it’s a small world

by Eric on January 29, 2015

California’s measles outbreak has now reached more than 70 cases. 1

Populations especially at risk are those born after 1957 and vaccinated between 1963-1967 or not vaccinated. People born before 1957 would have been exposed to measles naturally and are ok; those not exposed to the virus in the wild will be vulnerable. People vaccinated 1963-1967 might have got the “killed virus” vaccine, which the Centers for Disease Control now say is ineffective, and they will be vulnerable.

Unvaccinated people will be vulnerable2 for what ought to be obvious reasons.

California permits unvaccinated students to enroll in public schools if their parents file a form saying their beliefs do not permit vaccination.

The percentage of unvaccinated students in Sacramento-area schools is over fifty percent in some cases.

As the historian Robert Johnston remarks, scholars used to treat anti-vaccination activists as “the deluded, the misguided, the ignorant, the irrationally fearful” but now they command ‘If not sympathy, at least a modicum of respect.”

I suppose we should respect those whom we can rationally fear.



1This is the outbreak that the press keep saying, correctly if punctiliously, began at “Disneyland Park and Disneyland California Adventure,” as if there were some important meaningful reason they couldn’t say “Disneyland”; Disneyland is offering a pretty good discount right now, by the way.

2Rich Puchalsky, I think correctly, points out in comments that all are potentially vulnerable once we drop below a percentage where we have “herd immunity.”

{ 95 comments }

1

Rich Puchalsky 01.29.15 at 6:14 pm

I’m not really sure if I agree with some of the language in this post about who is vulnerable. I realize that it’s a short post, but it presents a binary between vulnerable and OK. As I understand it, “immune” is a medical term of art, but people who should be “immune” do actually sometimes contract the diseases that they should be immune to. They just contract them at a far lower rate. So a lot of the protection from diseases of this type is herd immunity: disease outbreaks die out because enough of the people exposed are “immune” so that the disease doesn’t have enough hosts to make it spread effectively.

I bring this up because I’ve often seen a kind a pseudo-libertarian sentiment that one shouldn’t care about whether other people are vaccinated — after all, one can get vaccinated oneself, and then their decision doesn’t affect you. But because of herd immunity, it does: even if you are vaccinated, if enough of the people around you are not vaccinated, you can still run a reasonable chance of getting the disease.

2

Eric 01.29.15 at 6:24 pm

I think you’re right, Rich.

3

BJN 01.29.15 at 6:57 pm

I don’t think the statement about “herd immunity” is correct. The vaccine won’t take in a certain percentage of the population (0.4% if you get two shots I think) no matter what. Herd immunity just means the rate at which there will be ongoing transmission between those who are not immune, whether from not getting the immunization or from the vaccine failing in you. If you got the vaccine and your body seroconverted, then you aren’t more or less at risk based on the immunization around you.

Ongoing transmission is important because those too young to be vaccinated and those whose bodies didn’t take up the vaccine are at risk when they wouldn’t really be otherwise, but if we are going to hate on scientific illiteracy, lets be precise in our language.

4

Rich Puchalsky 01.29.15 at 7:15 pm

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.

5

BJN 01.29.15 at 7:26 pm

This is perhaps being overly pedantic, but my only point is that we aren’t “all” at risk once herd immunity is breached. Some people experience primary vaccine failure, meaning that the body never reacts to the vaccine as injected. Some people also experience secondary vaccine failure, meaning that while they were immune for awhile, their body eventually stopped producing antibodies. This is what was referred to with the killed virus vaccine being ineffective: not that it didn’t provide immunity (not sure about primary conversion rates), but that the immunity waned over time.

All I was trying to say was that while a lack of herd immunity means that the virus will be able to continually jump from non-immune person to non-immune person in the population, whether for lack of vaccination or due to vaccine failure, it’s not as though those of us producing measles antibodies will be at risk.

6

Murc 01.29.15 at 7:34 pm

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.

7

MPAVictoria 01.29.15 at 7:44 pm

Anti-vaxers are some of the stupidest people in our public discourse right now. And that is saying something.

8

Rich Puchalsky 01.29.15 at 8:00 pm

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%.

9

Neil 01.29.15 at 8:21 pm

The New York Times reports that the Marin county health officer has the power to exclude unvaccinated children from schools, but that he believes that this should not be done until after there has been a case of measles in the school. Presumably he believes that stable doors should always be shut once the horse has bolted.

http://www.nytimes.com/2015/01/29/us/father-of-boy-with-leukemia-asks-california-school-officials-to-bar-unvaccinated-students.html?_r=1

10

Omega Centauri 01.29.15 at 8:22 pm

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.

