Crashing the Pox Party

There has been much abuzz about “pox parties” – the practice of parents getting a bunch of unvaccinated kids together with an infected one (pick one, really, though chicken pox is the focus of the recent article in Time) in the hope that their little sweethearts become ill and therefore “naturally” immune to the disease. This deliberate infection involves things as seemingly innocent as breathing the same air as the infected to the stomach-turning sharing of bodily fluids (Saliva lemonade, anyone?). To compound the issue, it seems that parents aren’t always taking into account how the viruses are transmitted, and end up trying oral transmission to  transmit a disease that is transmitted through the air. And yes, the whole thing is as stupid as it seems.

Given that the people partaking in these events have likely not vaccinated their children against anything else, these parties could be a source point for multiple highly contagious infections. Most of us have had chicken pox as children and don’t remember it fondly – now imagine having chicken pox with mumps, mono, and maybe a little hepatitis A to top it off. It is also easy to forget in Western luxury that these innocuous childhood illnesses are actually lethal. Just measles? Well, one death per 3000 measles infections might not seem like much, until you consider the fact that in 2008, 164,000 people died of the measles worldwide - approximately the same number of civilians that have died in the entire length of the current Iraq war. That’s an annual number, and it’s gone down by almost 80% over 10 years. How? The World Health Organization has implemented vaccination programs in the developing world. They increased the global vaccination rates from an average of 73% uptake to 81% uptake. And that was without any participation in the program by India. And it saves 569,000 lives annually.

Let me say that again. The measles vaccine is currently saving 569,000 lives per year in comparison to 2000.

But that’s measles! We’re talking about plain old chickenpox, how bad can it be? Well, barring shingles (a disease more typical of adults, extraordinarily painful and the cause of the majority of the deaths due to the Varicella-Zoster virus that also causes chicken pox), childhood chickenpox is not fun either. One in ten unvaccinated kids who get chicken pox will have serious enough symptoms to warrant a doctor visit. By deliberately infecting your unvaccinated kid, you’re signing up for 2 weeks of fever, a more severe pox rash, and dehydration. But worse than that, you’re signing up for that 1 in 10 lottery shot at secondary bacterial infections of the skin, the underlying tissues, the lungs, the bone, the joints, or the blood (you might know it better as sepsis). And hey, if that doesn’t scare you, the virus itself can turn nasty and cause pneumonia, or best of all, encephalitis, where the virus is infecting the brain. And once that’s all done, anyone who has ever had chicken pox has a lifetime potential of the virus spontaneously reactivating and turning into shingles. Just 20 years ago, before there was a chicken pox vaccine, about 50 kids and 50 adults would die of the Varicella-Zoster virus annually in the US.  Now personally, I’m of the opinion that any preventable death is an unnecessary one. If you know your kid will be exposed to chicken pox and you can prevent them from getting sick, why wouldn’t you?

 

Of course, the topic is not nearly as simple as this. In some respects, I understand the mentality of parents sending their children to pox parties. They legitimately are trying to do what they think is best for their kids. And they think that abstaining from nasty unnatural vaccines made by big corporations and getting their kids “natural” immunity is the best thing for them. The problem is that they’re making these decisions based on bad information.
But I’m getting ahead of myself. Let’s get to the underlying issue here: is vaccinating a choice that parents should make? Or are we, as suggested in Vaccine Epidemic, a book published earlier this year, merely the pawns of government coercion and biased science? As much as I love a good conspiracy theory, spoiler alert: no, so seriously, please vaccinate your kids.
Habakus and Holland dramatically assert “vaccination choice is a fundamental human right,” not as the first sentence in their book, but the first chapter’s title. You can’t miss it. Autonomy, the idea that we have the right to choose what is best for ourselves, is a fundamental human right, they argue, and therefore the right to choose whether we vaccinate is also a fundamental human right. And, although I find their shock tactics distasteful, I can’t argue with them. I agree that lining up the entire population of the world and giving them a shot in the arm without ever telling them what or why or obtaining their permission would be morally wrong.

 

But that exact same argument can be used to utterly defeat their position.

 

Allow me to explain. Autonomy hinges on two words that most people have heard but few truly understand: informed consent. It’s the idea not just that you agree, but that you grasp the entirety of the situation, its consequences, the different options you can choose, the risks of the scenario with actual context for what those risks mean, as well as a complete understanding of the benefits. Informed consent ensures everybody is on the same page and knows where things are heading and why. It’s something that is rather unique to medicine – typically when you sit down in a restaurant, your server doesn’t inform you that there is a 1 in 2,000 chance that your food has come into direct contact with rats or that it’s possible but unlikely that you could be fatally wounded by a falling serving tray over the course of your meal, or that, if you wanted, you could put off your meal to another time when you were more hungry.

Would you like to see our dessert menu?

You see, to have informed consent, it’s not just enough to consent. It’s not just enough to say okay, I want to deliberately infect my kid with chicken pox so that he develops natural immunity, and I want to avoid vaccines because I’ve heard there’s nasty preservatives in them. Informed consent requires a thorough examination of the issue, with some concrete data. Do these parents know how the immune system works? If they did, they’d know that vaccines work the exact same way that being infected does, only in a much less dangerous way because the virus is either dead or had the stuff that made it infectious removed. Do they understand the real-world implications of not vaccinating? That if everyone chose not to vaccinate, these diseases would run rampant, killing the most vulnerable people in our society – their children, their aging parents? Do they know that vaccines are the only way to eradicate an illness entirely, that if everyone was vaccinated, we could make diseases like measles and polio disappear from the surface of the planet? Do they know that this can happen even if the vaccine is not 100% effective? Do they know that doing things nature’s way means astronomical mortality rates of infants and young children due to infectious disease?

 

More importantly, do they know that “natural” is big business, just like the pharmaceutical companies they so dread are? Do they know that the Canadian supplement & functional food industry alone brings in in shy of $3 billion annually. Do they realize that alternative medicine practitioners have financial incentive to encourage people to use their services too? Do they know that this whole vaccine-thimerosal-autism thing has been debunked from here to last decade, to the point where it is utterly redundant and tiresome to read the medical literature on it? (Seriously, the titles of these papers have not changed over the last 5 years. It is a field going absolutely nowhere because people will not let this thing die. If Jenny McCarthy would stop asking where the studies are, maybe these poor grad students could get on with their lives and research something that hasn’t been done to death.)And you know what, I get it. Denialism is one of the more interesting aspects of human psychology. Vaccine denialism has all the interesting bits. There’s all sorts of potential for conspiracy theories, from the dull profiteering to the much more intriguing mind control and brain washing. They can cherry pick out the confirmatory studies like nobody’s business, usually bizarre studies published in obscure journals written by people who have no business doing science (like lawyers, for example). They have tons of false experts, from the laywer-turned epidemiologists who have no idea how to interpret scientific data, to the Playboy bunnies. They move the goalpost constantly – with every negative study, there’s a further “well what about this?” and the ubiquitous “long-term effects” question, which makes no sense given that the autism/vaccine link is supposed to be in early development, and that vaccines have been around for a few generations now with no apparent ill effects, and in fact quite the contrary. There’s the feelings of a lack of control, of scary things people don’t understand, of blame for random circumstance. There’s the cognitive biases towards things happening together causing each other. They also spend so much time attacking vaccines that most people forget that they have little to replace them. Potentially lethal pox parties? No thanks.

Eat up, kids!

If you’re choosing not to vaccinate for rubella, are you prepared to have a child with major birth defects? Because in a world without the MMR vaccine, if you get sick with rubella around the time you get pregnant or at any point during the first trimester, you’re looking at about a coin toss for deafness, cataracts, and/or heart defects at birth, plus mental deficiencies and a host of other effects as they develop. 50-50. Or, you could play it safe to avoid the never-been-demonstrated-to-be-a-real-association vaccine-autism thing.

 

So is vaccination choice a fundamental human right? Sure, if you’ve got a flair for the dramatic and a book deal. However, the anti-vaxers need to realize that by spreading their half-truths, anecdotes and fear, they are denying parents the ability to make that choice. Informed consent is about information and its real world application, and I think most people would willingly choose to be a part of a world where we can prevent over half a million deaths in a single year with a single vaccine at the price of a bit of a sore arm.

81 Responses to “Crashing the Pox Party”

  1. Bryan says:

    Excellent writeup.

    Bryan

  2. Ianiv says:

    The link in ” utterly redundant and tiresome to read the medical literature on it?” is broken

  3. Mike says:

    Yup. No fear mongering going on here. Bravo.

    • If you know the information and still want to live in a world where children die of preventable infectious disease, that’s your right.

      • Mike says:

        I realize that you think your fear mongering is justified and that you think that the information you have is complete.

        But if you’re going to assume that anyone who believes your information is incomplete must want to see children dying of preventable diseases, then its probably not worth continuing this discussion.

      • Stating real world numbers and explaining the consequences of decisions is part of informed consent, not fear mongering. This article is clearly not a compendium of all vaccine information, nor is it intended to be. I did not discuss the rare side effects of vaccines because they are well-known and dealt with elsewhere.

        If you have a safer, more effective way of preventing infectious disease that isn’t already in use (like hand washing and adequate nutrition), then I’m all ears. I will be happy to write another article about your new technology and advocate for its implementation. I will clap as you accept the Nobel Prize. Until then, whether or not you want to see children dying of preventable disease, that is the logical consequence of parents choosing not to vaccinate their children.

    • Mike says:

      I’ll answer your second paragraph, but only if you indulge me on something else first. You say “If you’re choosing not to vaccinate for rubella, are you prepared to have a child with major birth defects?” If you want to argue that’s not fear mongering, go right ahead. While you’re at it, you can argue this statement too “Do they know that doing things nature’s way means astronomical mortality rates of infants and young children due to infectious disease?”. “They” presumably being the parents in 1st world countries who are considering deviating from the current recommended vaccine schedule?

      You also say “This article is clearly not a compendium of all vaccine information, nor is it intended to be” yet you touch on just about every argument folks like you make when going on an overvax rant. From using data that reflects substandard living conditions as a way to elicit an emotional response from people choosing what to do for their children in 1st world countries, to allowing an 8% increase in global MMR vaccination rates to take sole credit for saving 569,000 lives every year, to making the “but we have studies showing there’s no link between thimerosol and autism, so what are people so scared of” argument, to finding a way to toss in a playboy reference, to making the “natural is big business too” argument, to skipping over any discussion of the risks since it’s already so well-known how safe the current schedule is. All you’re missing is a quote from Paul Offit, the resident expert on vaccine safety from Philadelphia, without making any mention of how rich he has become from owning vaccine patents.

      You say: “Do they know that the Canadian supplement & functional food industry alone brings in in shy of $3 billion annually. Do they realize that alternative medicine practitioners have financial incentive to encourage people to use their services too?” I don’t get your point. Globally, the vaccine industry is projecting sales of about $52 billion by 2016. So either both industries are corrupted by money in which case we should be concerned about how corrupt things might get when there’s a $52b pie in a few years, or the industry revenues are irrelevant, in which case I’m not sure why you’re bringing it up.

