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Status: Married
Age: 42
Sign: Pisces
City: Tulsa
State: Oklahoma
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Tuesday, October 20, 2009
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Please vaccinate your children. Don't buy into the BS hype being propagated by anti-vax'ers. They are just as bad as nutcases who claim Obama is the anti-Christ and we're all being ruled over by lizard men from space.
http:../../..www...nycskeptics...org/..blog/?p=1078
The New Plague
By John Snyder, on October 19, 2009, at 7:03 am
A
new epidemic is creeping across parts of the US. It primarily affects
infants and children of higher socio-economic status, and it has the
potential to cause horrible illness and death. It has already begun to
cause outbreaks in scattered communities throughout the country. If it
is not contained quickly, more carnage will result. The epidemic I am
describing is not Swine Flu. It is not a newly mutated animal virus
imported from some far-flung corner of the globe. It is the epidemic of
parental vaccine fear, and it is a major threat to the safety of
children everywhere.
As a pediatrician living in New York, I
often see soon-to-be parents who are expecting their first child and
are looking for a doctor for their new baby. These prenatal visits are
usually a time for parents to ask some basic questions about my
practice, maybe a few questions about what to expect in the first days
after the birth of their child, and mostly to get a feel for me and my
office. But an interesting change has occurred over the last few years.
A new item has cropped up in the usual list of new parent questions:
vaccines. A common question I get is “what’s your philosophy about
vaccines?” My response to this question is something along the lines
of, “well, it’s not a matter of philosophy. It’s actually a matter of
science, and I follow what the science tells us.” In fact, I can’t
remember the last prenatal visit that didn’t include at least one
question about vaccines. What in the past was a given – that children
would receive the vaccines recommended by their pediatrician, in the
order that they were recommended – is no longer so for many parents
today [1]. This bedrock of pediatric care has been recast as a
question, an uncertainty, a matter of opinion and debate. It is a
dangerous new dynamic that seriously threatens the safety of our
children. Many parents have vague concerns about unspecified risks, but
in general need only reassurance to go forward with vaccinating their
children. Some parents have specific concerns based on information
gathered from friends, acquaintances, on the internet, or in the media.
Some have fears about vaccines in general, or the number of vaccines
given, and are less easily reassured. Some parents are ardently opposed
to vaccines altogether, and refuse to have their children vaccinated at
all.
What has led to this new epidemic of fear? The answer is
complex, involving a convergence of multiple factors: a lack of
understanding of how science works, mistrust in medicine in general and
in expert advice even more generally, mistrust in government oversight
and the pharmaceutical industry, and a growing counter-....culture
trend, particularly in more highly educated socio-economic populations.
The most common vaccine concerns can be summarized as follows:
1.
Vaccines have been linked to autism – While this is true, vaccines have
been linked to autism, they don’t actually have anything to do with
autism. I will not tackle this myth here, but suffice it to say, not a
single shred of valid scientific evidence has ever been put forth to
support a causal link between vaccines and autism. However, volume upon
volume of excellent, peer-reviewed data has unequivocally shown no such
a linkage [for a complete set of references, see the references section
of this post from the Science-Based Medicine blog].
2. Vaccine
ingredients, like thimerosal, aluminum, squalene, and others can lead
to immunological and neurological consequences in infants – Again, no
valid data exists to support such a belief, and the existing science
points us in the opposite direction.
3. Too many vaccines can
overwhelm an infant’s immune system, leading to a host of disease
conditions – This is absurd on its face to anyone familiar with basic
immunological principles. All of the childhood vaccines combined, are
but a mere drop in the bucket compared to the immunological challenges
an infant faces every day. Not only can an infant’s immune system
easily handle the combinations recommended in the routine schedule, but
the number of immunologic stressors, if you will, contained in the
current schedule (that enormous, and growing list the anti-vaccine
community complains so much about) has actually been decreasing due to
improved vaccine technologies [2].