11

Ben 01.29.15 at 8:23 pm

Rich is correct, as far as he goes, but he doesn’t follow the logic all the way.

With herd immunity, nobody is at risk more than trivially. Without herd immunity, vaccinated people are at low risk (in aggregate), and unvaccinated people are at high risk. Clearly it is in everyone’s interest that we attain herd immunity, which occurs at about 80% ish vaccination levels (depending on loads of stuff). If there is no herd immunity? Get vaccinated. Vaccinate your children.

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).

It doesn’t follow that it is necessary or desirable to have compulsory vaccination however, which is I think where the “libertarian” boogie-word comes in. But the reason is more complicated than Rich gives credit for.

Firstly, once herd immunity is attained (with a margin for doubt, say 90% vaccination) there is no longer any justification for inflicting the side effects (inevitably in a group there will be some people who suffer) on the remainder of the population. Nobody will benefit, so at this point it’s not even like refuseniks are being selfish – there is actually no point.

Second, when herd immunity is not attained, there is little difficulty persuading people, since in that scenario the benefits of vaccination are clear, and self-interest is enough. You do have to do some, you know, work, and actually write to people, have letters sent home from school, appear on local TV news to remind people how many thousands of people used to die of or be terribly disabled by measles. But it works, and here in the UK we don’t have compulsory vaccination, and information campaigns when herd immunity dips to danger levels are all that is actually required, not compulsion. Voluntary action, when given accurate information, is sufficient.

Thirdly, those who refuse, the holdouts, are those who feel for a variety of reasons that they have most reason to refuse. Some are simply awkward, or have irrational reasons. And since we all love science we despise such people /snark. But if blood relatives have reacted badly to measles vaccine in the past you are correct to think you are more at risk of side effects yourself, even if you cannot explain why, since the immune system is highly heritable. And heck, even if you just don’t like the idea, or are afraid of needles, you still suffer more disutility from vaccination than someone who doesn’t really mind. So actually, allowing the 10% non-vaccinated people to self-select is the best way, rather than having random enforcement of compulsory vaccination until funding is withdrawn, as of course it always is as soon as herd immunity is obtained.

So I am all for vaccines, I have them and so do my children but there is no need for compulsory vaccination, and as argued above compulsory vaccination is actually inefficient both in the usual and in the economic meaning of the word.

12

Sasha Clarkson 01.29.15 at 8:35 pm

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!

13

Patrick 01.29.15 at 8:42 pm

Ben- if your arguments were actually both cogent and accepted, we would forever hover at an equilibrium point between herd immunity and catastrophe, with the very castigation of non vaccinators that you want to avoid as the only thing pushing us to the better side of that line.

Fortunately, your position is neither.

14

Ben 01.29.15 at 8:43 pm

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

15

BJN 01.29.15 at 8:49 pm

“Herd immunity” is a product of R0 (R-naught), meaning the average number of people that one infected person would cause to become infected in the absence of immunization. Obviously, the word “average” there is doing a lot of work, and variation in environment, hygenic practices, population dynamics like age structure among many other things are going to change that. 80% is on the very low end of estimates for measles and only under some circumstances, with 92%-94% being the more commonly cited figure. Measles in particular is one of the most infectious diseases around, which was why it was targeted for elimination in the first place

We are always going to have imported cases until the disease is eliminated globally. Considering that the people most likely to be affected by short transmission chains when we are hovering on failing herd immunity (the immunocompromised, the very young) are exactly those who most need protection from the disease, I woudn’t be blase about just sending some letters around once we have a full blown epidemic brewing. Sure, we may not be able to always reach 100% of people, but when you have very significant numbers of unvaccinated people clustered together, like we have in Southern California, then I would say yes, we really do have a problem that needs dealing with.

16

Ben 01.29.15 at 8:55 pm

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.

17

Rich Puchalsky 01.29.15 at 8:59 pm

Ben: “With herd immunity, nobody is at risk more than trivially. “

I don’t think that this is true. Specifically, it depends on what you mean by the word “trivially”. Someone who has not been vaccinated is always more likely to get a disease than someone who has (on average), whether the area has good herd immunity or not. The question is whether this added risk of disease is trivial. My understanding is that the risk of not being vaccinated even in an area with good herd immunity is well above the risk of having a bad reaction to vaccination. (Again, this is on average. If some people have good reason to believe that they in particular will have a bad reaction to a particular vaccination, they should clearly not go by averages. But this seems like something that they should talk to their doctors about.)