      • 1) 1/3000 deaths from measles is from CDC information based in North America, well as the 100 deaths a year from Varicella Zoster. And in any case, would you actually argue that vaccines are good enough for African babies but you’re not convinced it’s good enough for North American babies? And yes, rubella will cause birth defects in 50% of pregnancies if the mother is infected in the first few weeks before conception or during the first trimester. It has nothing to do with the developing world or not – it’s the infection and not the access to treatment that is the problem.

        2) Increasing measles vaccinations decreases incidence of measles, and decreases deaths from measles. It didn’t change in India, which didn’t participate in the program. The countries that had higher vaccine uptake had fewer cases and fewer deaths, and vice versa. There are of course confounding factors, as you have with every epidemiology study, but if the real numbers are even half of what I quoted from the WHO, does that change my point at all? Plus, even if death was not a risk, vaccination still decreases suffering by preventing disease, and benefit the economy by preventing time off work for illness/caring for sick kids. Think of how much more productive we could be during the winter months if we had a safe and effective vaccine against the common cold (unlikely, of course)!

        3) I was merely pointing out that all industry is profit driven. Financial motivation behind information should be considered when thinking skeptically, but it should be considered for everybody, and by itself it discounts nothing. See: Bad Science by Ben Goldacre.

  4. Jason says:

    Those measles statistics are amazing. Great first article.

  5. Moderation says:

    Perhaps Mike would like to point out the exact examples of “fear mongering” he is concerned about. If not, then saying the article is fear mongering would be like me calling him an exaggerating bag of hot air without give an example … which I would never do, therefore I point out that Ms. McCollough never stated or implied that Mike “must want to see children dying of preventable disease”. *

    *example of exaggerating hot air baggery

    • Mike says:

      1) You should check the definition of fear mongering

      2) 1st world and 3rd world countries are apples and oranges when it comes to immunization and mortality rates. In the absence of proper sanitation / hygiene / nutrition / health care, the risk/benefit analysis changes.

      3 http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733835814
      show me how the dramatic reduction in MMR uptake in the UK following the 1999 Lancet paper has resulted in more measles in that country.

      4) At least we agree that its unlikely a safe and effective vaccine for the common cold will ever exist. As for how this would allegedly improve productivity, if half the people who got the shot felt like crap for the rest of the day, and only about 3 out of every 100 people (in a successful year) were spared from a cold due to the shot, and the shot did little to nothing to reduce the rate of deaths or hospitalizations due to cold, I’d view the shot as a money making vehicle above all else.

      5) Yes, I realize you were pointing out that industry is driven by profit. What I was asking was how you thought that fact advanced your argument.

      6) Vaccinate: it’s good for the economy. I love it. Is that what they’re teaching at medical school these days?

      • Mike says:

        Sorry “moderation”. I meant to post the above comments in response to Rachelle up above…

      • Chris says:

        They did not completely stop vaccinating in the UK, so it just became endemic. Of course, two adolescents died from measles and several kids have been hospitalized. The the story is a bit different in Japan (and I hope you don’t decide it is a third world country). From the paper Measles vaccine coverage and factors related to uncompleted vaccination among 18-month-old and 36-month-old children in Kyoto, Japan:
        From that paper:

        According to an infectious disease surveillance (2000), total measles cases were estimated to be from 180,000 to 210,000, and total deaths were estimated to be 88 [11,12]. Measles cases are most frequently observed among non-immunized children, particularly between 12 to 24 months.

        Now, could you be so kind has to tell us what the relative risks are for the MMR vaccine (with the Jeryl Lynn mumps component) versus getting measles, mumps and rubella. Please provide the title, journal and date of the peer reviewed papers (or link to actual paper as I did above) to support your answer. Thank you.

        And as far as economy goes, in the last outbreak of measles in the USA there were deaths up to one in five hundred cases, with a good percentage hospitalized. Just to be conservative, how does paying for the hospitalization for one out of a thousand of cases of measles more cost effective than giving a child two MMR vaccines in a lifetime. Again, please support your answer by posting the title, journal and dates of the peer reviewed journals, for example:

        An economic analysis of the current universal 2-dose measles-mumps-rubella vaccination program in the United States.
        Zhou F, Reef S, Massoudi M, Papania MJ, Yusuf HR, Bardenheier B, Zimmerman L, McCauley MM.
        J Infect Dis. 2004 May 1;189 Suppl 1:S131-45.

        Pediatric hospital admissions for measles. Lessons from the 1990 epidemic.
        Chavez GF, Ellis AA.
        West J Med. 1996 Jul-Aug;165(1-2):20-5.

        Measles epidemic from failure to immunize.
        Dales LG, Kizer KW, Rutherford GW, Pertowski CA, Waterman SH, Woodford G.
        West J Med. 1993 Oct;159(4):455-64.

        Oh, and a reminder that measles can cause permanent neurological harm (apologies for the now politically incorrect terminology):

        Impact of specific medical interventions on reducing the prevalence of mental retardation.
        Brosco JP, Mattingly M, Sanders LM.
        Arch Pediatr Adolesc Med. 2006 Mar;160(3):302-9. Review.

        Which says:

        Approximately 1 in 1000 children with clinical measles develops encephalitis.36, 39 Although most children with encephalitis recover without sequelae, approximately 15% die and 25% of survivors develop complications such as MR.39 We assumed that approximately 1 in 5000 cases of measles leads to MR.

        I would also like to repeat the question of what your suggestion for preventing measles involves. Again, please provide the title, journal and date of the studies that support your answer. Thank you.

      • Chris says:

        Okay, blockquote and superscript does not work here.

        Quote from first cited paper is: “According to an infectious disease surveillance (2000), total measles cases were estimated to be from 180,000 to 210,000, and total deaths were estimated to be 88 [11,12]. Measles cases are most frequently observed among non-immunized children, particularly between 12 to 24 months.”

        And quote from the last cited paper: “Approximately 1 in 1000 children with clinical measles develops encephalitis.36, 39 Although most children with encephalitis recover without sequelae, approximately 15% die and 25% of survivors develop complications such as MR.39 We assumed that approximately 1 in 5000 cases of measles leads to MR.”

        I should be happy that it allowed the one link.

      • Chris says:

        “3…URL removed…
        show me how the dramatic reduction in MMR uptake in the UK following the 1999 Lancet paper has resulted in more measles in that country. ”

        This is absolutely the only time you included any real data, and it shows that you could not even read the table you posted. Let us look at that data of the year and cases…

        Year___Notifications
        1999___2,438
        2000___2,378
        2001___2,250
        2002___3,232
        2003___2,488
        2004___2,356
        2005___2,089
        2006___3,705
        2007___3,670
        2008___5,088

        Mike, 5088 is a bit over twice 2438. That is called an “increase”, or in other words “more measles.”

        I see your problem, Mike, you seem to have an issue with actually reading the data. You only posted one piece with real data and actually asked us to tell you how doubling the number of notifications is “more.”

        Before you take a basic statistics course, work on some basic arithmetic.

        (Looking at updated HPA data, there has been an increase in MMR uptake in the UK, so the numbers of notifications is down to closer to 1000 (a bit over 800 from Jan to Aug 2011. Which is really sad considering it has a much smaller population compared to the USA, which had about 200 cases as of Aug 2011:
        http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6034a5.htm )

      • Mike says:

        D’oh! Sorry for the spam. Hopefully this shows up in the right spot….

        Chris,

        Yes, I notice there is a jump in the 2008 numbers. Similarly, there is also a spike in the 2002 numbers and a dip in the 2005 numbers. Prove that the 5000+ cases in 2008 are the direct result of lower MMR uptake. Or show that there were more serious injuries/death due to measles in the 10 years after the lancet paper compared to the 10 years previous.

    • Rachel says:

      Here’s one example: “Do they know that doing things nature’s way means astronomical mortality rates of infants and young children due to infectious disease?”

      • Chris says:

        By reading history and seeing what happens when vaccine levels drop in certain countries. Here is one example (pay attention to the comparison between neighboring countries):
        Impact of anti-vaccine movements on pertussis control: the untold story

        What do you mean by “astronomical”? As noted in that paper Japan went back to vaccinating babies for pertussis after there were 41 infants deaths due to the disease (and they could not blame a vaccine they did not get). Is that not high enough for you? What is your limit for child mortality before you actually care?

        And then there is what happened when the Soviet Union broke apart: a diphtheria epidemic. There were more than 4000 deaths, most of them children.

        And neither of those papers are from long ago. One is less than twenty years ago. So yes, we know that “nature’s way” means that more kids die due to vaccine preventable diseases.

        Now, if you have some actual data that shows the DTaP and Tdap vaccines are more dangerous than diphtheria, tetanus and pertussis then just post the title, journal and dates of the peer reviewed papers with your evidence. You might also tell us exactly how you would prevent children being injured or dying from those three diseases, with supporting evidence.

      • Chris says:

        Oops, I screwed up in a comment I have in moderation. I kind of read what you wrote as “How Do they know that doing things nature’s way means astronomical mortality rates of infants and young children due to infectious disease?” It kind of changes what you said. Sorry.

    • Chris says:

      Yes, it was that jump that caused them to declare measles endemic in the UK. The news articles about measles actually started about 2004, and there is a lag in infection when there is a drop of vaccine uptick.

      You cannot deny that you have trouble with basic arithmetic. There is no reason to take you seriously.

  6. I had a lengthy email conversation with a friend of mine who is staunchly anti-vaccine. The source of his arguments is a book called “Vaccine Safety Manual”. He sent me a copy because he was certain it would convince any fair minded reader to question the efficacy and safety of national immunization programs.

    It didn’t.

    You can read why: http://opinionsquestions.blogspot.com/2011/11/book-review-vaccine-safety-manual.html

    It’s distressing that books like Vaccine Safety Manual and Vaccine Epidemic have convinced so many parents not to immunize their children against potentially deadly diseases.

  7. Rachel says:

    From Paragraph 2: “Given that the people partaking in these events have likely not vaccinated their children against anything else, these parties could be a source point for multiple highly contagious infections.”

    This statement is very generalized. I have selected the Varicella vaccine to be the only one I avoided with my three children. It was simply too new for my liking. The multiple risks you state in your article, which I absolutely did understand when making my decision, are risks I have chosen to accept. I am not a minority. There are many parents who have gone this route knowing that the likelihood of experiencing a serious infection or other complication is far outweighed by the likelihood of natural immunity from a normal chicken pox infection.

    @Mike is absolutely right when he observes that our choices do not imply or state that we wish to see children dying. If we are discussing the Varicella virus, which you tell us you are, the societal implications are in no way equal to the accepted alarming risks of avoiding vaccination agains Mumps, Measles, Rubella, etc.

    Do you also notice that you avoided quoting the percentage risk of experiencing severe complications with a Chicken Pox infection? When I discussed the vaccine with my physician these statistics came up. As did the footnote that, generally speaking, these complications occur with children who already experience other health problems. I am not uninformed. I am taking responsibility for my family to the very best of my abilities.