As I mentioned above, the
reasons for this spreading wave of mistrust of what was once regarded
as the greatest weapon against childhood disease, are complex. But a
single, now thoroughly discredited paper published over 10 years ago,
purporting to show a linkage between the MMR vaccine and autism, is
responsible for at least this current, modern wave of anti-........vaccinationism.....
So much has been written about this paper and the damaging fallout
resulting from its publication, that I wont rehash it here [3]. But the
subsequent media frenzy, and numerous tangential theories, equally
unsupported by science, has kept the frenzy alive [4][5].
My
pediatric practice is situated at the nexus of three Manhattan
neighborhoods (the West Village, Chelsea, and the Meat Packing
District) that seem to comprise just the right balance of wealth,
edginess, and socio-cultural awareness that lends itself to this new
mistrust of vaccines. But these neighborhoods are not unique. According
to sources at the NYC DOH, the Upper West Side of Manhattan and Park
Slope in Brooklyn are also hot-spots of parental vaccine resistance.
What stands out about these neighborhoods, and others like them, is
that they contain a high percentage of middle to upper middle class
families that tend to be young, well educated, and liberal in their
political and social views. Because I live in one of these areas, work
in another, and fit this description pretty squarely, I can identify
with the underlying tendencies at work behind the concerns of these
parents. A healthy questioning of authority (doctors), an underlying
mistrust in the competence of the government (the CDC), overt mistrust
and a general level of cynicism of big business (the pharmaceutical
industry), and a sense of empowerment that comes with one’s social
status, all contribute to this tendency to mistrust vaccines and those
who recommend them. The difference between these concerned parents and
myself (also a parent), is an understanding of the scientific method
and the role it plays in this issue. One term that I have purposefully
left out as a key element in this new epidemic is “skepticism.” While
many of these parents believe they are being skeptical of vaccines,
their manufacturers and the agencies that recommend them, this couldn’t
be further from the truth. What they are being is misled and taken
advantage of. They would actually be better characterized as
anti-skeptics. To quote Brian Dunning of Skeptoid.com,
The
true meaning of the word skepticism has nothing to do with doubt,
disbelief, or negativity. Skepticism is the process of applying reason
and critical thinking to determine validity. It’s the process of
finding a supported conclusion, not the justification of a preconceived
conclusion.
The net result of this snowballing paranoia and anti-....skepticism,
is that the door has opened wide for anti-vaccine fear-mongering by an
increasing number of organizations and non science-based “maverick”
doctors, and parents are listening. Not a day goes by in my practice
without encountering the effects of this mass-hysteria. Parents are
afraid of vaccines, victims of a cultural mythology about vaccine risks
that has been bolstered by a wave of media hype and irresponsible
pseudo-....journalism. I spend a large amount of time with parents
discussing the real science and trying to debunk these hardened myths.
Often I am successful at convincing them to vaccinate their children.
Many, while agreeing to all or most of the vaccines, ask to use a
“spread-out” or “alternative” schedule, like the one recommended by Dr.
Bob Sears (see my take-down of him on the Science Based Medicine blog).
While not every parent is familiar with Dr. Sears, most are aware that
there is an “alternative” to the schedule recommended by the CDC
Advisory Committee on Immunization Practices and the American Academy
of Pediatrics. Forget that an enormous amount of thought and
deliberation went into devising this schedule by our nation’s leading
experts in pediatric infectious disease, epidemiology, and vaccinology.
Parents now know there’s an “alternative,” and for some that’s good
enough. Many who choose the “alternative” schedule can’t really give a
reason why, other than “I’ve heard it’s safer.” This is no different
for the vast majority of parents who have concerns in general about
vaccines; they know they’re worried about vaccine risks, they just
don’t know exactly why. Amazingly, this lack of a basis for their
concerns doesn’t prevent these fears from taking control and informing
what is likely the most important decision they will ever make about
their children’s health. Fears about non-existent vaccine risks prevent
children from being protected against very real, very dangerous agents
of death and disease.
