it’s a small world

I am not a doctor, and my second-hand understanding of this may be wrong. But I don’t think that it really works quite how BJN describes at #3. Here’s a popular-press article about the Disneyland outbreak. That article quotes the CDC as saying that two doses of the vaccine are 97% protective. It also quotes a CDC person as saying that the response can wane in some people: i.e., that you can serioconvert but that the protective effect may not last forever.

You know, I’ve just about reached the point where I’m willing to say “Not vaccinating your children for non-medical reasons (and no, conspiracy theories about autism don’t fuckin’ count) is child abuse, and state intervention is required.”

We wouldn’t tolerate parents who, after their child has contracted measles, declined to treat them. It would be a national outrage. But for some reason it is acceptable for them to not just put them at massively increased risk, but to undermine our national health.

I think that what BJN is writing and what I’m writing work out the same, for most practical purposes. On average, people who get two doses of the measles vaccine still sometimes get the disease, and their chance of getting it does (on average) depend on whether herd immunity cuts short transmission chains in the surrounding population or not.

The question of whether an individual who is currently producing antibodies is really 100% sure not to get the disease is surprisingly difficult to Google.

I did wonder whether the Wired article that I linked to before had slipped an order of magnitude when it cited 97% vaccine effectiveness from two doses — I’ve seen, elsewhere, numbers like 99.7%, which would leave 0.3% instead of 3%. But this slightly more direct source also shows 97%.

Practicularly the distinction between whether those whode bodies are still producing anti-bodies are it risk isn’t useful. The hundreds of millions of us who had the vaccines and/or are old enough to have contracted it as a kid, just don’t have a way of knowing whether out immune systems are suufficiently responsive.

I’m hoping this episode, and the press it is recieving will be the beginning of the change in the anti-vaxer tide? I alread heard today that some California parents are suing to have non-vaccinated kids not allowed to go to school. [I think they had an exception for those who had a valid medical reason for avoiding the vaccine]. I think the recognition that we have community level responsibilities as well as indivudual rights just might begin to start registering.

Ben – I am all for vaccines too: but those actively opposed to vaccination are applying for a Darwin Award, not for themselves, but by proxy for their children The process is a form of Russian Roulette with, in the case of measles, a good probability of survival; nonetheless, if we live in societies where we are supposed to care for each other, to my mind, refusal vaccinate should be treated on a par with child abuse!

Sasha, I would answer your comment #12 but an answer to your comment is exactly what my comment #11 was. Why not read it?

And yet @Patrick #13, that impossible and intolerable position is exactly what we do here in the UK, and we tolerate it and possibate it just fine, without any castigation. Mere persuasion is sufficient.

It serves no purpose to castigate anti-vaxers. People do it because they enjoy it.

The more agency we allow people to have, the better. On the other hand, if we are to rely on persuasion alone, we had better make sure it is effective.

I had measles and it was the sickest I have ever been. How well I remember those disfiguring red blotches all over (and probably inside) my body! Fortunately, I recovered after two weeks with no ill effects, though I know of at least one acquaintance who became deaf in one ear from measles.

I have to say that I myself found it extremely difficult to persuade a much younger friend that measles could be dangerous and even fatal even with the best of modern medicines and nursing care. (Paradoxically, this is the partly the result of perceived improvements in treating illnesses.) Photos, testimony, and the like might be of some help.

The constant vigilance you describe involves multiple epidemiologists tracking disease spread, conducting interviews, and spending resources that could be put toward other diseases. 10+ cases is a massive amount of work when you are dealing with something as infectious as measles. The reason I was being pedantic about language before was precisely because we need to not talk about herd immunity as a magic protective spell, but as an abstract concept that can still involve significant transmission. The link Rich posted before refers to multiple chains of 10 or more infections in the US before the Disneyland outbreak.

Thanks for using the simplest language though. I still have half a semester until I earn my Masters in Public Health, and when I talk about vaccination with CDC managers who have been doing this 20 years, they sometimes use big words that are hard for me to understand.

@lynne, the term is accurate. What you said was both justified and true- he is benefittng from your decision to vaccinate, and you can afford to support them, indeed it costs you almost nothing. I don’t think you made a friend though!

Unfortunately the flu shot is an exception to the “vaccines unambiguously good” story. It is a killed vaccine not an attenuated strain, and so it is relatively ineffective, and it has relatively high side effects, due to the method of production and the interaction/causal relation with egg allergies. I don’t get the flu shot, but it’s coin toss really as I am not an at-risk group and herd immunity is nowhere in sight.

Conversely the HPV vaccines are a miracle of modern science with none of the problems of either killed or attenuted-strain live vaccines.

Nevertheless vaccinations do carry some risk because with attenuated-strain vaccines they are actually giving you an infection with actual measles. That’s how they work. (Albeit a weakened strain which most people’s immune system easily defeats, but not everyone’s does and some people react quite badly).

Would it make sense to do HLA typing on people who react badly, and see if any associations turn up?

In the best case it could lead to a test that might predict who is likely to be OK.