    You talk about someone making a decision like mine as if we are being “duped”, or “tricked” into believing some lie. This is also too general, and annoyingly one sided. You know as well as I do that any person who is suspect of the Autism/vaccine connection they would use the identical argument about your position. In both cases, the argument is faulty.

    Additionally, you seem to be stating that the Autism/vaccine connection is the only reason a person may avoid vaccination. But you would be incorrect with this assumption as well. There are many reasons for making this sort of decision. Again, in my case, there just hadn’t been enough time for study on the Varicella vaccine when it was being offered to my children and so, without this information, I declined. Again, weighing the risks with the benefits, I came to my conclusion.

    I have been, and am so fortunate to have a healthy family, and do hope for the future to continue as brightly. I know that not every family is in this same position, and that is a humbling thought. The reality is that each of us has our own life, framework, matrix for decision-making, and our own justifications. This article only feeds the one-sided opinion that an Opt Out position is irresponsible and ill-informed. In as many cases as this statement is correct, it is also incorrect.

    • Hi Rachel, as I mentioned to Mike, I wasn’t trying to talk about vaccine risks but rather about the risks of not vaccinating. If you were aware of all the information (as you assert that you are) and you weighed the risks and the benefits, then you can give informed consent to vaccinate/not vaccinate, and I respect that decision. Sorry if I didn’t make that appropriately clear.

  8. Composer99 says:

    Mike:

    Which do you think is a better example of fearmongering:

    (1) Describing the results of official, robustly-gathered statistics and epidemiological studies on infectious diseases and attempts to control them and describing the typical results of being infected with these diseases.

    (2) Misrepresenting (or even lying about) the safety and efficacy of vaccines and other proven health measures, including unsubstantiated allegations of conspiracy between the manufacturers of vaccines, regulatory agencies and third-party researchers.

    In the face of the mass of evidence, whining about cracks against Jenny McCarthy is tone trolling.

    The whole profit motive discussion is self-serving hypocrisy on the part of anti-vaccine activists. The evidence for the safety & efficacy of vaccines, compared to the alternatives, is clear, and no amount of pointing to the money made by Dr Paul Offit (which no anti-vaccine activist I’ve seen has ever bothered to substantiate) or by pharmaceutical companies will suffice to refute it.

    • Mike says:

      If (1) is all you see from Rachelle’s article and (2) is all you see from my comments, that’s unfortunate, but you’re certainly entitled to your own interpretation.

      As for examples of fearmongering, I think you also need to check the definition.

      As for Paul Offit, are you saying he hasn’t gotten rich from promoting vaccines or that even if he has, he should still be viewed as a trusted authority on vaccine safety?

      • Chris says:

        Actually, Dr. Offit and his team got a single payout from their twenty years of research. Dr. Offit’s share was about six million dollars. The royalties from his at least one of his books go to the Autism Science Foundation.

        Are trying to tell us that people should not get paid for their work?

        From the Children’s Hospital of Philadelphia Vaccine Education Center the blurb for Dr. Offit says: “Dr. Offit is Chief of Infectious Diseases at The Children’s Hospital of Philadelphia and the Maurice R. Hilleman Professor of Vaccinology and professor of Pediatrics at the University of Pennsylvania School of Medicine. He is an internationally recognized expert in the fields of virology and immunology and was a member of the Advisory Committee on Immunization Practices to the Centers for Disease Control and Prevention. Dr. Offit has published more than 130 papers in medical and scientific journals.”

        That pretty much outlines why he should be considered an expert on vaccine safety. Do you have someone in mind who would be better? And why (do list their qualifications). Thank you.

        (by the way, he was not a member of the ACIP when RotaTeq was approved… all you have to do is go to their site on the CDC webpages and download the appropriate meeting minutes)

      • Composer99 says:

        Mike:

        I will admit that my comment on misrepresentation was aimed at anti-vaccine cranks such as Mike Adams, denialists such as Barbara Loe Fisher, and Dunning-Kruger victims such as Jenny McCarthy and not at you specifically and that I ought to have been more clear on that.

        Beyond that, I stand by it.

        I also note that you failed to show how any money made by Dr Offit somehow invalidates his publications on vaccines in, say, the scientific literature.

      • Mike says:

        It’s not that the money invalidates his publications (although I was under the impression that the whole ’10,000 vaccines at once’ thing was from an interview as opposed to a published paper). It’s that when he receives a multi-million dollar payout for helping to bring a new vaccine into the mix, he disqualifies himself from being perceived as a neutral commentator on the ‘no such thing as too many vaccines’ issue. If mainstream news outlets want to quote information from published journals, that’s completely different from getting him to provide a sound byte.

      • Composer99 says:

        Also, I should still like to understand why you think open, forthright discussion on infectious diseases, including their likely consequences, constitutes fearmongering in comparison to the dramatic fantasies concocted by anti-vaccine activists & cranks regarding vaccine efficacy & safety or regarding nebulous, nefarious conspiracies involving vaccine manufacturers, regulatory agencies, third-party researchers, pediatric associations, &c &c &c.

      • Mike says:

        I’m assuming you’re not implying that I’m an anti-vaccine activist who’s concocting dramatic fantasies. If you want my opinion on something specific, then give me an example. I take issue with anyone who I perceive as being less than forthright, including the so called anti-vaccine activists.

        As for fearmongering, it’s completely irrelevant what an anti-vaccine activist may or may not do. If you don’t see why a comment such as : “If you’re choosing not to vaccinate for rubella, are you prepared to have a child with major birth defects?” is offside, then you’ve been drinking the kool-aid for too long.

      • How is it offside? A world in which nobody is vaccinated for rubella is a world in which there will be children with major birth defects because of it. I’m merely asking you to a) confront and accept the realities of what happens when as few as 20% of the population opts out, or b) come up with an alternate solution to prevent the horrible effects of infectious disease.

        As someone who has spent a lot of time volunteering with disabled children, it makes me incredibly upset to think that someone would brush off congenital defects as exaggeration and hyperbole. So much of anti-vaccination objection focuses on insanely rare things like Guillian-Barré (which are literally one in a million and so far only a theoretical relationship), or the potential for allergic reaction to the contents of the shot (scary but not life threatening or altering if dealt with by a trained health care professional), or assertions for which there is no evidence. Rubella puts embryos and fetuses at EXTREMELY high risk, and there is absolutely nothing that can be done for them once the mother has been infected. Without the vaccine, rubella outbreaks will happen in cycles. Pre-vaccine, that meant 20,000 children born (US data) with congenital rubella syndrome in a single year (http://www.cdc.gov/vaccines/pubs/vacc-timeline.htm). That’s not counting all the miscarriages. That, to me, is worth a passing consideration.

      • Mike says:

        Richelle,

        I apologize for making you incredibly upset. I am certainly not brushing aside congenital defects as hyperbole and exaggeration. But we don’t actually live in a world where nobody is vaccinated for rubella. If you’re making that statement to a prospective mother who has made a conscious decision not to get an MMR booster before conceiving, I don’t know what to say to you.

        Whether the statement is offside and whether it meets the definition of fear mongering are not things that can be resolved through a published study, so I’m ok with agreeing to disagree with you on this, as I don’t want to upset you any further.

        What I’ve been suggesting all along is proper double-blind testing so that parents know nobody is being fooled. Proper testing to know if there is such a thing as too many. And proper testing to know what predisposes a child to be more susceptible to a serious injury. Getting everybody on the same page is the path to preventing the horrible effects of infectious disease, while at the same time making sure we’re not causing any new problems.

      • This is practically a post within itself so forgive me for being long winded. I wouldn’t be talking about congenital rubella syndrome as an offhand comment, but I would be discussing that failing to vaccinate her children for rubella would put her future children at risk, as well as the children of other pregnant women. And yes, we do live in a world where there is vaccination but as I mentioned in the article it doesn’t take many unvaccinated people to start the potential for an outbreak, particularly since anti-vaccination sentiments seem to pop up in pockets.

        As for your suggestion on proper double blind studies, I don’t see many inherent flaws in vaccine study design, as the flaws typically come up more in the interpretation of the data. As Chris has pointed out at length, there are rather extensive ethical issues with running double blinded trails in humans. I’d love to vaccinate a bunch of people with placebos or real vaccines and then directly expose them to illness a few weeks later, but apparently that’s frowned upon. The lack of placebo controlled trials for vaccines is not special. It happens all the time in medicine. You cannot give someone enrolled in a trial less than the standard of care, and this is true across the board. You cannot run a cancer trial where you test your drug versus people placed on a “waiting list” for treatment. You cannot give a bunch of people cars without seat belts to conclusively demonstrate the efficacy of seatbelt wearing in modern vehicles. Yes, companies exaggerate the truth of their products, which is why independent research is done. This research is on-going but is more about tweaking knowledge than overturning it. If something massively expected comes up, I’ll be the first to let you know.

        There is no plausible mechanism for there being such a thing as “too many” vaccines any more than there is a plausible mechanism for getting “too many” colds as a healthy person. You could certainly make a case for immunocompromised individuals experiencing harm from live vaccines, but live vaccines should never be given to immunocompromised people. So… problem solved? Your body deals with an incredible number of antigens and potential infections every single day. What makes you think that vaccines are somehow special and different compared to the natural immunity we gain from breathing air, eating food, getting a paper cut or touching a door handle?

        And as for the serious injuries, these are so rare that they are extraordinarily difficult to study. As you can imagine, most physicians will only see one case in their lifetime, leading to individuals retroactively trying to case-match, which is in itself a source of design error and bias. When the rate of G-B in Canada is only 1/100,000 and most of those are in individuals >80, you can see how it might be problematic to attempt even the simplest study connecting childhood vaccinations and G-B. There have been studies done looking at influenza vaccines and G-B that have found no significance and in some cases minor protection, but we honestly just don’t have the data to make that call. If G-B turns out to be associated, then that’s worth investigating, but from a public health perspective, a remarkably, remarkably rare occurrence that deserves mention and concern but not widespread panic. Here are a list of ways to die that are more likely than getting G-B: Motor vehicle accident, falling, gunshot wound, drowning, lightning strike, earthquake, dog attack, contact with hot tap water. If you own a car, dog or hot water heater, I don’t think G-B or other phenomenally rare vaccine-associated events should be at the top of your priority list.

        The only serious and well-established vaccine injury is anaphylaxis from allergy to vaccine components. The solution to this is simple and I’m fairly certain it’s already been implemented: ask parents if their children have been given any egg products yet and if they’ve had any allergic reaction. Don’t give adjuvant vaccines to kids with allergies or suspected allergies to eggs. Certainly it is all over the vaccine information websites and product monographs. And of course, anyone giving a vaccine should also have easy access to an epipen in case of an anaphylaxis.

        So… I’m still failing to see the problem here. What you’re asking for is already happening. And yes, the science isn’t complete because science will never be done. You could wait until the extinction of our species and we still would not know everything we could know about vaccines because answers lead to questions lead to answers lead to questions. Sometimes you just need to assess the plethora of good data that we do have and make a judgment call.

