant:

Click to enlarge.

I bet it gets deleted because it’s full of truth.

Vaccine apologetics?

I don’t usually associate apologetics with scientific concepts. I associate them with religious things. Often, you have people on the radio or on television, defending their faith. I don’t blame them nor find any fault with this. For things that are untestable, apologetics is a good way to defend beliefs. For science, we have evidence. You either believe the evidence or you don’t. If you don’t believe in something that is tangible, testable, and objective, then you’re a denialist.

Denialists are scarier to me than apologists because these are people who are presented with actual, verifiable evidence of scientific claims, and they still find it in themselves to deny the evidence and continue to live in their own world. One such denialist showed up on “The Poxes” and commented on the “Measles” chapter. Here is what the denialist wrote:

Click to enlarge, of course.
The denialist was responding to this passage in that chapter:

“It wouldn’t be until the 1960s that a highly effective vaccine was developed and launched all over the world. The number of cases dropped precipitously to almost nothing in many parts of the world. While deaths had been avoided through better medical care once someone was infected, outbreaks still occurred in great numbers right up until the time when the vaccination level reached 90%, then outbreaks were halted because of herd immunity.”

That part of that chapter was not fiction. It is true that the advent of the measles vaccine in the 1960’s brought about the decline of measles cases and measles outbreaks in the United States. There were no huge leaps in food preparation, food hygiene, sewer systems, or hand washing in the 1960’s. Those things were well in place before the 1960’s, and they did squat to stop the spread of measles. Here’s the number of cases per year of measles:

Here is a graph with more information:

Can you see when measles cases dropped precipitously? When did we start having sewers or washing our hands in the United States? Sometime around the 1960’s? Nope.

The reason why improvements in hygiene and food preparation don’t do anything against infections like measles, rubella (German measles), or chickenpox, is that these infections are transmitted through droplets suspended in the air. You can scrub down a room until you can eat off the floor and still have measles suspended in the air if a person infectious with measles had been there a few hours earlier. You can hermetically seal all food, water, and waste, and these viruses would still linger in the air.

The best infection prevention against measles is to cycle the air in a room through a filter or let the room stand unoccupied for several hours and then scrub it down once the droplets settle onto surfaces. The thing is, you wouldn’t know that these droplets were there because they’re microscopic. Furthermore, someone with measles is infectious a few days before they get any symptoms. So you could very well have a healthy person walk into a room and contaminate the hell out of it.

I’m willing to give the denialist the benefit of the doubt and say that they have not “done their research” on measles, hence the misunderstanding. But this is another comment this person left for me on a blog post about the flu vaccine:

Click to enlarge, won’t you?

This person is not dumb. They’ve done “research”. They just refuse to see the evidence. (Of course, that Cochrane Collaboration did not find anything like that. The denialist is reading into it what the denialist wants to see.)

So, no, I’m not apologizing for vaccines. I don’t need to. The evidence is there. It is clear. It is testable. It is objective. Let whoever has ears (and eyes and intelligence) to understand the evidence listen and learn and help us move forward as a species.

Original Antigenic Sin (Sounds ominous, doesn’t it?)

One part of immunology goes a little bit like this:

1. You get exposed to a bacteria or virus.

2. Specialized cells called macrophages (or neutrophils) gobble up the bacteria or virus (or fungus or whatever), and digests it with some enzymes and other chemicals.

3. The macrophage then presents the bits and pieces of the virus or bacteria it just ate. To whom? They present it to B lymphocytes and T lymphocytes.

4. B lymphocytes take the bits and pieces, also called antigens, and create specific antibodies against it.

5. The antibodies attach to circulating viruses and bacteria, inactivating them and marking them for destruction by the T lymphocytes and additional macrophages.

6. If you survive this first encounter, the B lymphocytes go dormant, waiting for the next time you’re infected.

7. If you get infected again, the B lymphocytes are pressed into action again, but they produce the antibodies to which they are already coded, and they do so furiously. New B lymphocytes go back to step 4.

Of course, this is the “quick and dirty” description of what happens inside of us when we are exposed to viruses and bacteria that cause disease. The actual process is much longer and complex, too long and complex to explain here. But you get the point. You’re exposed, you make antibodies, and, if you’re exposed ever again, you respond quickly and vigorously, preventing the new infection from gaining a foothold and making you sick.