Oh, and the real connecting point here, is that the attenuated-strain polio vaccine causes, definitely, without any doubt, several hundred cases of acute flaccid paralysis every year (from tens of millions of vaccinations, IMO a good trade-off where polio is endemic). But: That’s why we don’t use it in the UK any more… the balancing risk of worse disease from wild poliovirus is no longer present.

I had measles. In high school, acct not being vaccinated; in the early eighties the anti-measles vaccination [I had the others] was less obviously stupid.

Not fun.

[my significantly-younger sister was vaccinated, though: my parents tell me that they asked if I and other-sister should be vaccinated, to which doc replied, “nah, they should be right”. Reasonable call, but gee it sucks playing bets that don’t pay out.]

From Peter Erwin @23 – “‘@ LynnI think the medical profession and the media are to blame for people’s distrust of vaccines.’

“I can understand the claim about the media — it’s fairly well documented how uncritical repetition of the original flawed British study by the British media helped create the anti-vaccine hysteria there, and you do after all mention that “the news was full of reports”. But what’s the evidence for the entire medical profession being “to blame”, other than your experience of one doctor?”

First – I want to note that my children are vaccinated – I am in no way an anti-vaxxer. I am surprised to learn that one can go to school when unvaccinated; in IL, an unvaccinated child would be expelled from the school (I thought it was a federal mandate – you could have a religious exemption, but in our school, that was hard to claim.) It is very strange that in some school districts HALF of the children are unvaccinated. Wow. That’s a belief and trust in the idea that bad things won’t ever happen to you or your children – a kind of optimism that I do not share.

However, it is interesting the level of hysteria that comes from 100 or so cases of measles in the state of California (pop. nearly 39 million people.)

It is also interesting that the anti-vax movement is supposedly the result of the Wakefield study. However, is that really true? Is all this anti-vax propaganda and behavior simply because of one flawed study that has been discounted over and over again? Perhaps not.

Prior to 2001, thimerosal was a common ingredient in children’s vaccines. As the vaccine schedule became filled with more and more vaccines, concern was raised by parents (not just because of Wakefield) about the amounts of mercury that was being injected into infants. As I understood it, when one looked at the overall amount of thimerosal used in children’s vaccines, the amount was more than what the EPA allowed (different agency, yes.) At the same time, the dangers of mercury were being broadcast loudly to pregnant women. Of course those women are going to worry when they hear a form of mercury is being injected into their baby – multiple times by the time that baby was 6-years-old.

Fears also grew because as the number of vaccines grew, so did the number of those diagnosed with things like autism, allergies and asthma. Wakefield didn’t come from nowhere – his study spoke to the fears of many parents. Why is that? Was there no real problem to be seen – did we always have autistic children among us and just not notice until Wakefield lied to us about the problem? Parents knew no one who had been impaired by vaccines and yet, Wakefield’s study sucked them all in and turned them against vaccines? WHY? Because they’re just crazy weird Whole Foods junkies?

Of course, the FDA found “no evidence of harm” but in 2000, the agency recommended the removal of thimerosal from children’s vaccines. (It is still used in adult vaccines.) I’m not sure how studies can be done to show the safety of thimerosal – given how prevalent vaccines were back in the day, where was the control population to be found? Anyone know the answer? Please chime in.

The medical establishment has not offered a compelling reason for why we’re seeing big increases in autism (and it IS increasing – not just because we are now flagging the “nerd” as autistic – the numbers of severely impaired autistic children has grown rapidly and will be a serious healthcare issue when these children become adults and their parents/caregivers die.) In that absence of information, parents fill in reasons for why they see more severely autistic children today – and vaccines have become a reason for many.

and further to 30, note that Wakefield’s work hardly mentioned thimerosal – it was all concentrated on his own (as it turned out, more or less completely wrong) theory about the action of measles virus in the gut. Nevertheless, he’s cited (and these days I think funded) a lot by people who are all about thimerosal. This suggests to me that the take-up and refusal of the vaccine is the actual problem, while thimerosal is a local symptom.

dsquared @31:
One might compare with the problem of doctors failing to wash their hands, a public health problem which kills several orders of magnitude more people every year and which is also the subject of public health initiatives. But the doctors-washing-hands campaign isn’t carried out by vilifying and excoriating non-compliers, even though it obviously very well could be. It’s done by making compliance more convenient

I really don’t think that’s a valid comparison.

You’re contrasting doctors with parents who sometime choose not to vaccinate their children, not because it’s inconvenient but because they’ve been misled into believing it’s wrong and dangerous. And some of them are actively trying to discourage other people from vaccinating their children.

Are there vocal groups of doctors who go around advocating that doctors shouldn’t wash their hands, that it’s better for patients if they don’t? Do doctors fail to wash their hands because they’re genuinely uncertain about whether it’s good for the patients or think it’s better for their patients if they don’t? Are there some hospitals where some large fraction of the doctors are actively refusing to wash their hands?
Or do doctors fail to wash their hands — even though they all agree it’s an important thing to do — because of laziness, forgetfulness, lack of time, lack of sleep, etc., things which are certainly amenable to “making compliance more convenient”?