A trendy way to die
So why are
parents so quick to make such bad decisions for their children when it
comes to this issue? And why does there seem to be a connection between
zip code and vaccination rates? Unlike most of the world, where
vaccination rates are directly proportionate to socioeconomic status,
it appears that may not always be the case here in NYC, and probably
other urban centers around the country. Typically, under-....vaccination
has been found to be most prevalent in inner city, black children with
unwed teenage mothers, while un-vaccinated children have tended to come
from higher socioeconomic backgrounds, and have mothers who are married
with a college degree [6]. The reasons for this are that under-....vaccination
has typically been a result of poor access to good health care
continuity for children at or below the poverty level. Non-....vaccination
is usually a result of a decision made by a parent who has major
concerns about vaccine safety, and who is empowered to reject the
expert advice of authority. Such strong, anti-vaccine positions were
once confined to a very small subset of the population. Complete
vaccine refusal remains, fortunately, a relatively rare occurrence in
the US. But under-....vaccination is being seen increasingly now in
communities where being up-to-date with vaccinations was a once given
and, in fact, a marker of the highly educated and socially aware. Now,
as more and more socio-....economically advantaged, empowered,
parents play with the vaccine schedule, cherry-picking which vaccines
to give and when, the problem of childhood under-....vaccination may
be changing from being predominantly a result of inner-city poverty, to
that of cultural elitism. In other words, we are experience a very
dangerous fad, where it is now trendy to question the advice of one’s
doctor, and to mistrust medical experts in general. Of course children
are the ultimate victims.
The growing trend of questioning the
safety of vaccines, and even the very concept of vaccination itself,
has resulted in pockets of underimmunizati....on throughout the
country. The increasing number of such hot-zones has already resulted
in outbreaks of completely preventable childhood disease.
Measles
Soon
after the infamous Wakefield paper was published in 1998, vaccination
rates against measles, mumps, and rubella, plummeted in the U.K.
Outbreaks of these diseases began popping up all over the region,
eventually reaching epidemic proportions. And, although the fictional
link between the MMR and autism arose over 10 years ago, there’s no
sign that things are getting any better. Last year saw the highest
incidence of measles cases in the UK in over 20 years, all due to
pockets of underimmunizati....on resulting from media coverage of
Wakefield’s discredited findings. Predictably, it wasn’t long before
the wave of fear reached our shores. Although not as widespread, this
uprising against vaccines, based on nothing but pseudo-science and
newly spawned campaigns of misinformation,.... began to create a
dangerous climate of vaccine refusal here in the U.S. It didn’t take
long for outbreaks of mumps and measles to occur in areas scattered
throughout the country. In 2006, the largest outbreak of mumps in over
15 years, centered in Iowa and involving 10 other states, effected over
2,500 people. Last year, measles cases in 15 states contributed to the
largest US outbreak in over 10 years. In Brooklyn, an unimmunized
traveler from Israel infected other unimmunized children in a
pediatrician’s office, sparking the borough’s largest outbreak of
measles in almost 20 years. Other recent outbreaks in Indiana, San
Diego, Arizona, Milwaukee, Washington State, Pennsylvania, Michigan,
and Texas are just the tip of the iceberg if this dangerous trend of
vaccine refusal continues.
Hib
Much to the horror of
pediatricians, recent outbreaks of invasive disease due to Haemophilus
influenzae type b (Hib) have brought back this dreaded scourge. Hib is
an extremely nasty bacterium that used to cause invasive disease in a
startling 1 of every 200 children in the U.S. under 5 years of age.
That was, until the vaccine pretty much eliminated it from our country
after its introduction in the late 1980s. The vaccine has been so
successful, that pediatricians my age and younger have likely never
even seen a case of invasive Hib disease. Not true for those trained
just a few years earlier. They remember that, of the children
unfortunate enough to come down with invasive Hib disease,
approximately two-thirds will develop meningitis, and about 5% will
die. Up to 30% of the survivors suffer permanent brain damage. Those
children lucky enough to avoid meningitis develop pneumonia, septic
arthritis, osteomyelitis, cellulitis, epiglottitis, or generalized
sepsis. Now, because of pockets of underimmunizati....on and the
spread of so-called “alternative” vaccine schedules, younger
pediatricians will be able to learn, first-hand, about a disease they
could previously only read about in text books.