      • Mike says:

        So let’s recap.

        As per your most recent reply, this is what you would be discussing with a pregnant woman: “I wouldn’t be talking about congenital rubella syndrome as an offhand comment, but I would be discussing that failing to vaccinate her children for rubella would put her future children at risk, as well as the children of other pregnant women.”

        This is how you suggested that conversation might go in your original article: “If you’re choosing not to vaccinate for rubella, are you prepared to have a child with major birth defects?”

        And you became ‘incredibly upset’ when I called the comment ‘offside’. Like I said before, if you’re unable to see what’s wrong with your original comment, I don’t know what to tell you.

        Regarding the rest of your post, it’s the “we already know how safe vaccines are and we already know there’s no such thing as too many, so there’s no point in studying them any further” argument. Indeed that is at the heart of what we disagree on.

        Since you don’t see many inherent flaws in vaccine study design, perhaps you could write a future post on the effectiveness of the VAERS system, or perhaps a post on how double-blind studies really aren’t that critical.

        Regarding the issue of ethics, I have already posted my comments regarding the flaws in the argument presented by the person that Chris referred to. You made the comment “I’d love to vaccinate a bunch of people with placebos or real vaccines and then directly expose them to illness a few weeks later” which is ridiculous. Even if you were trying to be sarcastic, relying on herd immunity for protection and purposely exposing a child to various illnesses are not the same thing. Yet another apples to oranges comparison. Kind of like the way you compare seatbelts to vaccines.

        If you want to argue that double-blind studies are unethical, do it by showing that the children relying on herd immunity within the study are at more than minimal risk of suffering serious injury from the diseases they receive placebo vaccines for.

      • Mike, you cannot do a study on humans if it is reasonable to assume that harm might come to them as a result of your experimental group. Relying on herd immunity alone will either do nothing or harm people, but will not benefit people. The study you propose will never be approved by any university ethics board. This does not change the fact that RCTs are still the be-all-end-all of clinical evidence. I’m just saying it is ethically impossible to use them to study standard-of-care practices. In contrast, non-standard of care vaccines are studied in RCTs all the time. Look up “HPV vaccine” on Google Scholar. Look up “HIV vaccine.”

        I fire off a lot of points in the article and while I stand by what I wrote, I never said that it represented a transcript of the conversation I would be having with a concerned parent in my office. There is a difference between “Richelle, writer” and “Richelle, med student.” I’m not putting my hand up in class to ream out a professor when they make unsupported claims or drawing moustaches on pictures of Jenny McCarthy in grocery store magazines, either. There is a time and a place for things even if the message is the same. In a piece about informed consent in the face of blatant misinformation, don’t you think you’re missing the point?

        I never said that we know everything, nor that vaccines are not worth studying any further. In fact, I explicitly said that we will continue studying them forever (more accurately, perhaps, until something better comes along). And when that something better comes along, we will study that ad nauseum, because that’s what we do in science. There are 22,200 articles about vaccines on Google Scholar that have been published in the last 12 months (http://scholar.google.ca/scholar?hl=en&q=vaccine&as_sdt=1%2C5&as_ylo=2011&as_vis=0). That is not the sign of anybody saying “Okay, we know it all, move on.”

        As for your suggestion on an article about ethics in RCTs, I know you were being sarcastic, but I’ll have to do that. The topic is particularly interesting since it’s not on common for pharmaceutical companies to run early phase RCTs in third world countries because a) their standard of care is lower, boosting apparent benefits b) it’s cheaper and c) the ethical standards are less stringent. What are your thoughts – is it okay to run vaccine RCTs in countries where there is low uptake? Would you be satisfied if they were running well-controlled, well-designed MMR vaccine trials in South East Asia and India (areas of relatively low uptake)?

      • Mike says:

        You say, “Mike, you cannot do a study on humans if it is reasonable to assume that harm might come to them as a result of your experimental group”

        I’m assuming the ‘experimental’ group in this case is the unvaccinated children? My argument is that in north America, with high levels of herd immunity, these children are not being put at more risk than their vaccinated counterparts. There is a risk to being vaccinated just like there’s a risk to being unvaccinated. And the risk to being unvaccinated is largely dependent on the likelihood of an unvaccinated child catching a vaccine-preventable disease.

        As for your “If you’re choosing not to vaccinate for rubella, are you prepared to have a child with major birth defects?” comment, I fail to see how the fact that it was “Richelle the writer” making the comment makes it ok. The comment is either offside or it isn’t, regardless of which version of “Richelle” made it. I also fail to see how a reasonable person could claim there’s a time and place to be drawing moustaches on pictures of Jenny McCarthy in grocery store magazines, unless it’s solely for the purpose of displaying one’s level of immaturity.

        Another quote from your most recent post: “I never said that we know everything, nor that vaccines are not worth studying any further. In fact, I explicitly said that we will continue studying them forever”

        This is from your original article: “If Jenny McCarthy would stop asking where the studies are, maybe these poor grad students could get on with their lives and research something that hasn’t been done to death.”

        Regarding your last question to me: “What are your thoughts – is it okay to run vaccine RCTs in countries where there is low uptake?” No. It’s not. That’s the whole point. It would be most unethical to do double-blind studies in countries where herd immunity cannot be relied upon.

        All the evidence I pointed to, (and I laid out the data points I was using 1-7, and the conclusions I was drawing from those data points a-e to make it easy for anyone who wanted to challenge any of it. Nobody has) was pointing to the fact that the ‘experimental’ group in such a study would in fact not be put in harm’s way by doing such a study.

  9. Gem Newman says:

    Very well said, Richelle. The patience that you demonstrate here in the comments section is incredible. Hey, at least it’s not creationists and geocentrists this time, right?

    • It’s easy to be patient with people when you’ve tried to have discussions with people who assert that the Earth must be the centre of the Universe because God put it there, that’s why, and if you buy my book I’ll prove it.

  10. Mike says:

    Chris,

    Lots of great information. Much more compelling than anything that was presented in the above article. I appreciate you taking the time to provide all that info. I’ll try and read through as much of it as I can and respond to your comments in a day or two….

    • Mike says:

      Chris,

      Again, thanks for the interesting reading material. I do appreciate you taking the time, and I have done the same here. If you take the time to read through it all, I would welcome your comments.

      So here are some items that I believe to be fact based on your provided links:

      1. In the UK, MMR uptake dropped significantly after the Lancet paper was published in 1998. Less than 80% uptake is what I read on another post on this site. I’ve seen numbers as low as 60% in other places when talking about the UK. At this point, you’ve pointed out that 2 adolescents in the UK have died from the measles. Whether you’re implying that they died as a direct result of lower MMR uptake I’m not sure.

      2. Japan clearly seems to have a measles problem (and no, I’m not going to refer to Japan as a 3rd world country). From what I have been reading, Japan has the largest measles problem in the developed world. I was unable to determine if Japan has the lowest measles vaccination rate in the developed world. I would hope someone could confirm this for me, since if Japan was not at the bottom of the list, that would raise some questions.

      3. The numbers from the Japan study you pointed to seemed to indicate roughly 80% of that country is fully immunized. I believe something around 70% for 18 month olds, 90% for 36 month olds, and I believe it said the nationwide estimate was about 81% in the year 2000 which is the year where 88 children died.

      4. The numbers from the Japan study show that about 1% of the population had chosen not to vaccinate with MMR due to what could be construed as ‘anti-vaccine’ sentiment. (roughly 75 of the 5000 survey participants)

      5. The charts in figure 2 of the ‘untold story’ review you posted seem to indicate that within about 5 years of a dropoff in DTP vaccination rates, a spike in incidence is seen. The UK chart shows that Pertussis was well controlled with vaccination rates around 80%. A drop to around 30% coverage resulted in a spike in Pertussis infections, and the rate seems to have recovered by the time the vaccination rate rose back to around 80%

      6. The ‘untold story’ review you posted classifies the concern in the UK over a 1974 report, ascribing 36 neurological reactions to whole-cell pertussis vaccine to be an ‘anti-vaccine’ movement. The review did not mention if the report turned out to be a hoax. I’m not trying to dismiss the review, but I’m sure many would disagree that this review is being completely objective regarding the data its looking at. (Although I’m also quite sure no one who calls themself a skeptic would see it that way).

      7. A common theme in all the data seems to be that there are significant variations from year to year in infection rates, both before and after vaccination is introduced.

      8. On a sidenote, there is much conflicting information about whether measles in the UK was actually influenced by the introduction of measles vaccine. This chart is interesting because its adjusted for population growth and based on a logarithmic scale. http://childhealthsafety.files.wordpress.com/2009/01/0707275measleslog.jpg. I’m not saying I believe what the chart seems to be implying, but I was hoping you could let me know what is wrong with it.

      Here are some conclusions I drew from the information you provided:

      a) A child who has been fully vaccinated for a particular disease is less likely to catch that disease compared to a partially or non-vaccinated child.

      b) There is no available data to suggest the measles problem in Japan can be attributed to anti-vaccine sentiment

      c) The disconnect between the UK and Japan in terms of vaccination rate vs measles incidence points to the fact that there are more variables at play than purely MMR uptake

      d) Abandoning all vaccination in north America would be devastating to our overall health.

      e) There is no available data to prove that a 0.1% decrease in vaccination uptake in North America would yield significant increases in vaccine-preventable deaths and complications.

      Regarding some of your questions:

      Regarding the economy: Yes, I would agree that regarding a measles outbreak, vaccination would be a more economically efficient. Scary though that measles has become more deadly at 1/500. I should have been more specific in my comment from above that I was poking fun at the notion that a doctor would suggest promoting a vaccine for the common cold on the basis of its benefit to the economy.

      Relative risks of MMR vs getting the diseases: Therein lies the problem I have. It’s with how we assess the risks of our vaccine policy. We deem the benefit to be all the millions of lives saved. And in that case, unless kids are routinely dropping dead on the spot after a shot, it would take some pretty significant data (or personal interaction with a child that appears to have been vaccine injured) to sway anyone that the risk is even worth taking a closer look at. There is the vaers system in the US which is supposed to be tracking adverse events. Care to hazard a guess as to what percentage of actual adverse effects are estimated to actually be reported through vaers?

      Double-blind placebo controlled trials are supposed to be the be all and end all of science, yet with vaccines and children, the medical community takes an exemption on the grounds that it would be unethical to allow a child to go without a vaccine. Each vaccine is looked at on its own, and the adverse effects are monitored for a short period of time. No testing of receiving multiple injections at once even though the government will still recommend doing ‘catch up’ appointments for children who are behind on multiple vaccinations. And there’s no proper data to show the relative risks of more vs less aggressive vaccine schedules. Instead, Paul Offit is trotted out to reassure people that children can handle 10,000 vaccines at once.

      Does he deserve to get paid for his work? Absolutely. Do I have a problem with someone who made millions off of the addition of a new vaccine to the schedule being the assumed authority on the ‘there’s no such thing as too many vaccines’ issue? Absolutely. And I’m not saying I have proof that he’s wrong. I’m just saying that as a consumer, it’s a little stinky.