(And I’m pretty sure there are some public-health campaigns that, to varying degrees, “vilify and excoriate” non-compliers. That’s traditionally how anti-smoking and anti-drunk-driving campaigns operate, for example. And many states go so far as to have laws penalizing drivers who don’t wear seat belts, or motorcyclists who don’t wear helmets, which isn’t exactly a case of just “making compliance more convenient”.)

“Populations especially at risk are those born after 1957 and vaccinated between 1963-1967 or not vaccinated.”

Not to be another fly in the ointment on this, but are people who have not been vaccinated not also likely to have had measles, and thus have immunity that way? I speak personally here – I was not vaccinated (not because of my parents’ beliefs but because of medical over-caution that meant neither I nor my sister were vaccinated because my aunt once reacted badly to a vaccine – 10 years later, and doctors were happy to vaccinate her own children) and caught everything under the sun. Mumps, whooping cough, measles, rubella, the whole shebang. My sister too.

Are there likely to be a large cohort of people still now vulnerable because they weren’t vaccinated?

I wonder if anybody knowledgeable would comment on why measles is suddenly made out to be such a big deal when a few decades ago, childhood diseases like measles were just a routine part of life and nothing to be scared of.

“Let’s take the case of the major killers of the nineteenth and twentieth centuries. The major killers of the nineteenth and twentieth centuries, up until the first decade or so of the twentieth century, were certain infectious diseases — that’s what killed people. Those infectious diseases were not waterborne diseases; they were airborne diseases. A major killer of children in the nineteenth century was measles. Now think of that. When I was a child, everybody had measles. Everybody in my class had measles. Nobody died of it. But in the nineteenth century, children died of measles.

The major killer of women of childbearing age in the nineteenth century was not childbearing; it was tuberculosis. Now, why is it that tuberculosis was the major killer of people in the nineteenth century — the germs are still around — and is now a very small fraction of the death rate? Very few people get tuberculosis now. People do, but very few, relative to the population. And children don’t die of measles. Well, now, of course, they’re inoculated against measles, but nobody in my generation died of measles, although measles are still a primary cause of child mortality in West Africa. The reason is because both tuberculosis and measles, in their severity and eventual effect — and the probability of getting tuberculosis — are closely related to nutrition.

Measles is a protein-consuming disease. If you already have a severe protein deficit, as children in West Africa do, and then you get the measles, you die. Measles actually destroys protein, it consumes protein. So if you’re already underfed, you’re in big trouble if you get measles. But if you’re well-fed, as I was, and as my classmates in school were, then it’s just an annoyance.”

Richard C. Lewontin (http://globetrotter.berkeley.edu/people3/Lewontin/lewontin-con4.html)

I’m not nearly as old as Lewontin but even in my time, measles was routine and nobody was scared of it (yes a very tiny number of deaths occurred but insignificant compared to other every day risks). So what has changed?

Also, would anybody explain what is the basis for the claim that the unvaccinated endanger the vaccinated?

The vaccine isn’t 100% effective on an individual level. There are two things you can do to decrease your risk of not catching a disease like measles.

1. Get vaccinated.
2. Minimise exposure to people with the disease.

On their own, each of these will reduce your risk, but not eliminate it. A vaccinated person still has a non-negligible chance of catching the disease if many people around them are sick. If both happen, however, the risk can be effectively eliminated.

If you do step 1, but no one else does, then the only way to do step 2 is to live in a quarantine tent. If everyone gets vaccinated, then you get step 2 as well just by living in a vaccinated community.

A few points:

Before the vaccine was introduced, about 400-500 people every year died from the disease, about 1,000 more were in some way permanently disabled from the brain swelling that occurred, and 38,000 were hospitalized. It was not a small problem, even if people remember it as such today. Yes there were many things that killed people back then, many of which have been reduced or eliminated due to sanitary improvements. Doesn’t mean that measles isn’t a problem, especially when it is vaccine preventable.

If there are enough unvaccinated people around, the virus will be able to continually find new hosts and become endemic. Some people who are vulnerable then: Children under 1 who have not yet received the vaccine, the elderly the immunocompromised (HIV sufferers, people undergoing certain kinds of cancer treatment, otherwise very sick people) and the small percentage of people whose bodies don’t take up the vaccine after two doses.

Primary vaccine effectiveness after two doses is 99.6%. I’m not sure where the 97% number that Rich found earlier is coming from, but I’m guessing that either includes long term secondary vaccine failure or was talking about a global context where things like vitamin deficiency and cold chain failures can interfere with vaccine effectiveness. Just going with the 99.6% number because it is the most conservative, in a country of 300 million, that still leaves more than a million people vulnerable.

One reason that measles in particular is of concern is that it is incredibly infectious, becoming virulent in more than 90% of vulnerable people exposed. This means that preventing ongoing transmission needs a very high rate of compliance. It’s true that the old version of the vaccine had a higher than acceptable secondary failure rate, but that doesn’t mean that it failed in everyone. Just more than we would like to keep the rates high. Measles is also still endemic worldwide, so traveling outside the country or being in contact with people from outside the country is a major risk.

The MMR vaccine is safe, and safer than the polio vaccine. The most common side effect is fever, which is easily controlled for. Less than 1 in a million doses results in a severe allergic reaction. If there are other severe side effects, they are so rare that they cannot be statistically correlated with the vaccine.