18

Harold 01.29.15 at 9:13 pm

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.

19

Ben 01.29.15 at 9:19 pm

@BJN #15, the process I described is one of constant vigilance, not blasécite (?blasécence? corrections sought).

We have occasional local outbreaks, with a few tens of cases followed by local information and immunisation campaigns, including the full spectrum of media as I described, not “just sending some letters around”.

I agree that an unvaccinated cluster is “a problem that needs dealing with” which is why I described the process of dealing with it.

If you think to “always reach 100% of people” is a valid goal I don’t know what to say other than that I went to lengths to explain why it isn’t, and in the simplest language.

20

BJN 01.29.15 at 9:33 pm

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.

21

Lynne 01.29.15 at 9:43 pm

Two families near me don’t vaccinate their children. When I was talking to one of the fathers I said, “Well, I guess we can support a certain number of free riders”. He did not like that term, but I think it’s accurate. I wonder whether he would vaccinate his children if they lived in a place that was a hotbed of diseases that can be vaccinated against, but he doesn’t. We have good vaccination rates here.

That said, I think the medical profession and the media are to blame for people’s distrust of vaccines. When I was agonizing over whether to give my first child his shots (diphtheria, pertussis, typhoid and ?) it was because the news was full of reports of children who had been damaged by this vaccination. It was also in the news that the shot contained mercury. So I was concerned, and really wanted to know how to tell if my baby was having a bad reaction to the shot. The doctor just yelled at me, “Get the shot!” Literally. No discussion, no telling me what to watch for, what was a normal reaction and what might be a sign of a bad reaction.

And the way the flu shot is rammed down our throats (so to speak) every year is enough to make anyone skeptical. However, just because the medical system is patronizing doesn’t mean immunization can’t be a good and life-saving thing, so my children received all their mandatory shots, plus a meningitis shot when there was a terrible local outbreak.

22

Ben 01.29.15 at 10:03 pm

@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.

23

Peter Erwin 01.29.15 at 10:42 pm

@ Lynn
I 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?

… the way the flu shot is rammed down our throats (so to speak) every year is enough to make anyone skeptical.

If you weren’t aware that the flu typically kills somewhere between 20,000 and 30,000 (sometimes more than 40,000) people each year in the US alone, then perhaps…

24

J Thomas 01.29.15 at 11:04 pm

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.

25

Ben 01.30.15 at 12:00 am

@JThomas, it’s certainly not crazy, but since most (>99%) people are OK with the vaccine, and the best case is a test with a fair number of false negatives it might not be cost-effective.

In related news there is a story out right now about the Polio vaccine in India, which is a heck of a lot more complicated….

Short story: As of 1908s, about 75% of cases (my estimate) of acute flaccid paralysis in India were caused by poliovirus. Now, with polio on the point of eradication, cases of AFP are down from 200,000 PA to 47,000 PA… But. When Polio accounted for the majority, ***all*** cases of AFP were diagnosed as polio (because why not! This didn’t matter at the time because there was nothing to be done either way). But. now polio is nearly eradicated, definitive antibody and PCR tests are being done, and we find that nearly all current cases of AFP are non-polio!

Headlline: Non-polio paralysis up from zero to 47,000 PA!!!!

I hope you can all see what is wrong with that headline. If you can’t you are an idiot but I will explain anyway because I enjoy it. The previous “Polio” figure was “presumed polio” but included all cases of AFP, whether caused by poliovirus or not. The New figure only includes actual poliovirus involvement proved by antibody or PCR tests. So obvs., comparison is not to the point, as the figures are not collected on the same basis. So: Whut?

The first-order conclusion is that the previous “polio” figures were only about 75% poliovirus, and 25% “other”. (The current figures, being based on more reliable tests, are more accurate, and therefore should be used to re-interpret the older figures which were based on rubbish tests which we knew were rubbish then but had nothing better, so give us a break).

So: Is it “since evil Bill Gates’ polio campaign started, non-polio flaccid paralysis is up t 47.000 cases PA”? or is it “Since philanthropist Bill Gates’ polio campaign, total acute flaccid paralysis is down from 200,000 cases PA to 47,000 cases PA”?