      There are plenty of published studies showing that when you go looking to link a particular neurological problem to a particular vaccine or particular vaccine ingredient, you come up empty. So as far as ‘evidence of harm’ (and assuming that the onus was actually on me to produce evidence of harm), all I have are court rulings, anecdotes, and some home videos. Certainly not enough to convince anyone in the skeptic community.

      But that’s not the issue. The issue is whether the risk of actually doing proper double blind studies outweighs the benefit that our society would achieve in convincing parents that the risks of vaccination are in fact being calculated in a way that prevents us from being fooled.

      • Chris says:

        Childhealthsafety is not a peer reviewed paper, and it is screwed up graph of unreferenced data. I challenge to find tell who runs that website. Here is the same data discussed by someone who is quite clear about his identity and credentials (and this was written before he moved to work for the CDC):
        http://www.iayork.com/MysteryRays/2009/09/02/measles-deaths-pre-vaccine/

        Your opinion is not as compelling as the evidence I posted. Sorry. Next time just post the the title, journal and date of the papers to support your opinion. Though I see you tried and came up empty.

      • Chris says:

        You may also wish to become familiar with the issues about human subject studies from someone who works with Independent Review Boards. It is a series of four posts discussing the history and ethics of these studies:
        http://silencedbyageofautism.blogspot.com/2011/03/vaccinated-vs-unvaccinated-rct-overview.html

        If you wish to have a very good presentation for high school kids, find your local university’s human subject study education coordinator. This is the person who explains the rules to the graduate students, others who does research associated with the university, and sometimes those who are places on an IRB. We had this at my daughter’s high school last year and it was fascinating. It is not just medical research, but even just survey where personal information can leak.

      • Mike says:

        Hi Chris,

        Once again, you provide some interesting reading material, which I do appreciate. Have you read it yourself? Further, did you actually read my comments from above? You’ve dismissed my post as being ‘opinion’ when in fact the items 1-7 and a,b,c,d,e that I provided in my previous comment are all backed by the very same scientific studies that you provided.

        Regarding the last portion of my post, the fact that double-blind studies are not done for childhood vaccinations is also a fact, not an opinion. My post ended with the question of whether the risk of proper double-blind studies outweighs the potential benefits of putting the vaccine-safety issue to rest, which is a question and not an opinion. All you seem to be left with is the standard “show me which medical journal to look at to support your opinion” question, which further suggests that you didn’t actually read what I wrote. Feel free to explain to me which statement you think I made in my previous post that wasn’t backed up with scientific data.

        Regardless, I’ll address your comments for anyone reading this who might mistakenly believe you have a solid grip on this particular subject, since actual truth is often difficult to extract from the rhetoric that generally surrounds the issue of vaccine safety.

        Regarding the chart I provided showing a steady drop in Measles deaths well before the widespread use of a vaccine: Your response was that the chart was not from a peer-reviewed paper and that it’s a “screwed up graph with unreferenced data”. You referred me to another site where the same data is being discussed. What you failed to realize was that the site you pointed me to actually highlights that the graph I provided is correct. Measles deaths did drop dramatically in both the US and the UK well before the introduction of a vaccine.

        The website you provided does a very good job at explaining the different roles that proper sanitation and vaccines each played in reducing the damage due to measles. I would suggest you read the link yourself, and I would recommend that the author of this post have a look at it as well. I found it very informative, and refreshingly objective.

        As for the link you provided on human subject studies, it’s a very informative look at the ethics and legalities involved. However, it’s not the least bit objective. One of many such examples of the bias shown in his discussion is the statement: “Only by some strange, alternate sense of ethics could one argue that it would be okay to go ahead with the study”. The author of this blogpost that you seem to be placing too much trust in comes to his conclusion in the following manner:

        First of all, he only examines the question from the perspective of ‘do vaccines cause autism’, which is not the reason for doing a proper double-blind study. He then goes on to minimize the possible adverse effects of vaccine reactions and maximize the possible harm that could come to a child who receives placebo during the study. Based on that, he comes to the conclusion that a 5000 child double-blind study would put the unvaccinated subjects at more than minimal risk compared to their vaccinated counterparts, and is therefore unethical. He makes no mention of what the odds of a serious vaccine injury are, nor does he make any mention of what the odds of contracting a vaccine-preventable disease are for the unvaccinated control group. He does not back up any of his arguments with actual data.

        I’ve heard skeptics argue that the chances of permanent disability due to vaccine reaction is about 1 in 1 Million. What are the odds of an unvaccinated child suffering a serious injury from a vaccine-preventable disease in the US or Canada, assuming the rest of the population has ~85% vaccine coverage? Compare that to the 1 in 1 Million chance of suffering permanent damage from a vaccine. It’s not the slam dunk you think it is. If there was a way to prevent serious injury from vaccines AND serious injuries from vaccine-preventable diseases, wouldn’t that be the way to go?

        The purpose of the double-blind study is that it’s the only way to truly minimize the chances of the expimenters getting ‘fooled’. It’s the basis upon which all of the arguments against alternative medicine are made. But when it comes to vaccines, the scientific community changes the rules.

        Science can’t have it both ways. If they truly want to reassure parents that the adverse effects of vaccines are properly understood, then they need to do proper testing. But instead of actually doing such testing, science has chosen to grant immunity to vaccine manufacturers for anything that goes wrong with their products, and has set up a whole separate court system specifically to handle all the cases of vaccine injury. Brilliant. Perhaps the author of this post would like to argue that this system is ‘good for the economy’?

        Had the scientific community never been wrong about anything in the past, I might be ok with the notion of simply trusting that they know what’s best for my child. But they’ve been wrong plenty of times, and often with dire circumstances, and often due to financially motivated reasons. So until the scientific community is ready to apply the ‘gold standard’ to vaccine safety, I’m not satisfied that they correctly understand the risks associated with giving 30-something vaccines to a child. I guess I’m a little skeptical that way.

      • Chris says:

        I read what you wrote, and commented as necessary. But I will not debate your opinions, just the evidence. The evidence must be from a well documented scientific paper, so just post the title, journal and date of the evidence that support whatever argument you are making.

        And if you wish to discuss double blind studies on human subjects, then propose a design that would not cause the unvaxed arm to be harmed. Explain clearly how it would conform to the Declaration of Helsinki and the Belmont Report. Provide supporting documentation (title, journal, date) that studies with this design have been approved and done in the last thirty years.

        The biggest issue with the rather odd measles mortality chart from childhealthsafety is that is not a true indication of the effect of the measles vaccine (aside from the squishing of the graph with the logarithmic scale). It only shows that medical and hospital care has improved. It also ignores that measles causes other problems, not just death. From Impact of specific medical interventions on reducing the prevalence of mental retardation:

        “Approximately 1 in 1000 children with clinical measles develops encephalitis.36, 39 Although most children with encephalitis recover without sequelae, approximately 15% die and 25% of survivors develop complications such as MR.39 We assumed that approximately 1 in 5000 cases of measles leads to MR.”

        Now, I also included an explanation from a scientist now working for the CDC. You must have noticed the two plots of the American experience with the MMR. Since there are many more factors affecting mortality (advancements in medical care) then there are in morbidity (environment, vaccines), the the latter is more useful.

        It would also help if you could find and show us where the data that Mr. Miller and Mr. Stone used for their graph on childhealthsafety (since you only posted a picture of a graph). Where is the data from Wales and England? For example, ere is the actual USA census data:
        From http://www.census.gov/prod/99pubs/99statab/sec31.pdf
        Year…. Rate per 100000 of measles
        1912 . . . 310.0
        1920 . . . 480.5
        1925 . . . 194.3
        1930 . . . 340.8
        1935 . . . 584.6
        1940 . . . 220.7
        1945 . . . 110.2
        1950 . . . 210.1
        1955 . . . 337.9
        1960 . . . 245.4
        1965 . . . 135.1
        1970 . . . . 23.2
        1975 . . . . 11.3
        1980 . . . . . 5.9
        1985 . . . . . 1.2
        1990 . . . . .11.2
        1991 . . . . . .3.8
        1992 . . . . . .0.9
        1993 . . . . . .0.1
        1994 . . . . . .0.4

      • Mike says:

        Hi Chris,

        This is getting a little stale. I’ll address your comments, but since it does not seem likely we will find any common ground here, feel free to let this thread drop, as I won’t be offended if you choose not to respond.

        Regarding your comments, I feel like I’m repeating myself once again, but here goes:

        You are asking me once again to provide the journal title that I am using to support my argument. And once again, I am telling you that I used the 2 reports that YOU provided to support my argument: The one on Japanese Measles deaths, and the one regarding the ‘untold story’ of anti-vaccination movements. If those reports do not contain reliable information, then why did you refer to them in your original response to me? I’ll also repeat a question from my previous post: “Feel free to explain to me which statement you think I made in my previous post that wasn’t backed up with scientific data”.

        Regarding the double-blind studies, you ask me to “propose a design that would not cause the unvaxed arm to be harmed”. In fact, that’s not a requirement. The requirement would be to show that the unvaxed arm would not suffer more than minimal harm compared to their vaccinated counterparts. I did provide such an argument largely by relying on the data in the 2 papers that you had pointed me to.

        The author of the blogpost that you had pointed me to tries to argue that such a study would be unethical by assuming that an unvaccinated child would suffer more than minimal harm by participating in such a study. He did not use any data to back up his claim, and I call BS on him. I’m surprised that you are satisfied with his analysis of the issue when he did not use any actual data to support his argument. Seems like a double standard to me.

        Regarding the measles data. You are repeating once again the statistics of what the odds are of a serious permanent injury (or worse) to someone “IF” they catch the measles. I am well aware of those numbers. Is there anything I said in my comments above that indicate I’m not aware of those numbers?

        Again, I’ll repeat what I said before which is that the site you pointed me to, written by the scientist that now works for the CDC, very clearly explains that there was an “absolutely, spectacularly, incredible drop in measles case-fatality rates” between 1900 and 1955 (before vaccination). Again, if the information being provided by the site you pointed me to is not reliable, then why did you use it as a reference?

        Regardless, this issue is irrelevant to the issue of whether double-blind studies on vaccination are a good idea. And as I said when I originally posted the graph, I was providing it as an aside, simply because I found it interesting, and I was wondering what the true story was behind measles deaths in the first world. The site you pointed me to did a very good job of explaining it. I would encourage you to re-read the site and my comments and let me know if you find me saying anything that contradicts the information on that website.

        Regards,
        Mike.

      • Mike says:

        Chris,

        Yes, I notice there is a jump in the 2008 numbers. Similarly, there is also a spike in the 2002 numbers and a dip in the 2005 numbers. Prove that the 5000+ cases in 2008 are the direct result of lower MMR uptake. Or show that there were more serious injuries/death due to measles in the 10 years after the lancet paper compared to the 10 years previous.

      • Mike says:

        Trying this again since it didn’t appear in the right spot…..