The basic problem is a long and well-recognized public health dilemma: do successful prevention and the disease you’re preventing stops killing people, and they forget the reason to go to all the trouble of doing the prevention, so stop supporting the prevention effort. Perhaps we’ll see a bit of a turnaround in the anti-vaxxer momentum as the ongoing childhood disease prevention campaign fails enough to let some children die, and people get religion on vaccination again. But that turnaround will predictably again reverse years down the road once people again forget about the fact that dead children are the consequence of not vaccinating.

One useful thing we can do to keep up the vaccination effort at the highest possible ongoing level is to reduce the cost of that effort. That way, even after the fact that not vaccinating results in dead children fades from popular memory, high rates of vaccination could still be maintained because there would be no reason for people to defect from the campaign.

I’m not talking about monetary costs, but about human costs. I doubt that many people who choose to not have their children vaccinated are really much motivated by anti-vaxxer theories, by the human cost of the supposed risks of vaccination the anti-vaxxer theorists put forward. People have to put forward some rationalization for going against the expert advice to vaccinate, and all the anti-vaxxer theories do is provide a handy rationalization. I strongly suspect that the real human cost that motivates people to not get their children vaccinated is the screams of their children.

I’m an Internist myself, and the average age of my panel is somewhere north of 75. But I work in a clinic with all sorts of primary care providers, and they do a lot of childhood immunizations, so I get to hear children screaming in utter terror somewhere down the hall several times a day. It gets to me, several doors and no relationship at all to these children.

I hope it goes without saying that when you balance even one dead child against about a million “merely” terrified children, I still vote to terrify that million to save that one. We still need to vaccinate our children, and make that mandatory when that is necessary to protect the public health. But we also need, to the greatest extent possible, to stop putting children and their parents through the ordeal of the needle. We need to make developing other means of delivery a priority.

Before people start objecting that we should not put ourselves to potentially great expense just to “coddle” children and their parents in terms of delivery vehicle, when the important thing is that we already have the vaccines to save children’s lives, consider that we bother to do all sorts of coddling in medicine to coax people into doing what’s best for them. When I started out in this racket, we did a lousy job of controlling hypertension because, while the medications we had were pretty good at control, the patient had to take them three, or even four times a day. A clear majority of patients couldn’t be bothered to remember to take a pill four times a day, and so their hypertension remained uncontrolled. Then we decided that scolding wasn’t going to work to get them motivated to start remembering to take their pill four times a day, so we developed once a day medications, and now almost every patient’s blood pressure can be controlled. We didn’t insist that patients buck up and pay the modest human cost of remembering to take a pill four times a day, instead we coddled them, reduced the human cost to them to just taking a pill once a day, and that worked.

I think you can make a much better case for “coddling” children terrified of the needle. It’s not just a humanitarian issue, it’s probably what’s behind resistance to vaccinating children, and is therefore a barrier to successful prevention.

“However the anti-vaxxers had everyone so panicked about “mercury” it had to be removed and replaced with something else.”

The CDC and the health care sector are the ones who did such a great job of educating people on the dangers of mercury. It then became difficult to tell pregnant women that there is absolutely no danger to the ethyl mercury that was in children’s vaccines at levels beyond what the EPA deemed to be safe – people heard “mercury” and tuned out “different formulation that other mercury, leaves the body faster.” As per the CDC, these are the ingredients in one of the formulations of the DTaP virus today:

“aluminum phosphate, formaldehyde, glutaraldehyde, 2-Phenoxyethanol, Stainer-Scholte medium, modified Mueller’s growth medium, modified Mueller-Miller casamino acid medium (without beef heart infusion), dimethyl 1-beta-cyclodextrin, ammonium sulfate”

That’s an alarming list of ingredients to be injecting into your tiny baby! And that’s in just ONE of the vaccines a baby can expect to receive in one doctor’s visit. At 2 months, the schedule calls for the infant to receive eight different viruses. As a parent – one who believes in the value of vaccination – that makes me uneasy. The medical establishment has done NOTHING to calm those fears.

You can diss anti-vaxxers all you want, but there is that sticky fact that vaccines contain things that we are warned are very dangerous (now I wonder what the hell is: “modified Mueller-Miller casamino acid medium (without beef heart infusion).”

The oft-made official statement that “there is no harm to any of this” is clearly not accepted by many people – particularly when there seems to be an increase in alarming health care issues concurrently with the increase in vaccines added to the schedule. Rather than dump on the anti-vaxxers, medical professionals should be looking for ways to communicate their message about the value of vaccines in ways that help to assuage the valid and powerful fears people have about these shots. I don’t see that happening.

MSM,

The medical position has never been that “there is no harm to any of this”. Herbalists and such may believe, or at least tell the general public, that their potions are harmless because they are “natural” or some such nonsense, but physicians have it beat into them that no medication is harmless. The capacity, often great capacity, to do often great harm, is exactly why a given agent is put under prescription control, so that someone familiar with the risks posed by any medication can balance those against the benefits.