Which?

26

Ben 01.30.15 at 12:07 am

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.

27

J Thomas 01.30.15 at 12:15 am

#25 Ben

@JThomas, it’s certainly not crazy, but since most (>99%) people are OK with the vaccine, and the best case is a test with a fair number of false negatives it might not be cost-effective.

If you get a cheap test that doesn’t have many false negatives, it can easily withstand 2% false positives or depending on the herd immunity needs even 5%.

If it were to turn out that it’s one or a few HLA combinations that result in most of the bad results, then a cheap HLA test which detects those combinations would be all you need. Of course it might turn out that the problem is more complicated and can’t be settled by an easy test. But in the best case that would work.

28

Collin Street 01.30.15 at 12:31 am

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.]

29

harry b 01.30.15 at 2:25 am

Is the problem people are having with Ben’s optimism contextual? He says

*when herd immunity is not attained, there is little difficulty persuading people, since in that scenario the benefits of vaccination are clear, and self-interest is enough. You do have to do some, you know, work, and actually write to people, have letters sent home from school, appear on local TV news to remind people how many thousands of people used to die of or be terribly disabled by measles. But it works, and here in the UK we don’t have compulsory vaccination, and information campaigns when herd immunity dips to danger levels are all that is actually required, not compulsion. Voluntary action, when given accurate information, is sufficient*

My understanding of the UK is that’s true. But my understanding of the US is that i) the level of distrust of government in some communities is staggering; and the capacity of government to do high quality public education around public health issues (or, for that matter, just education of anyone about anything) is low relative to that of the UK government. So it is much more dire when we’re below herd immunity.

I had the vaccine twice, then got the disease (so I’m told, I was a kid, I do vaguely remember it, as one of the many diseases I got). My kids have all been vaccinated.

30

Main Street Muse 01.30.15 at 4:12 am

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.

31

dsquared 01.30.15 at 5:18 am

It is also interesting that the anti-vax movement is supposedly the result of the Wakefield study. However, is that really true?

Interestingly, it isnt’. Vaccine take-up is often a lot lower than you’d think, and the measles one has had takeup problems since it was invented, for reasons that aren’t very well understood at all. (I totally disagree with Ben when he says that whatever we do in the UK “works”, btw – there are big takeup problems in a lot of areas, particularly in London).

What amazes me is that vaccination is the one area of public health where it is still (apparently) assumed that you catch more flies with vinegar than with honey, and that the best way of marketing to people is by scolding them, the louder the better (and by using phrases like “herd immunity”, not exactly an ad man’s dream). 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, and by tailoring communication to reach the people who need to be communicated with.

All too many people talking about vaccination programs don’t seem to have got this message and think that they’re helping by saying nasty things about Jenny McCarthy. This doesn’t apply to the people on the ground, by the way, to anything like the same extent. There’s a lot of very interesting literature, by the way, contained in the MMR strategy documents that nearly every health authority in the UK produces.

32

dsquared 01.30.15 at 5:20 am

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.

33

Helen 01.30.15 at 6:25 am

IANAS, but apparently the “mercury” in Thimerosal was completely harmless because of having a completely different chemical structure, much as eating chlorine via salt on your chips is more harmless (in that dose anyway) than having a teaspoon of chlorine bleach. However the anti-vaxxers had everyone so panicked about “mercury” it had to be removed and replaced with something else.

34

Peter Erwin 01.30.15 at 11:09 am

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”.)

35

Peter Erwin 01.30.15 at 11:46 am

Helen @33:

As I understand it, thiomersal/thimerosal breaks down to form ethylmercury, whichcan be toxic in significant doses. However, ethylmercury is eliminated by the body much faster than methylmercury (the form of organic mercury contamination which bioaccumulates in fish, for example), which is why the small amounts of ethymercury used as a vaccine preservative aren’t harmful. The initial fears about thiomersal in vaccines were based on extrapolations of methylmercury’s behavior.

36

Katherine 01.30.15 at 2:50 pm

“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?

37

Haftime 01.30.15 at 3:38 pm

d2 – are you sure that Wakefield didn’t have an effect?
http://www.hscic.gov.uk/catalogue/PUB14949/nhs-immu-stat-eng-2013-14-rep.pdf
page 36.
The original paper was published 1998.

38

TM 01.30.15 at 3:46 pm

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?