Pertussis
Pertussis,
or whooping cough, is one vaccine preventable disease that still
circulates with high prevalence despite the existence of a good
vaccine. In fact, the incidence of pertussis is actually increasing in
the U.S. There are several reasons for this, including inadequate
vaccination of infants, waning of vaccine-....induced immunity in
adolescents and adults, and a high frequency of undiagnosed pertussis
infection that can lead to spread of disease to susceptible
individuals. Another reason is that, although an adolescent/....adult
version of the vaccine (Tdap) is now recommended and routinely given to
children 11 years of age and older to boost their immunity, similar
recommendations.... to vaccinate all adults are usually unheeded by
internists and obstetricians. This is a major problem, because infants
and children (in whom pertussis can be an extremely severe disease) are
infected by adults whose immunity to pertussis has waned. Anecdotally,
I can tell you that most of the physicians I’ve spoken to who take care
of adults, are not even aware of these recommendations.... (I’m
currently working on a study of knowledge and attitudes of
obstetricians about the Tdap vaccine.) Now, add to this the changing
attitude of parents concerning vaccines, and we have a dangerous set-up
for an even worse scenario with regard to the future of pertussis
control in this country. Not surprisingly, it has been shown that when
parents refuse or delay the pertussis vaccine for their children, these
children have a significantly higher risk of developing pertussis [7].
The danger of an increasing incidence of pertussis is that, while it is
an extremely annoying disease for adults, it’s an extremely dangerous
one for infants and young children, in whom complications are much more
common and include pneumonia, dehydration, encephalopathy,.... cerebral hemorrhage, and death.
The Pendulum Swings
An often-used saying by those who fight against the irrationality of anti-........vaccinationism,....
is that “vaccines are the victim of their own success.” Certainly, one
could not point to a more successful public health measure than
vaccination. Vaccines have saved more lives and prevented more disease
and disability than all other public health measures combined. They
have been so successful, that most parents (and most physicians) have
no first-hand knowledge of the diseases against which children are
vaccinated. These horrific diseases are but an abstraction, and the
ubiquitous nature of the myths about vaccine dangers – in the
mainstream media, spouted by celebrities on TV, and on the internet –
have become much more “real” to an increasing number of parents. Now,
it seems, that the worst of our fears may be coming true. Not that
vaccines cause autism, or multiple sclerosis, or asthma, or cancer, but
that the parents who fall prey to these beliefs are leading us down a
very dangerous path – a path we’ve been down before, and upon which we
should never again have to tread. The pendulum has swung, and it may
just be too late.
References:
[1] Omer S, Salmon D et al. Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-....Preventable Diseases. NEJM 2009 360:1981-1988.
[2]
Offit P., Quares J., et al. Addressing Parent’s Concerns: Do Multiple
Vaccine Overwhelm or Weaken the Infant’s Immune System? PEDIATRICS Vol.
109 No. 1 January 2002, pp. 124-129
[3] Deer B. The Wakefield factor. Briandeer.com
[4] Mooney C. Why Does the Vaccine/Autism Controversy Live On? Discover June 2009
[5] Hall H. Vaccines & Autism: A Deadly Manufactroversy..... eSkeptic June 2009
[6]
Smith P. Chu S. et al. Children Who Have Received No Vaccines: Who Are
They and Where Do They Live? PEDIATRICS Vol. 114 No. 1 July 2004, pp.
187-195
[7] Glanz J., McClure D. Parental Refusal of Pertussis
Vaccination Is Associated With an Increased Risk of Pertussis Infection
in Children. PEDIATRICS Vol. 123 No. 6 June 2009, pp. 1446-1451
6:15 PM
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