We don’t vaccinate, and in many cases mandate vaccination, because vaccines are harmless and without risk. We vaccinate because the benefits outweigh the risks. This can’t be estimated with great precision, because mortality statistics were not kept so well in the pre-vaccine era, but child mortality, the risk of death by age 6, was close to 50% back then.

Imagine all the children you know in a group. Then mentally put an X through half of them, and imagine them gone forever. I’m not even asking you to imagine the manner of their leaving us, just their absence. That’s the message about the value of childhood vaccination. It’s rather unwieldy, as it involves thinking about dead children. But it isn’t really very technical. It’s entirely empirical.

The answer to the sorts of facts you bring up about the scary nature of this or that ingredient in vaccines is the same, empirical. Vaccinate and you get bad results on a one in a million basis. Don’t vaccinate and you get 50% of children dead by age six. You don’t need to understand anything about the mechanics of how vaccines work, or what’s in them, including the theoretical risk posed by some of the ingredients. You just need to look at results.

The issues you raise have absolutely no bearing on whether or not to vaccinate, or whether or not to make a given vaccination mandatory, because the observed results are so one-sided. Take the most out-sized estimate of the risks of every one of your scary ingredients and pile them up, and it doesn’t come close to the size of the benefit.

The risk of side effects is of course not therefore irrelevant. Of course even very rare adverse effects of vaccines, as of any medication, need to be prevented as much as possible by responding to any side effects observed by improving the vaccines. I think they also need to be improved by finding alternatives to the needle, making their administration less traumatic to young children who don’t understand risk/benefit analysis, but just know that some terrifying adult in a white coat wants to poke a needle into them. But none of these concerns are relevant to the question of whether to vaccinate and to require vaccination of others.

You were explicit, Main Street Muse, that it was an alarming list of ingredients. Not strawmanning; pointing out the absurdity of a fear of a list of chemicals. That said, I’m sure the worry that vaccines contain chemicals (gasp!) play a role in many people’s distrust of them, not just yours.

Public opinion researchers have made the point that public campaigns of myth-busting and fact-checking only work before a fact has become integrated as part of ones’ group identity. After that point, being confronted with contrary facts, with or without shaming or antagonism, is just as likely to strengthen a false view.

I read somewhere today that one conclusion was to begin NOW a pro-pasteurization campaign before the growing hipness of raw milk becomes a thing (a disproportionate degree of food-born illnesses result from consuming raw milk).

This would suggest that, if we want to be free of measles to a greater degree than would be provided by a negative feedback loop triggered by measles infections themselves (as Ben describes @ 12, we should just make them compulsory for those who want to participate in society: at this point in time, persuasion would have little chance of success.

If there’s any robust social science on how to build trust and solidarity among people…(maybe those experts could go to work for Elizabeth Warren ’16?)

49, 52, 53:
The argument made here is I believe wrong-headed and I am certain is ineffective. People are worried about “unnatural” “chemicals”. Smug scientists respond that everything contains “chemicals” and that plenty of poisonous substances are “natural”. Of course technically that is true but frankly it’s not gonna win any hearts and minds. Even if most people have trouble expressing the concept scientifically, there is a legitimate difference between worrying about substances that we have collectively known for thousands of years, and worrying about the hundreds of thousands of synthetic chemicals that have been developed only in the last century and the vast majority of which have never been properly tested for their toxicity on humans.

Re the 50% claim: that is completely bogus and again is only going to backfire. The dramatic reduction of child mortality that occurred mostly in the last century has little to do with vaccination (or indeed any other medical advances), it is overwhelmingly due to improved nutrition and sanitation. Overstating the benefit of vaccination is not a good strategy.

#57 Neil

“People are worried about “unnatural” “chemicals”. Smug scientists respond that everything contains “chemicals” and that plenty of poisonous substances are “natural”. Of course technically that is true but frankly it’s not gonna win any hearts and minds. Even if most people have trouble expressing the concept scientifically, there is a legitimate difference between worrying about substances that we have collectively known for thousands of years, and worrying about the hundreds of thousands of synthetic chemicals that have been developed only in the last century and the vast majority of which have never been properly tested for their toxicity on humans. ”

I’m sorry but that’s bollocks. They’re the same chemicals. And whether a particular compound had been around for thousands of years or was synthesized last year had no bearing on its toxicity. The only relevant difference is the new compound is much more likely to have been exhaustively tested for toxicity.

Something which has been around for thousands of years will typically come from plants, and people will mostly not eat it. In each culture there will be a few plants that are known to be very poisonous (and maybe useful for that). Some that are considered safe after some known treatment. And then there’s everything else which people mostly avoid eating on general principle.

There are many millions of recent human-produced organic chemicals. Most of them have not had all that much testing. Very few of them have been tested on pregnant women — usually there is a warning that pregnant women should avoid them.

Hormone analogues are a big deal. We can’t predict which things will be human hormone analogues because we haven’t discovered all the human hormones yet. Have we started releasing something generally that is a hormone analogue for honey bees? Who knows?

If we were prudent we would ban use of all but a few new chemicals where they can contact human beings or where they can get into living ecosystems for a couple hundred years, until we get a better idea how to test for the harm they might do. Allow new medicines in reasonably small quantities after testing. Most of the rest of it, arrange a global ban for now.