        Chris,

        Yes, I notice there is a jump in the 2008 numbers. Similarly, there is also a spike in the 2002 numbers and a dip in the 2005 numbers. Prove that the 5000+ cases in 2008 are the direct result of lower MMR uptake. Or show that there were more serious injuries/death due to measles in the 10 years after the lancet paper compared to the 10 years previous.

      • Chris says:

        Again you just post your opinions, absolutely no real evidence to support them. I will note that many of your questions can be answered if you actually read the citations I posted. I don’t see how you are qualified to judge the references in those citations. I see no reason to actually read the citations and explain them to you.

        Again, if you have any real evidence that any version of an MMR vaccine is more dangerous than measles, please include the title, journal and date.

      • Chris says:

        Let me rephrase that: you need to read the references for comprehension. I should not have to hold your hand to explain what they mean (like how the level of vaccine uptake required for herd immunity is required, which is actually stated in a paper you seem confused about). If you desire more help in deciphering the study reviews you should take a basic class in statistics.

      • Chris says:

        Mike, not only can you not count, but you are repeating yourself.

    • Chris says:

      “Feel free to explain to me which statement you think I made in my previous post that wasn’t backed up with scientific data”

      I can’t because you never posted any scientific data. You just made a bunch of statements without any supporting evidence, so by definition they were just opinions.

  11. Doc Laura says:

    Hi Richelle…..

    Thanks for this well written morning read…..I once again find myself admiring your passion, and hoping there’s some scientifcally plausible way that it can be transmitted over the internet….

    While your article is a solid exposition of the facts in support of vaccine safety, the reality is is that once opinions are set, they are extremely resistant to change….

    The issue is, that we are not effectively taught how to utilize logic and argument in decision making, and thus are prone to fall under the thrall of arguments from authority…When someone becomes convinced that vaccines can cause autism despite (and in spite) of the undisputed scientific evidence to the contrary, it represents a failing at a much more basic level….that person was lost even before they gave the any thought to the specific issue of vaccines…

    Laura

  12. Left with no choice and no voice says:

    Every time I hear an antivaxxer talk about their right to choose, it makes me furious.

    I have a rare blood disorder in which I make very few functional antibodies. This also means that I do not have titer levels to vaccines, despite having received all of them. This also means that a simple cold will leave me sick for months. What happens if I go to the grocery store and am breathed on by one of these kids while they’re asymptomatic? Where’s my choice? Even if I were to hide inside a bubble and never socialize, I still have to leave my place for medical appointments. I still need to purchase groceries. I still need to obtain clothing. In short, I cannot keep my exposure to other people at zero.

    Their ‘choice’, if I were to be exposed, would likely result in me being hospitalized, having to get an increased amount of antibodies from donor blood (because I make almost none), and sicker than their children would ever get.

    Where’s MY choice?

    • Mike says:

      Not that I’m trying to be unsympathetic to the rare blood disorder that you have, but I’m curious what your expectations are of let’s say parents of a 4 year old with a cold or the flu. If being breathed on by such a kid could leave you sick for months, or worse, what is your expectation of parents in that situation?

      • I believe the point that No Choice is making is that it is everyone’s responsibility to protect those who can’t protect themselves. We live in a social environment and although individualism is important in our culture, we must balance what we want with what everyone around us needs.

        It’s the same reason we cover our mouths when we cough and stay home when we’re sick. To say that you have the right to be sick in public and cough how you like implicitly denies the rights to health of people around you. I can’t force you or your kids to not go around coughing on people who are immune compromised, but using your personal freedom to do that does make you really, really selfish.

  13. Mike says:

    A Kleenex is not a vaccine. When the US government sets up a separate court system to handle all the claims from children who are being injured from covering their mouths when they sneeze, at that point you can compare it to the idea of insisting we all vaccinate to the gov’t recommended schedule.

    • Chris says:

      What are you talking about? You are not making any sense, and the last time I checked Canada is not part of the USA. Those of us who live near the border and have relatives on both sides of that border, we know that they are two separate nations with some distinct (especially legal) differences.

      Actually the US Vaccine Court is for those to prove there is injury beyond what is on this table (and it is not a table made of wood that you sit around discussing stuff).

      • Mike says:

        It sounds like you’re saying that because the VICP was created in the US that somehow it’s irrelevant to anyone living in Canada. Are the vaccines children receive in Canada any different than their US counterparts in terms of likeliness of serious side effects? As far as I know, the US has more influence over global vaccination recommendations than any other single nation. I deem the method in which the US tracks and compensates for vaccine injuries to be quite relevant to the overall discussion.

        And as another commenter has pointed out on this site: “Insulting people in a public forum is not going to help win people to your side. It will just make rational people think you have no real argument.”

      • Chris says:

        So answer these questions:

        1) Is the Canadian vaccine schedule identical to that recommended by the American CDC?

        2) What evidence do you have that the MMR vaccine used in either country is more dangerous than measles?

        3) Which is the bigger number: 5000 or 2500?

      • Mike says:

        1) Not identical, but similar. But unless you’re trying to imply that the Canadian schedule is somehow ‘safer’ than the US schedule, I’m not sure what point you’re trying to make.

        2) I would presume that actually catching the measles would be more dangerous than receiving the MMR. I’m assuming you’re also aware that the notion of herd immunity is that it allows an unvaccinated person to avoid catching the measles. Which is exactly why you would only do such a double blind study in a part of the world with high levels of herd immunity.

        3) 5000 is larger than 2500. Similarly, 2000 (measles notifications in year 2005) is less than 2500.

      • Chris says:

        I’m sorry, where on the American schedule is the DTaP-IPV?

        And you still don’t understand that the articles vilifying the MMR peaked in 2005, not 1998. So there were the typical fluctuations, end it was after that the increase became pronounced. You seem to have the same logical thinking processes as a table leg.

        I applaud Composer for sticking with you for so long.

      • Mike says:

        Chris,

        Although I do have a response to your comment, when you make a statement like: “You seem to have the same logical thinking processes as a table leg.”, I choose to no longer respond to any of your comments. Merry Christmas.

    • Composer99 says:

      Mike:

      Do you have any substantial claims against the current vaccine schedule (e.g. backed up by sound evidence) other than some bizarre “stick-it-to-the-Man” sentiment or your opinion on Paul Offit?

      Between this thread, and a previous one (which discussed a CBC report on anti-vaccine activism) here on SkepticNorth, one begins to wonder if, in fact, you are arguing in good faith on the subject.

      • Mike says:

        You’ve been focusing on Paul Offit more than I have. Which statement did I make about him (or anything else for that matter) that fits into a ‘stick it to the man’ category? Indeed there are some people who view vaccines as a ‘don’t trust anything big pharma says’ issue. I’m not one of them.

        You seem unable to grasp the concept of someone who sees the value of vaccination, but is not satisfied with the current system. I view double-blind studies as something that will contribute to higher vaccination rates and less misunderstandings about vaccine side effects, and result in an overall health benefit. If that’s your definition of arguing in bad faith, oh well.

  14. Composer99 says:

    Mike:

    Your opinion of Paul Offit on this very comment thread, or perhaps here – where his name first appears to come up, by the way (*) instead. Both of those comments are in my opinion fairly dripping with dismissiveness.

    The second comment of yours I link to, in fact, has a distinct “stick it to the Man” quality. In the link in the OP, the CDC states of measles mortality in 2000-2008:

    Cumulatively, an estimated 12.7 million measles deaths were averted during 2000–2008; of these, 8.4 (66%) million deaths were averted by maintaining routine immunization coverage at the 2000 level, and an additional 4.3 million (34%) deaths were averted as a result of measles SIAs and increases in routine vaccination coverage.

    Note how the CDC credits these averted deaths to vaccines.

    But to you, “to allowing an 8% increase in global MMR vaccination rates to take sole credit for saving 569,000 lives every year” is “going on an overvax rant” (both quotes from your Nov 30 6:49 pm comment – feel free to verify if I’m misquoting).

    Skeptics and advocates of science-based medicine have been pointing out for years that research has not borne out autism as an adverse effect of vaccination, even while anti-vaccine advocates continue to claim it is (why else would Age of Autism still be an anti-vaccine site?). Furthermore, anti-vaccine advocates have routinely failed to come up with convincing evidence of other alleged neurological or miscellaneous disorders (for example, the craptacular and now retracted Wakefield et al 1998 paper in Lancet or a number of equally bad Hewitson et al papers from a monkey study, some of which are also retracted – I’d provide hyperlinks but I think I get two before going into moderation so Google will have to be your friend here). None of this is out of line with CDC, Public Health Agency of Canada, or WHO estimates of actual adverse effects from vaccines.

    Yet to you this is just another part of an “overvax rant”: “making the “but we have studies showing there’s no link between thimerosol and autism, so what are people so scared of” argument”.

    So how ought one interpret you rubbishing official CDC publications or suggesting that Public Health Agency of Canada and/or CDC data on adverse effects is wrong or misleading or part of a stock debate “argument”?

    Based on your comments above, I gather that the lack of satisfaction you have with the current system pertains to:
    (1) The risk/benefit ratio of vaccines vs the diseases they prevent seems, in contemporary wealthy polities, seems to suggest that the risk to vaccines outweighs the risk of the diseases
    (2) You would like to see more double-blind placebo controlled tests of vaccines.

    To answer (1): Without vaccine uptake rates high enough to maintain herd immunity, infectious diseases can easily gain footholds and infect under-vaccinated populations or people who are unable to be vaccinated (such as measles in UK, pertussis in California, diptheria in former USSR, polio in Nigeria, mumps in Japan).

    To answer (2): Both Chris and Richelle have already explained in some detail why retrospective double-blind trials of the current vaccine schedule would be considered unethical and would not be approved by IRBs. Do you have any reason to believe that prospective blinded trials on new vaccines are not being undertaken?

    If you feel a bit put upon, it may have something to do with the fact that on many sites dedicated to skepticism and advocacy of science-based medicine, many people arrive on comment threads and raise eerily similar concerns to yours (the double-blind trial stuff, for example, is raising warning signs for me personally) and are then found to be either espousing blatantly anti-vaccine views or are getting information from cranks (e.g. whale.to), quacks (e.g. Joe Mercola), or anti-vaccine activists (e.g. Age of Autism or Barbara Loe Fisher’s NVIC). I don’t know or care if this is how things will shake out if you continue to participate on this thread or not. Maybe it will, maybe it won’t. But regulars (such as Chris, in particular) have seen a lot of that sort of thing before.

    (*) Thanks to the way comment threads work on Skeptic North it can be difficult to properly track the order in which comments have come in. As such, I could very well be wrong on this point.

    • Mike says:

      Hi Composer,

      I appreciate you taking the time to post your comments. And I appreciate the level of civility you are displaying.

      I don’t see either of those comments you referred to regarding Paul Offit as having a “stick it to the man” quality. I don’t have an issue with him. I have an issue with media who don’t disclose that he received a multi-million dollar payout for a vaccine patent. Perhaps your motive is to “defend the man” at all costs?