This is the reason why some diseases like chickenpox usually only attack us once. The “memory” of the dormant-then-activated B lymphocytes lasts long, and the chickenpox virus is antigenically similar from one wave of infections to the next. That is, the antigens don’t change in shape, and the antibodies can attach to the new infection as easily as they did when they first defended you.

There are some exceptions to this reaction, also called an “anamnestic response”. There are times when the interval from one infection to another is too long, and the dormant B lymphocytes end up dying and are unavailable to defend you when the second infection occurs. There are also times when you have an underlying medical condition that prevents those B lymphocytes from responding. Or, if they do respond, the other cells cannot come along for the ride and help in the defense of your body.

The best way to keep your body always primed and ready would be to be continuously exposed to the disease. And that was the case when chickenpox and measles were around, killing people. You’d be exposed over and over since you were very likely to come into contact with a person who had them when you were a kid, when you had your kids, when your kids had kids, or if you were a person who had a new batch of snot-nosed  kids to deal with every so often – like a teacher.

One thing that vaccines did very well was to make cases of things like chickenpox dwindle and almost disappear. Instead of getting the infection and the high chance of bad outcomes from it (e.g. encephalitis, skin infections, or pneumonia), you just got a shot full of antigens – the bits and pieces of the virus – and your immune system would be primed and ready, sans actual disease. However, instead of being re-exposed from time to time, you no longer are exposed. If your B lymphocytes die off, then you’re not immune to the disease anymore. This is why we need boosters.

We also need boosters because, although we’ve tried and tried hard, there are still plenty of cases of chickenpox, measles, whooping cough, and other vaccine-preventable diseases. Are they around because other animal species can also get them and so “hide” in their natural host until they hit humans again? Not really. Humans are the only natural reservoir for many of these diseases, especially chickenpox and measles. (Yes, there are other diseases out there that hit animals and are related to human diseases, but they’re not exactly the same.)

Boosters work, and they work well.

However, vaccines don’t work as well with viruses whose antigens change quickly, or whose natural reservoir is not humanity. This is the case with influenza viruses. Type A and B viruses can infect humans, pigs, birds, horses, dogs, and even some seals. So we can get rid of the viruses from humans, but they’ll just go hang out with pigs until a non-immune person gets exposed to them. Also, influenza viruses change their antigens almost yearly. To our immune system, this year’s flu is not caused by last year’s flu. Our dormant B cells can throw off antibodies, but those antibodies are not adept to neutralizing this year’s flu if they were created against the flu from years ago.

Or is it?

During the 2009 flu pandemic, there was an interesting phenomenon occurring in the populations that were infected. Children were making plenty of antibodies against the new flu virus. Older adults were making plenty of antibodies against the new flu virus. But young adults and adults were not making these antibodies. What the heck, right? We’ll get back to that observation in a second.

An epidemiologist made an interesting observation about the immune system some years ago. He noticed that people exposed to a flu virus (say it is “flu X”) would make really good antibodies against that flu X. If they were exposed to flu Y, however, they would make a lot of antibodies against flu X, but very little against Y. When he took into account these people’s age, he noticed that they belonged to a subset of people that had not seen an epidemic of flu X ever, but were old enough to have seen flu W, M, or flu N at some time. On the other hand, people who had seen flu X when they were very young or had not seen any flu of any kind, well, those people made plenty of good antibody against flu Y.

This epidemiologist called this observation the “Original Antigenic Sin” theory. He theorized that people who had seen other flus would make antibodies only against the flu they had originally encountered when they were children. Their antibodies were being made by the dormant B lymphocytes that were called to action after the new infection. These people were young adults and adults, and they didn’t do well with new flu viruses because that reaction from old, dormant B lymphocytes was vigorous enough to trick other B lymphocytes into thinking that enough was being done. However, the reaction was not specific enough to deal with the new flu.

On the other hand, children who had not seen the flu before made a vigorous and specific response to the new flu because they had no old B lymphocytes to take over. Older adults also had a good antibody response to a new flu because their old and dormant B lymphocytes had died out. To them, the infection was new, immunologically speaking. Here, I made a table to explain it better:

Immune response is not indicative of disease outcome, by the way.