39

Randy McDonald 01.30.15 at 3:54 pm

“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. “

That is so completely ignorant. Measles killed hundreds of people a year in the United States until the onset of vaccination.

http://www.iayork.com/MysteryRays/2009/09/02/measles-deaths-pre-vaccine/

40

TM 01.30.15 at 3:59 pm

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

41

Minnow 01.30.15 at 4:01 pm

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

Seriously? It has been explained several times upthread in terms of herd immunity effects.

42

Brian Weatherson 01.30.15 at 4:02 pm

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.

43

TM 01.30.15 at 5:22 pm

I get it that the vaccine isn’t 100% effective but can we have this more specifically? How substantial is the risk we are talking about, and is it really worth the attention now being focused on it?

44

BJN 01.30.15 at 6:56 pm

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.

45

John Quiggin 01.30.15 at 10:35 pm

I can also remember, back in the day, that no one very much worried about car crashes. After all, everyone drove, and only a relative handful got killed. No need for drastic impositions on civil liberties like seat belt laws and breath testing.

This changed in Oz much earlier (around 1970) than in the US, AFAICT.

46

Glen Tomkins 01.31.15 at 6:29 am

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.

47

Rich Puchalsky 01.31.15 at 2:17 pm

BJN: “Primary vaccine effectiveness after two doses is 99.6%. I’m not sure where the 97% number that Rich found earlier is coming from”

Well, I linked to the source that I got it from, but I assume that BJN means “why does that source at the CDC claim 97%”. I don’t know. One of the possible reasons that BJN didn’t mention is genomic differences between vaccine virus and wild measles virus. Another possible difference might be that some sources suggest a higher efficiency for monovalent as opposed to trivalent vaccines. (Also see here.) (I looked at this a bit more because I’m interested, but of course anyone reading this comment should realize that it’s from a random person on the Internet with no medical training doing Google searches, and should not be treated as medical advice.)

48

Main Street Muse 01.31.15 at 2:22 pm

“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.

49

Neil 01.31.15 at 2:29 pm

@ Main Street Muse.
Yes, pretty scary ingredients. How about this? You wouldn’t want to put this in your body, now, would you?

Ingredients: Water(84%), Sugars (10%) (Fructose (48%), Glucose (40%), Sucrose(2%)), Fibre (24%) (E460, E461, E462, E464, E466, E467) Amino Acids (Glutamic Acid (23%), Aspartic Acid (18%), Leucine (17%), Arginine (8%), Alanine (4%), Valine (4%), Glycine (4%), Proline (4%), Isoleucine (3%), Serine (3%), Threonine (3%), Phenylalanine (2%), Lysine (2%), Methionine (2%), Tyrosine (1%), Histidine (1%), Cystine (1%), Tryptophan (<1%)), Fatty Acids (<1%) (Omega-6 Fatty Acid: Linolenic Acid (19%), Oleic Acid (18%), Palmitic Acid (6%), Stearic Acid (2%), Palmitoleic Acid (<1%)), Ash (<1%), Phytosterols, Oxalic Acid, E300, D306, (Tocopherol), Thiamin, Colours (E163a, E163e, E163f, E163a) Flavours (Ethyl Ethanoate, 3-Methyl Butyraldehyde, 2-Methyl, Butyraldehyde, Pentanal, Methylbutyrate, Octene, Hexanal, Styrene, Nonane, Non-1-Ene, Linalool, Citral, Benzaldehyde, Butylated Hydroxytoluene (E321)), Methylparaben, E1510, E300, E440, E421 And Fresh Air (E948, E948, E290).

It's a blueberry.

50

Glen Tomkins 01.31.15 at 6:26 pm

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.

51

Main Street Muse 01.31.15 at 10:12 pm

“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.”

Actually, they DO have significant bearing on whether or not people vaccinate. There is a fear factor that is not being addressed by the health care community. People who were vaccinated came down with measles in the Disney outbreak. Most people get vaccinated because they believe they become immune – I myself have never been informed that a particular vaccine is only X percentage effective – every doctor has suggested that with the vaccines comes immunity. Now thanks to Disney, I know that vaccines are kind of a crapshoot – pretty good odds, but there is the chance of failure as well.

And you also ignore the fact that the anti-vaxxers (and please note, I am not one of them!) ask people to imagine dead and damaged children as their reason for not vaccinating. Vaccines DO come with risks – and parents who’ve dealt with the downside to the risks become vocal opponents to vaccines – and their sorrow/outrage/anger often falls on fertile ears. (As with any medical procedure that is not without risk, vaccine injuries DO happen, but many are not reported to the CDC.)