      Regarding the CDC data, what was being discussed by the iayork.com site that Chris had referred to was the fact that with improved living conditions, deaths from measles are reduced dramatically, and eventually plateau. i.e. improved living conditions only gets you so far. Vaccination gets you the rest of the way. If the CDC is claiming that vaccination is the only reason for the reduced number of measles deaths, then I would argue that the CDC is not being completely forthright.

      Regarding your answers to items (1) and (2):

      (1) Yes, I agree. But you’re assuming I’m saying “the risk to vaccines outweighs the risk of the diseases” What I’m saying is that the risk to vaccines (namely the risk of steadily increasing the number of vaccines our children receive) is significant enough to warrant better investigation.

      And it’s not based on any specific piece of published research. The sheer existence of the VCIP and vaccine court, and the amount of money being paid out through that system is a glaring indication that something isn’t kosher.

      (2) Chris and Richelle have been arguing primarily that it would be unethical because the unvaccinated children would be put at greater risk. I disagree with them, and the numbered items I put forward in a previous post on this thread use the available data to support why I disagree with them.

      As for your last paragraph (well, 2nd last paragraph I guess) it seems to be a common theme for skeptics to play the “person A is associated with person B, and person B is a total quack, so let’s disregard anything that person A says” game. If you disagree with what I have to say, that’s fine. But disagree with my comments or my logic, not with who you think might be filling my head with nonsense.

      • Composer99 says:

        Mike:

        Regarding:
        I have an issue with media who don’t disclose that he received a multi-million dollar payout for a vaccine patent.

        Please (a) substantiate this claim and (b) show how it is relevant. The strength of a vaccinologist’s statements on the subject depends on the degree to which their claims accurately reflect the epidemiological & vaccinological literature and not on his or her paycheque or whether or not media just happen to mention it.

        Regarding:
        Regarding the CDC data, what was being discussed by the iayork.com site that Chris had referred to was the fact that with improved living conditions, deaths from measles are reduced dramatically, and eventually plateau. i.e. improved living conditions only gets you so far. Vaccination gets you the rest of the way. If the CDC is claiming that vaccination is the only reason for the reduced number of measles deaths, then I would argue that the CDC is not being completely forthright.

        You are engaged in blatant misdirection in this paragraph.

        The data referred to on Mystery Rays from Outer Space is total 20th century measles incidence & mortality in the United States. The CDC data you objected to is global surveillance data from 2000-2008, obviously including areas which have very poor living conditions compared to the US and for which reducing measles incidence will have a correspondingly larger effect on mortality.

        Regarding:
        What I’m saying is that the risk to vaccines (namely the risk of steadily increasing the number of vaccines our children receive) is significant enough to warrant better investigation.

        And it’s not based on any specific piece of published research. [Emphasis mine.] The sheer existence of the VCIP [sic] and vaccine court, and the amount of money being paid out through that system is a glaring indication that something isn’t kosher.

        If you’re not going to base your claim on the basis of evidence, why should anyone else accept it? It is your opinion that the existence of the VICP system, in and of itself, is a cause for concern. If you don’t have data, your opinion is as good as mine (no good at all).

      • Mike says:

        Hi Composer,

        Regarding your comments from Dec 19th:

        “Please (a) substantiate this claim and (b) show how it is relevant.” It has already been established earlier in these comments that he received a multi-million dollar payout for his share of the rotavirus vaccine patent. As for its relevance, it may be completely irrelevant to you, but it’s not to me. If you think a multi-million dollar payout could never cloud someone’s vision or impact their judgment, then you’re a less skeptical person than me. And like I’ve said several times on this thread, it’s not that his statements are meaningless or incorrect. It’s that they should be prefaced by the fact that he received a significant payout for a vaccine patent that he helped develop.

        Regarding the CDC data: I agree that you get more ‘bang for the buck’ in terms of immunization programs in 3rd world countries. However, it is still inaccurate to take the number of measles deaths worldwide from 2000, compare that to the number of deaths in 2008 and then conclude that the measles vaccine is solely responsible for any difference in those 2 numbers.

        Are you saying that between 2000 and 2008, the standard of living in those countries has not improved at all? If so, that’s very unfortunate, since frequent handwashing has the ability to save more lives than any single vaccine.

        “If you’re not going to base your claim on the basis of evidence, why should anyone else accept it”. I said it’s not based on any single piece of published research. My claims are indeed based on evidence, as outlined in items 1-7 and items a-e that I provided in one of the much earlier posts on this thread.

        Regarding your comments from Dec 20th:

        Yes, you figured it out. All I do is repeat what I hear from Joe Mercola. You solved the mystery. Bravo.

      • Composer99 says:

        With regards to my previous remark that I was skeptical of the good-faith basis of Mike’s contributions to this subject, I should like to point to previous threads on Skeptic North.

        His pattern of argumentation on the three threads (the two linked ones and this one) is not encouraging.

      • Composer99 says:

        Mike:

        Regarding your comment:
        If you disagree with what I have to say, that’s fine. But disagree with my comments or my logic, not with who you think might be filling my head with nonsense.

        If you are getting information from unreliable sources such as Mercola (or de novo from your own imagination and your perceptions) rather than the body of epidemiological & vaccinological evidence, it will obviously affect your logic, since you will be making inferences from false premises regarding the safety and efficacy of vaccines or the extent to which vaccine safety & efficacy are studied by actual scientists and regulatory agencies.

        For example, a search on PubMed using the terms ‘vaccine safety 2011′ (to get hits for this year only) finds 1,790 hits as of this writing. Although not all of them are for actual studies of vaccine safety (no doubt due to the way the PubMed search engine parses the search terms), it seems pretty clear that a lot of research is going on. (Apologies to all if the link is broken – you can easily do your own search using those terms by surfing to PubMed.)

  15. Composer99 says:

    Mike:

    After this comment, I really cannot conclude you are arguing in good faith on this subject, particularly after reviewing the other two threads on vaccines in which you were a substantial contributor.

    Let’s look at your comment in some detail, shall we?

    It has already been established earlier in these comments that he received a multi-million dollar payout for his share of the rotavirus vaccine patent.

    I asked if you could substantiate your claim that media were not generally reporting on Dr Offit’s payment for his rotavirus work since that was one of the things you had an issue with. I note you are not doing so in this reply.

    As for its relevance, it may be completely irrelevant to you, but it’s not to me.

    As I suggested, if a vaccinologist’s public statements on the safety of vaccines or of the current vaccine schedule follow logically from the applicable body of literature, what does it matter what his or her paycheque is? I trust you will not be surprised that “it [a multi-million-dollary payout] is not irrelevant to me” is not convincing on its own.

    If you think a multi-million dollar payout could never cloud someone’s vision or impact their judgment, then you’re a less skeptical person than me. And like I’ve said several times on this thread, it’s not that his statements are meaningless or incorrect. It’s that they should be prefaced by the fact that he received a significant payout for a vaccine patent that he helped develop.

    If Dr Offit’s work in the scientific literature was found to be aberrant or consistently flawed, or if his public statements were found to be out of line with the body of literature, and if these problems became particularly pronounced when reviewing his work on rotavirus vaccines, I would find it reasonable to conclude that the money he received for said work was affecting his judgement.

    Since to my understanding no such evidence of incompetence or malfeasance on the part of Dr Offit exists, and since in the comment of yours cited immediately above you appear to concede this point (“And like I’ve said several times on this thread, it’s not that his statements are meaningless or incorrect”), I confess I am once again completely underwhelmed by your argument on this issue.

    Also, contemporary skepticism, as espoused by organizations such as SkepticNorth accepts or rejects claims provisionally on the basis of the evidence marshalled to support them. Since you are the one continuing to “have issues” with various components of contemporary vaccine policy without putting forth evidence to substantiate your concerns & conjectures, I put it to you that you are the one who is being distinctly unskeptical.

    As for:

    Regarding the CDC data: I agree that you get more ‘bang for the buck’ in terms of immunization programs in 3rd world countries. However, it is still inaccurate to take the number of measles deaths worldwide from 2000, compare that to the number of deaths in 2008 and then conclude that the measles vaccine is solely responsible for any difference in those 2 numbers.

    You will recall that the December 2009 CDC weekly report, as linked to in the OP, states the following:

    During 2000–2008, global mortality attributed to measles declined by 78%, from an estimated 733,000 deaths in 2000 to 164,000 in 2008

    and

    Cumulatively, an estimated 12.7 million measles deaths were averted during 2000–2008; of these, 8.4 (66%) million deaths were averted by maintaining routine immunization coverage at the 2000 level, and an additional 4.3 million (34%) deaths were averted as a result of measles SIAs and increases in routine vaccination coverage.

    The report includes discussions of the methodology used to create these estimates and references to additional literature (WHO publications and work in epidemiological journals) on the subject.

    Against these references we have your assertion that “it is still inaccurate to take the number of measles deaths worldwide from 2000, compare that to the number of deaths in 2008 and then conclude that the measles vaccine is solely responsible for any difference in those 2 numbers” without showing the methodological flaws in the CDC report or showing that your characterization of the CDC’s statement is accurate in the first place.

    Once again, your support for your position is your own unsupported opinion, which amounts to an argument from personal incredulity in the absence of supporting evidence.

    I put it to you that your own arguments from personal incredulity are of necessity less credible than estimates calculated by professional epidemiologists & statisticians from empirical data and validated epidemiological modelling.

    However, to engage your point directly, deaths attributed to measles can be:
    (a) from measles directly;
    (b) from follow-up sequelae from measles (such as encephalitis);
    (c) from measles and co-morbid conditions where neither measles nor the co-morbid conditions would be sufficient to cause the deaths on their own.

    In all three cases, because vaccination reduces the incidence of measles we would expect to see a decline in measles-related mortality as a result of sustained or increased immunization campaigns even if the case-fatality rates remain the same (or even increase).

    As far as this goes:
    Are you saying that between 2000 and 2008, the standard of living in those countries has not improved at all? If so, that’s very unfortunate, since frequent handwashing has the ability to save more lives than any single vaccine.

    Relevant to this point, the CDC points out that:
    In 2008, the 47 priority countries accounted for 160,000 (98%) of the estimated 164,000 measles deaths globally.

    and that the priority countries were
    Afghanistan, Angola, Bangladesh, Benin, Burkina Faso, Burundi, Cambodia, Cameroon, Central African Republic, Chad, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Djibouti, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Ghana, Guinea, Guinea-Bissau, India, Indonesia, Kenya, Lao People’s Democratic Republic, Liberia, Madagascar, Mali, Mozambique, Myanmar, Nepal, Niger, Nigeria, Pakistan, Papua New Guinea, Rwanda, Senegal, Sierra Leone, Somalia, Sudan, Timor-Leste, Togo, Uganda, United Republic of Tanzania, Vietnam, Yemen, and Zambia.

    Further, we see from the CDC report’s table 1 that approximately 97% of the 2000 measles deaths also occured in the priority countries, a proportion which is quite similar to the proportion of measles deaths in 2008.

    In many of these priority countries I would not expect to have seen measurable gains in standard of living or public health for large segments of the population in 2000-2008, such as Afghanistan, Somalia, Myanmar, Bangladesh, or India.