During the 2009 pandemic, epidemiologists saw that older adults were not getting sick as much – or as severely – as younger adults. One of the things that explained this was this concept of original antigenic sin. Another thing that explains it is that older adults are more likely to be consecutively vaccinated for quite some time because they’ve been placed on the recommendation list. One other thing that could explain this was that these older adults had been exposed to the same H1N1 virus many years prior and had some sort of “lifelong” immunity against it.

Remember, during the pandemic, children were affected just as bad as young adults, throwing the original sin theory out the window. They made a lot of antibodies, but this wasn’t a sign that they fared any better.

It was that last point that didn’t make much sense. Yes, the 2009 H1N1 virus is similar to previous H1N1s seen in history, but, from an antigenic point of view, it was new. It was novel. And that novelty is the only thing that explains why it went around the world so quickly. Unfortunately, many in the media, in public policy, and – why else would I be well into 1,300 words of this post? – anti-vaccine people, believe that grandma and grandpa Smith, at the age of 70+, have an immune system that remembers a virus from decades ago.

And it’s that last point that anti-vaccine people have been harking for a while now, and especially in light of the current 2012-13 H3N2 flu season that has been so heavy. They claim that children should be exposed now to this potentially deadly flu in order to get “lifelong” immunity, and they use that observation from the 2009 pandemic as an explanation. When presented with the possibility that older adults fared better because of consecutive immunization, they scamper away or present some bogus explanation. When presented with the evidence that children didn’t do so well in 2009, they also counter with poor science and really no good evidence.

In essence, the anti-vaccine crowd would very much like to have kids exposed to a potentially deadly pathogen instead of being vaccinated because, in their minds, it will lead to lifelong immunity and none of the “dangers” of vaccines. They do this for measles, for chickenpox, for whooping cough, and now for flu. They ignore all the families who have been severely affected by influenza, some whose children have died and others who have been left with severe consequences of their infection. Worse, with regards to the flu, they ignore that the flu mutates very fast and has other animals as reservoirs, making our immune system susceptible to it every year, almost like clockwork.

Of course, almost like clockwork, anti-vaccine people will say that we all survived past pandemics and epidemics, so the flu isn’t deadly. This is almost like saying that we all survived World War II, so that war wasn’t deadly. That is, they have very different definition of deadly. And you can tell that they do because they say a vaccine is deadly while things like polio, measles, and flu are not. All the evidence says they are deadly. Very deadly.

So, now that you have this information, you’ll be able to counter the argument that an exposure to flu now is a guarantee to immunity later. Tell them that it doesn’t work that way with flu because it mutates fast. When they bring up what happened in 2009, tell them about the original antigenic sin and how they’re misinterpreting it. Then, when they bring up someone who didn’t die from the flu, bring up someone who has… And then ask for someone who has died from vaccines.

If you fill up a stadium with the number of people who have died from flu, you’d only need to fill a seat or two to represent the number of people who have directly died from a flu vaccine. Again, anti-vaccine people are not good gamblers.

How some choose to deal with loss

One of the recurring themes that I see in the world of conspiracy theories is that of loss and revenge. The conspiracy theorist has lost something or someone, and they do their own “research” in order to get back at whatever or whoever wronged them. There are also other conspiracy theorists that, although they’ve lost nothing and no one, will take it upon themselves to be the heroes.
You all know my policy on not naming any names on this blog. But that doesn’t mean I can’t link to their stuff, or to examples of their stuff. So hold on for some scary stuff.

Exhibit A in this thesis is the man profiled in this story from the Seattle Weekly. This man’s story is a sad one, really, because he lost a baby girl about 14 years ago. The girl died, from what we can tell in the story, about a day after receiving the hepatitis B vaccine:

“Lyla, who died a day after receiving the Hepatitis B vaccine shot 13 years ago. He wails in the song: ‘That evening, she stopped breathing/Her face turned blue/Oh Lord, her face turned blue.’”

Wait. A song? That’s right, he wails in his song because the man in question has built a top-of-the-line private recording studio in his home in order to make songs about vaccines. Actually, they are songs about the horrors of vaccines:

“[He] sees his band, pointedly called the Refusers, as akin to the antiwar protest-music bands of the ’60s and ’70s. The group’s music combines a toe-tapping, funk-rock beat with lyrics meant to convey the Nazi-like horror—as he and his allies literally portray it—of this country’s vaccination policies. “Vaccine Gestapo” is the name of one song. In a music video for another, his daughter Viola (also completely unvaccinated) portrays a scared Alice-in-Wonderland figure being chased by a mad doctor wielding a needle.