But we are not prudent at all that way, but a lot of people are starting to get disquieted. They increasingly disbelieve you.

I know that I should just let this go, but…

The concern about Thiomersal was relatively well-motivated, as public scares go, and doesn’t reduce to general fears about chemicals. Mercury is not dismissible as some general kind of scary-sounding chemical name that you’d find in a blueberry. It’s a well-known neurotoxin if anything is. As late as the late 1990s, no one had any real, scientifically well-studied idea of how serious this ethylmercury exposure was. There are significant aspects of this kind of exposure that aren’t really well understood now.

The CDC’s response, properly in my opinion, was to ask vaccine makers to remove thiomersal from vaccines as a precautionary measure. That was pretty quickly done. WHO, also properly in my opinion, allowed countries that aren’t as affluent to keep using thiomersal in vaccines, because without it you need to refrigerate the vaccines, and not all countries can afford to do that.

So it wasn’t all some big unmotivated scare, not unless you’re willing to include the CDC in it. Things worked pretty much as they are supposed to. People should, at this point, go back to fully trusting vaccines, especially since they no longer have thiomersal in them if you’re in an affluent country (and if you’re not, your chances of getting disease are on average higher and it’s worth risking the thiomersal). But it’s not surprising that parents wanted to reduce risk for their children as much as possible, and picked out the mercury that then was in vaccines as a possible and provably removable source of this risk.

A particular concern — as was the case with Thiomersal in vaccines — whether correctly handled by the relevant authorities or not — just blends in the general noise-level, which contains controversies, some of which may not be well-handled, or the resolution of which may not be clear at all. There will be well-credentialled folks handed microphones to pooh-pooh even well-founded threats and failures of supervision. Scientists may well be attacked by well-funded industry researchers to further cloud the science.

If a flu vaccine formula fails, or a flu vaccine has to be re-called or a flu vaccine factory shuttered, those events flow into the background of anyone trying to think about the MMR vaccine or any of the 13 other vaccine bundles now on the CDC recommended list.

And, all of that blends into the further torrent of information or misinformation, much of it about diffusely invisible harms. What are the chances that your cellphone will contribute to the incidence of a rare form of brain cancer? What are the chances you will be affected by radiation released by the Fukushima accident? Will chemicals leaching from plastic bottle or old plumbing or a tin soup can affect your health?

Neil 57: “The only relevant difference is the new compound is much more likely to have been exhaustively tested for toxicity.”

Unfortunately that’s wrong [you may think of drugs which do undergo tests but I was referring to synthetic chemicals in general, most of which are released into the environment without ever being tested for potential harmful effects], and it is precisely the kind of BS that will undermine your credibility with most of the public, just as Glen’s completely baseless claim: “Don’t vaccinate and you get 50% of children dead by age six.” When this is the quality of the pro-vaccination discourse, it’s hardly surprising there is widespread skepticism.

#65 Neil

Shorter TM. Because there are compounds that are released into the environment without extensive testing, we should be suspicious of those that have been tested extensively.

No. But we need much stricter quarantines. Do not produce anything new in large quantities until it has been tested extensively. Allow things that test as harmful only with very careful controls. More draconian controls on things that do not biodegrade easily than those that do.

Something that could have unknown biological effects, that could get concentrated by biological processes to create those effects in unknown circumstances? That could remain in the system for centuries or millenia? We don’t know the risks. Use it only when the benefits are extremely high.

I don’t mean to be trolling. Tell me how I have misinterpreted you. The discussion topic was and remains vaccination (you take me to be an egregious example of the low quality of “the pro-vaccination discourse”. But your claim concerns “synthetic chemicals in general”, which you say haven’t undergone testing. I pointed out that whether or not chemicals in general have undergone testing is not relevant to whether vaccines are safe. I am ready to be enlightened.

Neil, if you want to get away from new synthetic chemicals and back to vaccines, that’s fine with me.

Vaccines are mostly safe, particularly when you don’t take too many of them at too short an interval.

We don’t create vaccines unless there is a problem that looks like it’s worth a vaccine.

A successful vaccine makes the problem mostly go away in the short run. If it’s something like smallpox where as far as we know there is no reservoir apart from infected humans, a worldwide vaccine program might eradicate the disease forever.

But usually when the disease stops being a problem people want to quit using the vaccine. This is the same instinct as a sick person who stops taking his antibiotic when he starts feeling better.

On the side there are the scientific issues. Each vaccine is tested mostly in isolation, we know the health effects of any one vaccine are small and subtle. What about the effects of all of them put together?

There are rare serious effects, that can show up in the statistics because so very many people get vaccinated. Is our current level of vaccination worth those rare problems? If you look at the current levels of those particular diseases — low because of vaccination — the answer would look like no. But if we don’t vaccinate enough, maybe we’ll get new epidemics.

My natural thought is to do the experiment. OK, people don’t want to be vaccinated, then let them go without. When we get an epidemic then they will decide vaccination was a good thing after all. Or if we don’t then no problem. This is an experiment that normally we would not be allowed to do. No Human Use Committee in the country would allow it. But the test subjects not only volunteer, they are ready to sue to be research subjects! Let them do it and keep careful records.