    One thing I find interesting is that the proportion of African region measles deaths fell from approx. 50% of deaths in 2000 to approximately 17%, while SE Asia proportion of measles deaths actually rose from approx. 32% in 2000 to approx. 77% (while the absolute number of deaths was halved). This is perhaps not surprising as the report notes that “India has not fully implemented the measles mortality strategies recommended by WHO and UNICEF in 2001″.

    Your comment, however, suggests you haven’t tried reading the CDC report for comprehension and that you are continuing to rely on arguments from personal incredulity or personal lack of knowledge on this forum.

    Now we come to:
    I said it’s not based on any single piece of published research. My claims are indeed based on evidence, as outlined in items 1-7 and items a-e that I provided in one of the much earlier posts on this thread.

    If you are referring to your notes in this comment then you have a problem with the word ‘evidence’.

    Those points are inferences you made from evidence supplied by Chris, as you admit: “So here are some items that I believe to be fact based on your provided links” [Emphasis mine] and “Here are some conclusions I drew from the information you provided”.

    Also, none of the points you refer to support either claim of
    What I’m saying is that the risk to vaccines (namely the risk of steadily increasing the number of vaccines our children receive) is significant enough to warrant better investigation.

    or

    The sheer existence of the VCIP and vaccine court, and the amount of money being paid out through that system is a glaring indication that something isn’t kosher.

    Finally, on to:
    Yes, you figured it out. All I do is repeat what I hear from Joe Mercola. You solved the mystery. Bravo.

    Reading for comprehension is your friend. For starters, it prevents you embarassing yourself when you resort to such blatant misrepresentation. Let me repost what I actually said:

    If you are getting information from unreliable sources such as Mercola (or de novo from your own imagination and your perceptions) rather than the body of epidemiological & vaccinological evidence, it will obviously affect your logic, since you will be making inferences from false premises regarding the safety and efficacy of vaccines or the extent to which vaccine safety & efficacy are studied by actual scientists and regulatory agencies.

    You have thus far not demonstrated that your concerns regarding the vaccine schedule or the forthrightness of the CDC are based upon a review of the available scientific literature.

    So from whence do your concerns arise? Some other source? If so, provide it. Or from your own conjecture?

    • Mike says:

      Hi Composer,

      It’ll take me a couple of days to respond to all that, but I will. Stay tuned…..

    • Chris says:

      After this comment, I really cannot conclude you are arguing in good faith on this subject, particularly after reviewing the other two threads on vaccines in which you were a substantial contributor.

      I could have told you that. I commend you for sticking around so long, I have had limited time due to the holidays. I also find it pointless when someone does not understand basic logic.

      I found that he either does not read, nor comprehend most of the cites I brought up. He did not understand why Japan was having measles outbreaks when their vaccine rate was 81%, yet that same article said that 95% was needed for herd immunity. There are variables in epidemiology equations that take in account how transmissible each disease is, and measles is highly transmissible, so there needs to more vaccinated to stop outbreaks (which was explained in the movie Contagion, where it looks like a character was based on Mercola and Mike Adams).

      Sorry, I have not noticed since I am popping in for just moment before tackling holiday insanity: but has Mike cited anything remotely resembling scientific evidence?

      Never mind. This article has scrolled off the front page. Though, it would be nice to have Mike explain exactly how he would protect children from measles. Have him explain very carefully how to do it without any vaccine, and provide cites of how that method worked in a population similar to North America. But he will not answer, but will just continue to torture logic.

  16. Composer99 says:

    Big long comment in moderation.

    It will seem a bit harder to parse because (much to my surprise) Skeptic North does not process underline HTML tags.

    My apologies, all.

    • Mike says:

      Hi Composer,

      Bad Faith: To be honest, I’m not completely sure what arguing in ‘bad faith’ actually means, nor am I really concerned what you personally conclude regarding my motivations. You seem to have taken lots of time to search through previous comments of mine, and you haven’t come up with anything convincing to prove what a bad guy I am.

      Paul Offit: So please clarify exactly what it is you’re asking for. Are you simply asking me to provide a couple of news articles discussing vaccines where he is mentioned and/or quoted, and in which no mention is made of him receiving a multi-million dollar payout for a new vaccine patent? Or even if I did provide that would you just say “so what”?

      CDC Data: You go through a lot of effort to show that the vaccine is effective in reducing measles deaths in these countries. But I never disputed that fact. You make the following comment: “In many of these priority countries I would not expect to have seen measurable gains in standard of living or public health for large segments of the population in 2000-2008”. If you were actually able to demonstrate that there were no improvements in standard of living in any of those countries between 2000-2008, then I would concede that the reduction in measles deaths could be solely attributed to vaccination campaigns. But you have not done that. And if that was indeed the case, it’s a very sad state of affairs, since an estimated 3.5 Million children under 5 die each year due to illness that could be prevented with proper handwashing. Makes measles deaths pale in comparison.

      In an earlier comment of yours, when I used data from the US and UK to show that measles deaths will dramatically drop on their own in the presence of improved living conditions, you referred to it as “blatant misdirection” and you made the following comment ”The CDC data you objected to is global surveillance data from 2000-2008, obviously including areas which have very poor living conditions compared to the US and for which reducing measles incidence will have a correspondingly larger effect on mortality”

      Fair enough. I agree with you that 1st world and 3rd world countries are different enough that they deserve to be discussed separately. Which highlights why a statement like “Let me say that again. The measles vaccine is currently saving 569,000 lives per year in comparison to 2000” is not appropriate in an article questioning the decisions North American parents are making regarding vaccinations.

      Evidence: Yes, I did take data from the Japan Study and the other article Chris provided and drew conclusions based on the data. I’m under the impression that’s how research works. You collect a bunch of data and then analyze the data to draw conclusions. If you think any of my conclusions are in fact not supported by the data that was used, please let me know.

      You say: “Also, none of the points you refer to support either claim of:

      ‘What I’m saying is that the risk to vaccines (namely the risk of steadily increasing the number of vaccines our children receive) is significant enough to warrant better investigation’

      or

      ‘The sheer existence of the VCIP and vaccine court, and the amount of money being paid out through that system is a glaring indication that something isn’t kosher.’

      Yes, that’s correct. The points I refer to support the claim that proper double-blind studies of childhood vaccinations would not put the unvaccinated children at more than minimal risk compared to their vaccinated counterparts. That part I believe to be a fact based on the numbers provided by Chris. The two claims above are my opinion as to why I believe such testing would be worthwhile, since regardless of the outcome, it would result in more parents abiding by the same schedule.

      As for the existence of the VICP and the amount of money paid out through it, those two are certainly not a figment of my imagination or some concoction planted there by your buddy Joe Mercola.

      You say: “I put it to you that your own arguments from personal incredulity are of necessity less credible than estimates calculated by professional epidemiologists & statisticians from empirical data and validated epidemiological modeling”. Yes, I agree with that too. Certainly I’m less credible than people who are considered to be the ‘scientific experts’ on the subject. We are all wrong some of the time, and I’m probably wrong more often than they are.

      • Chris says:

        Wow, your contortions are truly tortured. I am only posting because I noticed you really don’t answer questions, yet drag my name in as evidence. Though you really did not understand anything I posted. That is quite amusing. Evidenced by the following comment:

        “In an earlier comment of yours, when I used data from the US and UK to show that measles deaths will dramatically drop on their own in the presence of improved living conditions, ”

        So why did the deaths from measles in Japan rise in the 2000s? Was there some severe decrement in their living conditions? And, really, what caused the morbidity of measles in the USA to decline by 90% between 1960 and 1970? Was it some kind of super duper sewer technology that knocked out respiratory viruses like measles from the air, but ignored haemophilus influenzae type b, varicella and rotavirus?

        “Yes, that’s correct. The points I refer to support the claim that proper double-blind studies of childhood vaccinations would not put the unvaccinated children at more than minimal risk compared to their vaccinated counterparts. That part I believe to be a fact based on the numbers provided by Chris.”

        I’m sorry. Where did you post a study design that would not cause harm to the placebo arm? I did not see it. For example, the following pdf file describes a double blind test of an early measles vaccine:
        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2134550/pdf/jhyg00119-0147.pdf

        Now that proves that any claim such a trial was not done is a lie. Now look at Table 1. What are the titles for the second, third and fourth columns? Now please tell us how you would prevent positive numbers for the third and fourth columns. That means that there should be no other number than what is in the first row. Now if you look carefully the numbers on the second row for those columns are all positive, and definitely more than the row above. Since the title of those two columns represent only one outcome, don’t forget there are other outcomes that cause permanent harm. Do explain in great detail how you will prevent those.

        Now please explain how you would design your double blind study to conform to the Declaration of Helsinki and the Belmont Report. Provide supporting documentation (title, journal, date) that studies with this design have been approved and done in the last thirty years. Do not post the epidemiological studies that have already shown vaccines to be safer like the Japan study I posted, since those are not the vaulted double blind studies you are aching for. Make sure to provide the documentation that the Independent Review Boards approved the designs.

      • Composer99 says:

        You really don’t get it, do you, Mike?

        Get back to us on this thread when you get around to clearly stating your objections to the current vaccine schedule, the VICP, and the way vaccine research is done and substantiating your claims with evidence and valid logical constructs instead of tone trolling, vague conjecture, and indirect implications of malfeasance on the part of the actual experts.

        Until then, let me share a link to a Google search for ‘slums india 2010′ (so you can replicate it yourself if the link doesn’t work) and you can tell me where the improved sanitation undertaken in 2000-2008 can be found.

        Checking the Google images is particularly enlightening in this regard.

  17. Tara says:

    If you keep yourself and your children healthy to begin with, there will be no need for a pox-party or a vaccination. My dentist can tell that I had chicken pox when I was two because of the pitted enamel on my adult teeth. Too bad my mother raised me on a bad diet, the same way she and her mother were raised.

    Through proper nutrition and healthy living, your immune system will be strong enough to fight off any diseases. There are many examples out there if you look.

    • Tara – What you mean to say is that with proper nutrition and healthy living you will be better able to fight the infections you do get. With vaccination, you have the best opportunity to avoid the infection in the first place.

      Your dentist may have it backwards:
      http://www.wisegeek.com/what-is-enamel-hypoplasia.htm
      “Enamel hypoplasia is typically caused by malnutrition, illness, infection or fever during tooth formation. Some medications can also affect the teeth that were developing at the time of dosage. Environmental factors can interfere with tooth formation as well, such as being exposed to toxic chemicals at a very young age. In many cases, the exact cause of enamel hypoplasia cannot be determined.”

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  • Richelle McCullough

    Richelle is a second-year medical student living in Calgary, but hails originally from Winnipeg. An outspoken advocate for lifestyle interventions within the scope of science-based medicine, Richelle’s favourite topic is to debunk complementary and alternative medicine. She is frequently trolled by geocentrists at her personal blog, Subspecies, and despite the distance, remains active with the Winnipeg Skeptics.