Because doctors chase children around to get them vaccinated, if and when they can get away from the long days at the office or the hospital, apparently.
So the man in question lost a daughter, and he vehemently blames the hepatitis B vaccine despite evidence to the contrary:

“Yet it soon becomes even more apparent that there are a lot of unanswered questions about his portrayal of Lyla’s death and its aftermath. Asked, for instance, if he is sure that the medical examiner talked to Merck before switching her assessment of Lyla’s death, he says: “I think so. I told her to.” In other words, [his] allegation is based on nothing more than his own suggestion to the examiner, prompted by his suspicions about the vaccine. He’s also not sure, now that he’s asked about it, whether it was the examiner or, as seems more likely, the police who came to his apartment looking for evidence of child abuse. “I don’t know . . . somebody . . . don’t ask me,” he says. Most crucially of all, [he] says he doesn’t know where the pediatrician’s notes are that prove that the examiner initially determined that Lyla had a swollen brain. “You have to take my word for it,” he says. Later, asked whether he would consent to having the case file from the examiner’s office released to Seattle Weekly, he declines. “To me, it’s a very invasive and intrusive request,” he says, questioning the Weekly’s “fixation” with Lyla’s death. “To me, it’s not the story.””

Oh, but it IS the story, very much. His rants and raves and songs about the evils of vaccination fall on the ears of those who can be swayed away from vaccines, placing them at higher risk for life-threatening – or at least harmful – infections. His evidence for his beliefs are based on his daughter’s unfortunate death. Yet, he doesn’t want to provide any supporting evidence?
Look, I know that it is very hard to lose a loved one, let alone a child. I don’t know this first-hand, but I have been in plenty of situations personally and professionally where someone loses a child. It is heartbreaking, awful. It’s like a personal hell, and I don’t doubt that he has gone – and may still be going – through it.
What I object to is his crusade against an enemy that just doesn’t exist. None of the assertions about vaccines made in his media have been proven, not by independent scientists, not by government agencies, and not by the epidemiology of sudden deaths in children. There is just no evidence to what he claims.
But he’s not the only one.
Exhibit B: There is this woman. Of course, she has her own anti-vaccine blog as well. Hers is also a story of loss, although not at the levels seen in “exhibit A”. This woman is the mother of an autistic child. She describes her situation thus:

“I am the mother of a child who regressed into autism following the simultaneous administration of the DTaP, Hepatitis B, Polio, HIB and Pnumo (sic) vaccines. When I discovered that none of the vaccines My son received that day had been studied for their relationship to autism, and that my pediatrician’s opinion that his vaccines did not cause his autism had no basis in science, I began to investigate and document the vaccine-autism causation theory and other vaccine injuries.”

So, again, we have a parent who is convinced that their child was injured by vaccines. She is convinced about it to the point that she seemingly has devoted her life and her career to promote the anti-vaccine agenda. You can head over and read the rest of what someone in the comments rightly pointed out to be a severe pimping of her book. (Aside: Dr. Offit writes a book and it’s “conflict of interest” this and “Big Pharma shill” that. This lady writes a book and she mentions it ad nauseum in a congressional hearing.) Unfortunately, many parents of autistic children are convinced that they have “lost” that child and will do and say almost anything to seek revenge on those who caused it.
If you don’t believe me that they truly think their child is somewhere between dead and dying, even if all they have is autism, take a read at exhibit C and his blog:

“’Look at me!’ I said hoping to end the tantrum, turning him so his face was in front of mine, but his eyes stared off to the side. ‘Look at me [child]!’ and he refused. This sent a chill up my spine. Not that I knew anything about autism, it was because this just wasn’t like him. I remembered noticing his lack of eye contact when his cousin was with us for the week. I thought that was just him having his feelings hurt and being jealous. But this was different, I was suddenly aware that I was attempting to break him, break his will and instead it broke me. I sobbed uncontrollably, something is wrong, this isn’t worth it, just let him bite, do anything he wants. I left the room, I left him to work it out on his own. I left him to run away. A little later he came into my office where I was hiding my shame, my self doubt, my heartache. He came in and climbed up into my lap and loved me. I cried so hard it made my wife cry. In the 9 years we have been together she has only seen me in this state 3 times, once for reasons I don’t want you to know about, this time when I had the come to Jesus with myself and the last time months later when I knew [he] was autistic… or something.”