In the long run we might create attenuated strains of various diseases and spread them naturally. This is far cheaper, and we don’t have to worry about people refusing to get infected. Today it’s basicly a science fiction idea, but there’s nothing to stop it except that this year people wouldn’t want it.

Neil, this was in part a response to your 49. My point was and is that this kind of reasoning isn’t going to convince. People evaluate the chemicals of which blueberries are composed differently than the chemicals produced by industry and medicine, and that attitude is entirely reasonable.

#71 Neil

There has already been discussion about why the experiment you propose is unethical

Yes, but if we can’t stop it, we may as well relax and enjoy it. And keep the best records we can.

Wanna talk fear factor? 100 people have measles in 14 states. One hundred people in a country of 316 million. And half of that group was infected at Disneyland. Can’t make this stuff up!

What’s the history of measles? Here’s what the CDC has to say… (http://www.cdc.gov/measles/about/history.html)

“In the decade before 1963 when a vaccine became available, nearly all children got measles by the time they were 15 years of age. It is estimated 3 to 4 million people in the United States were infected each year. Also each year an estimated 400 to 500 people died, 48,000 were hospitalized, and 4,000 suffered encephalitis (swelling of the brain) from measles.”

In articles I’m reading today, news media is comparing measles (once a common childhood disease) with ebola – remember ebola? A few months ago, we were all gonna die of ebola from the African visitors.

There is a level of hysteria on BOTH sides of the vaccine debate that is curious – and damaging.

I am a parent who has fully vaccinated my children – but quite frankly, the number of viruses the CDC wants injected into small babies is very high. It creates alarm bells in many, many parents – that, coupled with the alarming incidence in things like autism, asthma and allergies create a climate of fear. The language of the health care officials is failing to assuage the fear. We can bash the anti-vaxxers all we want OR we can try to figure out how to reach them in ways that help them understand the value of vaccines. The health care sector is failing in that regard.

And to say that the formaldehyde in vaccines is the same as that found in pears is not helping.

The CDC shrugs off reports of vaccine injuries – yet I know at least two people who claim their child was seriously injured by vaccines. To simply call them insane, crazy, stupid – that’s a failed way to argue with parents of very sick or dead children.

The incidence of autism (says the CDC) is now 1 in 68 children. They have no reasons (other than reclassification of autism) for the increase. Do you remember so many children with such profound issues? I do not. Yet today I know a number of parents struggling to care for children who are profoundly autistic (not just on the spectrum.) In the face of this very compelling health care crisis, we’re screaming about the 100 people who have measles.

Vaccines are not harmful, says the CDC – but most of their studies are behind a paywall and consumers cannot read them. Who’s the control group in these vaccine studies? Aren’t most American children vaccinated? Are control groups not needed to assert the safety of vaccines? That so many people have such distrust of the health care establishment is a serious health care problem – one that bashing anti-vaxxers will do little to solve

“but quite frankly, the number of viruses the CDC wants injected into small babies is very high.”

Vaccines are not viruses.

What, specifically, do you want the CDC to do? People believe all sorts of stupid things for all sorts of stupid reasons, and it’s not really obvious how to change that. Vaccine proponents seem to be doing better than, say, climate scientists, at getting people to believe good science.

temp @78

It’s funny, you get the same sort of pushback for saying what is and isn’t supportable with climate change. It’s basically the kind of argument people aligned with Pielke Jr. push, that it’s all just so contentious that we might as well give up on talking about it and suggest policy good for climate mitigation without talking about climate mitigation. Very strange. Of course in a world where 15% get polled believing that the moon landings were faked no amount of sweet talk is going to convince some people. We can probably live with that with climate policy, not so much with 15% aren’t getting their shots.

What, specifically, do you want the CDC to do?

The CDC’s position is hard: there’s never going to be a way to address the autism crap such that people won’t look for the cause in chemicals they stick into their kids. The substances that make kids cry – as opposed to snack-cakes with cream-like filling – are obvious ones to pick on. If the CDC provides some evidence of vaccine efficacy (in a somehow nicer way) that’ll be picked at, yadda yadda, and they aren’t in the community: doctors and nurses are. It’s up to those people who can look you in the eye and say “this is the best thing you can do” to get the vaccination message across.

Homeopaths and naturopaths and various other quacks aren’t gonna help in that effort.

Rich, you are correct. Apologies for spreading misinformation.

“The CDC’s position is hard: there’s never going to be a way to address the autism crap such that people won’t look for the cause in chemicals they stick into their kids.”

Then the CDC is a huge part of why we have anti-vaxxers today. Shame on healthcare professionals who are incapable of explaining – in English – why injecting multiple viruses and chemicals into babies is a lesser harm than the illnesses that can come from not being vaccinated (unless, of course, you’re one of the unlucky vaccinated ones who comes down with the illness anyway.)

Again, 100 people have the measles as a result of this “epidemic” of measles. The level of hysteria over the measles is far out of proportion to the number of cases.