The feeling of loss is palpable in his commentary. It really is. This discovery that his child was not neurotypical led this father to crusade against vaccines, as he was convinced that the hepatitis B vaccine his son received at birth and a few months later – since it is in a series – were to blame for the son’s autism. You can continue to read his posts, which suddenly stopped almost three years ago. You can read about his efforts to find out what happened to his child and who was going to pay for it:

“With new statistics coming out showing that the true number of children with autism is close to one in one hundred it is today that we need to pick up our weapon of choice and fight autism with every ounce of strength we have, but not alone, with others, within our community there are warriors of incredible strength and providers of impenetrable armor, find them, link hands and attack, attack as if your child’s life depended on it.”

Note the theme of loss: “(A)s if your child’s life depended on it”.
On the opposite side of the spectrum are the parents of children who have died from whooping cough and are now fighting hard to remind everyone that the vaccine is a safe and effective way to prevent whooping cough. They have made their campaigns very public, and they have taken all sorts of abuse from the anti-vaccine crowd.
For example, the parents of Dana McCaffery have been on the receiving end of harassment by one of Australia’s most rabid anti-vaccine people and organization. I am proud to write little Dana’s name because she should be the one we name, the one we remember when dealing with loss. She died a horrible death from whooping cough, a disease that suffocates you. And hundreds of children just like her are dying of whooping cough, a vaccine-preventable disease. Her parents, instead of being angry and vindictive, have taken it upon themselves to stop this from happening to other families.
Sadly, they are not alone in their loss. Thankfully, they are not alone in their purpose.
Of course, someone is going to accuse me that the death of one child doesn’t override or make less the death of another. The death of one child by whooping cough does not take anything away from exhibit A’s loss. The actions of exhibit A do. You can choose to make something good happen from the loss of your child, or you can choose to be angry and vindictive to the point of spreading misinformation and fear about a safe and effective way to prevent more loss. It really is your choice… But it will have consequences beyond your control.

Everything But The Cursed Vaccine

One of the big arguments that many anti-vaccine people will give you to downplay the importance of immunization is that “vaccines didn’t save us”. They will present as evidence the fact that deaths from vaccine-preventable diseases have been on the decline in the United States in modern times, particularly since potable water and sewer systems were installed in major population centers. They ask, then, that we do away with the US vaccine program and instead encourage good hygienic practices… LIKE WE DON’T DO THAT ALREADY.

If you were to read a public health message from any public health agency in October and November, that message would probably be about influenza, which peaks in the winter here in North America. In those messages, you will never read that the flu vaccine is the only way to prevent influenza. Better yet, you will even read from many public health professionals that frequent hand washing is the best way to prevent influenza, even better than the vaccine.

That’s right, anti-vaxers, the “Pharma Shills” are placing the interests of soap companies above those of Big Pharma. Shocking!

This is because public health professionals, for the most part, see public health problems as multi-faceted, multi-dimensional problems. No one problem is unique. Public health is not monolithic. Every single issue of public health concern has many sides to it, many causes, so it has many ways to approach it. When it comes to respiratory infections – like the flu – that are transmitted from person to person via respiratory droplets, we recommend to the public that they wash their hands, keep their distance if they’re sick and from sick people, and, if one is available, get vaccinated.

Let me explain it this way. What [expletive] general would ever send their troops to war without telling them all the ways they can defeat the enemy and equipping them with the best tools for the job? (Answer: One that doesn’t want to win.) So we tell the public all the evidence-based ways that they can prevent or control disease. It really isn’t all about vaccines.

But that is not what people in the anti-vaccine camp think. In their minds, we’re out there vaccinating at gunpoint. In their version of reality, we want everyone to develop autism from an imaginary conspiracy in their heads where vaccines cause autism while giving those of us who promote them some major profits. It’s almost like we’re not even on the same planet some times.

So you hear all of these talking heads – so-called experts – claiming that there are other ways, better ways to combat disease, so much so that vaccines are unnecessary and – in the minds of some of them – a dangerous proposition. There’s a pediatrician whose answer to childhood diseases is breastfeeding. There is a whacky lady down under whose answer to horrible things like whooping cough is everything BUT vaccines. (She has even denied that such a thing as whooping cough exists.) There are celebrities who trust homeopathy. And there are the poor parents who’ve believed these things and then lost – truly lost, as in dead – a child to a vaccine-preventable disease.

I’m not going to deny that potable water and sanitation have prevented a lot of death and disease in developed countries, nor am I going to deny that those systems are needed in developing countries to improve their standards of living. I’d be out of a job if I did. (Talk about conflicts of interest.) Potable water eliminates cholera. Draining swamps and installing nets eliminates malaria. Sewer systems take care of other waterborne infections.

But what about things like measles? It’s not waterborne. It’s not in the food. It’s in the air around an infected person, and it’s very infectious. What’s worse, the person is infectious to others before they have any symptoms. At least with diarrheal diseases – with the exception of asymptomatic carriers like Typhoid Mary – you have to get the diarrhea before you give it to others. That’s one good control measure we could instal: Diarrhea? Stay away! Yet that is not the case with measles or chickenpox. Even people with influenza are infectious about 24 hours before they are symptomatic.

The other thing about infectious like measles is that humans are the only reservoirs of the contagion. If we all got vaccinated, or at least the overwhelming majority (about 95%), we could eradicated – as was the case with smallpox. Then there wouldn’t be a need for any more vaccination. But no! Anti-vaccine advocates have done enough damage to the point that measles is making a comeback. I mean, those [expletive] will even go as far as to mail the [expletive] virus to other people!

So, yes, let’s have potable water. Let’s have sewer systems. Let’s give antibiotics/antivirals and continue research into their development and improvement. Let’s wash our hands, cook our food, and refrigerate the leftovers. AND let’s vaccinate, a safe and effective way to give these diseases the stab in the heart they deserve.

They Keep Moving The Goalposts

Consider this comment from an anti-vaccine advocate:

You can throw statistics out all you want. Everyone knows that vaccines do not cause autism in every single child or else we would have every child that received vaccines as an autistic person. Autism aside, let’s get the medical field, science and vaccine makers to promote legislation that requires that the full spectrum of adverse events be discussed prior to a doctor giving a vaccine. Why not also take away the shield that is the vaccine injury court and like every other business in the U.S. let the vaccine makers and doctors fend for themselves on defending the lawsuits for each and every vaccine injury. I am an insurance guy, so don’t tell me that you would have too many people claim vaccine injuries who were not really injured. That argument absolutely does not fly! May happen to where a few try to work the system, but not enough to say that all of the vaccine injury reports are lies. I also have many friends in the pharmaceutical industry. ALL of them have their vaccine exemptions for their kids. They say no way they would take the risk, so there is something there. For me, there are too many inconsistencies. Even the IOM didn’t get all the cases studied. Out of 158, I think that they only were able to study 23, so that means 135 were not able to be studied. UCLA and Harvard question the IOM’s latest report. The biggest thing for me is that I know how science and medicine work when there is money involved. I see it every day in one fashion or another. And the simple fact is some things happen, whether science says it is possible or not. Science is not always cutting edge, especially in the US or we would not be so lacking in the mortality rate compared to others. Our kids are just as sick as kids in many third world countries. Science has no answer, but it is happening.

Let’s analyze and deconstruct, shall we?

“Everyone knows that vaccines do not cause autism in every single child or else we would have every child that received vaccines as an autistic person.”
This is true, but that doesn’t stop anti-vaccine groups from working toward a goal where no child is vaccinated. If you read their messages you will clearly see that they want NO vaccines. They are asked what vaccines are safe, and they do not answer that question. So, yes, everyone knows that vaccines do not cause autism in every child, but the flip side to that is NOT that vaccines DO cause autism in some children. The evidence doesn’t point that way. This opening statement is a play on language.

“Autism aside, let’s get the medical field, science and vaccine makers to promote legislation that requires that the full spectrum of adverse events be discussed prior to a doctor giving a vaccine.”
Now, this is from an anti-vaccine person. Anti-vaccine advocates clamor for the government to lay off from mandating vaccines under the mantle of freedom and liberty, claiming that the government should not meddle in the doctor-patient relationship. Yet we have here an anti-vaccine advocate asking for legislation to do just that, mess with the doctor-patient relationship. Of course, this is borne from the conspiracy theory that physicians and other healthcare providers are trying to hide the alleged side effects of vaccines, as we’ll see in a couple of sentences.