I think that’s quite unfair to the CDC and healthcare professionals. The (full) explanation is complicated. We rely on other people’s expertise for many things in our society, and sometimes you have to trust that the entire medical establishment is not in conspiracy to hurt your children.

Main Street Muse,

“The incidence of autism (says the CDC) is now 1 in 68 children. They have no reasons (other than reclassification of autism) for the increase. Do you remember so many children with such profound issues? I do not. Yet today I know a number of parents struggling to care for children who are profoundly autistic (not just on the spectrum.) ”

I read about a study a while ago that linked autism in children to mother’s high stress levels during pregnancy

“New research published in Molecular Psychiatry Tuesday night tested the amniotic fluid of 128 mothers whose children were subsequently diagnosed with autism and the fluid of 217 control mothers.
It has found five steroid hormone levels were higher on average in the mothers whose children were diagnosed with autism than in those whose children did not have the condition.
“These results provide the first direct evidence of elevated foetal steriodogenic activity in autism,” the authors say.
“The current results may also be relevant to the literature on prenatal stress and autism.
“We found that cortisol, a biomarker typically associated with stress, is elevated early in the foetal development of autism.””

for Matt @ 91 and any others on this thread suggesting that concern over the side- effects of vaccines is simply irrational (like being scared of “demons”) that’s a serious misunderstanding of the situation. One example was the early rotavirus vaccine that was withdrawn because of an increased risk of intussusception associated with it – http://journals.lww.com/pidj/Abstract/2006/01001/Intussusception_Among_Young_Children_in_Europe.4.aspx

Although, as noted in the article, intussusception is not usually dangerous if diagnosed early, it is very dangerous if not diagnosed within 48 hours. ( I declare a personal interest here – someone close to me was unlucky enough to be in this situation, although this intussusception was not related to the rotavirus vaccine)

The safety of vaccines is important and the effects of vaccines should always be closely monitored so that any serious side-effects can be identified.

The Temporary Name: “There’s a lot of information at http://www.cdc.gov/az/v.html regarding vaccines, and if anything the CDC should lie more: they’re honest and up front about potential side effects and it’s understandable (and disappointing and dangerous) that parents get freaked out about taking a step that’s a risk…if they bother to look at that stuff. But come on, they don’t.”

I realize that “if anything the CDC should lie more” is written for rhetorical effect, but no, they shouldn’t. It’s bad risk communication practice to misrepresent in that way.

I don’t think that I can really back up a bald assertion like that at the end of the thread, not without looking up a whole lot of risk communication cites. But basically, yes parents will check, and yes they can figure out if they are being lied to. Or rather, some parents will have the (minimal) expertise to check, and they will end up being opinion leaders or empowering opinion leaders. Industry can lie because they are expected to lie: if a medical device maker lies about their product, there is a scandal, but in some sense it is an expected scandal so it blows over. If the scandal is bad enough, the company may die and be replaced by another company employing mostly the same people. But the CDC can’t die and be replaced, and if governmental authorities start lying in such a blatant way, that trust doesn’t come back when you need it.

And it’s not necessary. The truth about vaccination is that if you compare risks, you should vaccinate. No misrepresentation need take place. And the arguments I’ve seen in this thread are bad, half-misreprentation arguments:

* (temp retracted this, thank you, but I’ll still use it as an example) “Vaccines aren’t viruses”. Yes, but the particular vaccines under discussion pretty much are viruses, or have them as the active component.

* Formaldehyde in pears. If you don’t know why this is an argument, it’s a misrepresentation. Yes, formaldehyde is in pears, but do pears have enough formaldehyde in them so that they don’t rot? Of course not. But why is formaldehyde in vaccines? To kill microbes. So you’d think that there would have to be a whole lot higher concentration of formaldehyde in the vaccines than in the pears.

There isn’t, because they put the formaldehyde in the vaccines at high concentration, then they take it out or dilute it depending on the manufacturing process. So what’s left is not especially high concentration. Two seconds Google: vaccines in the U.S. have 0.1 mg of formaldehyde per dose (or, most often, much less), apples have 6.3 – 22.3 mg / kg. (Pears have 38.7 – 60 mg / kg, which is why people use that comparison, but why? The comparison with apples equally well makes the point, and you’re just piling on and picking an example that sounds strained.) One apple is maybe 1/3 pound, or 0.15 kg, so an apple has a minimum of 6.3 mg / kg x 0.15 = 0.9 mg of formaldehyde, nine times more than a vaccine with the most formaldehyde.

* Everything has scary chemicals in it. OK, but so what? This will not say anything to the people who actually check what you’re doing, and those are the ones who you have to convince as part of any communication.

* Without vaccination, lots of people die. Again, kind of misleading. Is someone speaking against all forms of vaccination? If so, OK. But people generally don’t: they generally pick on one vaccine, one ingredient, or have a general sense that there are a lot of vaccines and maybe they have a cumulative effect. In which case, if you can eliminate that ingredient and still have the vaccines (as with thiomersal) “lots of people will die” is false (if you’re in an affluent country). If someone is talking about cumulative effect, would lots of people still die if children took only the 5 most important vaccines? Yes, some would die, but you wouldn’t return to 19th century levels of mortality.