“Why not also take away the shield that is the vaccine injury court and like every other business in the U.S. let the vaccine makers and doctors fend for themselves on defending the lawsuits for each and every vaccine injury.”
The vaccine injury court was brought about, in party, by the demands of a well-known anti-vaccine advocate. She hoped that the vaccine injury court, which has a lesser burden of proof than regular civil courts, would give claimants of vaccine injuries more in the way of compensation than a civil court would. Unfortunately for her, the vaccine court bases its decisions – for the most part – on known science. It is that last fact that makes anti-vaccine advocates uncomfortable. They want to go back to civil courts where juries can be picked to be the most misinformed possible so that favorable decisions go their way. Again, they tried it one way, it didn’t work, and so they’re moving the goalposts again.

“I am an insurance guy, so don’t tell me that you would have too many people claim vaccine injuries who were not really injured. That argument absolutely does not fly! May happen to where a few try to work the system, but not enough to say that all of the vaccine injury reports are lies.”
This one is simple to explain. How many vaccine injuries are reported? Thousands, hundreds of thousands? By the commenters own claim, not every vaccinated child is injured. In fact, the reports are low in proportion to the number of children vaccinated. And I’m not saying that the injuries are a fraction. I’m saying they’re a minuscule percentage. Tiny. Small. Far more good comes from vaccines, from seat belts, from helmets. Sure, some people may get hurt when the intervention fails, but that number is incredibly small. As an insurance guy, the commenter should know that the fact that car accidents occur in a day do not mean that a significant proportion of cars are having accidents. Certainly, it’s not a proportion to cause panic, unless you go causing the panic yourself.

“I also have many friends in the pharmaceutical industry. ALL of them have their vaccine exemptions for their kids. They say no way they would take the risk, so there is something there.”
This is one of those biases that are not visible to the biased person but are to those of us who look at the whole equation. My friends are a lot like me. We have similar interests and even political inclinations. After all, we’re friends. Regardless of their profession, they think like I do. This is why this anti-vaccine person has friends who are also anti-vaccine. Note that he doesn’t mention what their role is in the pharmaceutical industry. Do they pack pills in bottles? Are they executives? Do they clean and repair toilets at the world headquarters of Merck? If all of his friends NOT in the pharmaceutical industry DID NOT exempt from vaccination, it would be worth taking into account. But I’m going to bet that the majority of his friends, regardless of their profession, think a lot like him… Probably enough to be anti-vaccine as well.

“The biggest thing for me is that I know how science and medicine work when there is money involved. I see it every day in one fashion or another. And the simple fact is some things happen, whether science says it is possible or not.”
I’ll paraphrase the writer Seth Mnookin for this one. Mr. Mnooking stated in an interview that all the evidence available points to the fact that humans cannot fly. Does that mean that he cannot fly, especially since he hasn’t tried it? Well, no, but he’s not about to jump off a building to check out his curiosity. What I’m getting at is that science doesn’t say if something is possible or not. Science is a process by which we come to understand events that we observe. As a result, these events must have already happened. Further, because these events indeed happened, they must be possible. The other thing that I need to correct in his statement is that it is not science and medicine that are corrupted. It is the practitioners of science and medicine that can be corrupted. Luckily, there are those of us that keep them honest.

“Science is not always cutting edge, especially in the US or we would not be so lacking in the mortality rate compared to others. Our kids are just as sick as kids in many third world countries. Science has no answer, but it is happening.”
Actually, no, it’s not happening. See, the United States measures infant mortality by different standards. Further, there is a very good system for reporting infant deaths. As a result, the infant mortality rate in the US seems to be higher or just as high as the infant mortality rate in third world countries. Think about it. Are all the infant deaths in the Horn of Africa being reported accurately? Are they really?

The take-home message from this deconstructing of an anti-vaccine advocate’s thoughts and opinions is that there will always be one little thing that they will hold on to in order to attack the science of vaccination and those who work to promote and improve on that science. We can give them all sorts of reasonable, well-thought-out arguments on why vaccines are needed, why they’re safe, and why we cannot stop vaccinating… But, if their beliefs are solidified enough, it won’t matter… They’ll find a way to keep on moving the goalposts.