“Don’t vaccinate and you get 50% of children dead by age six.” What’s the source for this claim? Would love to see it. Where/when did half of unvaccinated children die prior to the age of six?

Is there formaldehyde in the blueberry? Didn’t think so… nice straw man there.

52

Neil 01.31.15 at 10:52 pm

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.

53

Zamfir 02.01.15 at 7:25 am

Main Street muse, I can’t find information on blueberries, but many fruits do contain formaldehyde. Pears seem to top the list.

Neil’s list does include some longer-chained relatives of formaldehyde: butanal, pentanal, hexanal. Formaldehyde is methanal, the simplest member of that alkanal family. Apparently fruits make alkanals as part of their smell and flavour.

There is in fact formaldehyde in our blood, produced and broken down as part of our metabolism. It’s not a lot, but even a baby already has much more formaldehyde naturally in their blood than contained in a vaccine.

54

b9n10nt 02.01.15 at 9:08 am

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?)

55

Glen Tomkins 02.01.15 at 6:18 pm

MSM,

The Fear Factor

Medicine, like all science, is empirical. You can never prove a negative empirically. It is absolutely the wrong strategy (I could give you empirical examples if you want) to confront public fear of a medical intervention by discussing possible mechanisms of risk, such as your scary ingredient list, and trying to explain why they aren’t really scary.

The simple fact is that vaccinations could cause autism, and talking about how the Wakefield study was discredited does absolutely nothing to disprove that concern. Vaccinations haven’t at all been proven to not cause autism, or demonic possession, or whatever. One study that seemed to show that they do cause autism has been discredited, that’s all. We’re just back to square one on the possibility of an autism-vaccination link, we haven’t arrived at certainty of the lack of a link. We’ll never get there, because no matter how many empirical trials you do of the question, unless you try out the vaccination regimen under scrutiny on every Homo sapiens living or who will ever live, there remains the possibility that you will find causation in that last person you study.

One or more of your scary list of ingredients could cause cancer, or any other disastrous outcome your worst fears can imagine. No amount of discussion of why we think that there probably isn’t cause for concern will remove all concern. Engaging about these issues will simply serve to distract from the only relevant question, comparison of observed risk of outcomes

What you can do empirically to resolve these questions is to try to measure the risks of an intervention, the risks of not intervening, and compare them to see which is less risky. This is actually doable, at least potentially, because you haven’t set yourself the impossible task of disproving a negative, you’re after the far more modest goal of merely comparing observed risks.

The bad news is that I did have to say “try” because there are always methodological uncertainties, the largest being that your list of bad outcomes to look for wasn’t inclusive enough, you left out some side effect that will turn out to be caused by your intervention. That’s the problem that the autism people harped on, that in the clinical trials of safety and efficacy of the various vaccines we use now in our childhood immunization effort (scrutiny that all interventions receive before approval for use on the general public), they didn’t measure autism as an outcome. That sort of methodological uncertainty, plus many other involved in case definition, etc, etc., can leave a question of relative risk in a sort of limbo, if the size of difference in risk is not greater than the size of the uncertainty. A question like whether or not to do PSA testing is one of those fraught questions

The good news is that for the raft of childhood vaccinations in our current program, the difference in risks is so great that it is clearly larger than all of these uncertainties. This is not a fraught question. Whatever disagreement is out there, in the general public whose fear factor you fear, or the activists pushing that fear, is the result of people defecting from the empirical approach, from being guided by a comparison of observed risks, and instead going for some or other pet theory of what might cause particular harms. There is absolutely no benefit, and much risk of obscuring the real grounds of the argument, of trying to talk to such defectors in terms of any causational theorizing that this or that ingredient is or is not a cause for concern. People need to either accept medicine’s empirical approach and thereby accept that all our interventions carry risk, or, if they crave fake certainty, go see some herbalist or holistic practitioner who is willing to pretend that any intervention that can help by changing your body’s workings can’t also harm — by changing how your body’s workings. It’s never safe to try to alter nature.

Don’t try to invent a notional general public that is less rational than yourself, and therefore has fears that are groundless, but nevertheless have to be addressed by the medical community. All medicine has is observed results, it should never try to argue causational theories. Fortunately, observed results are good enough to convince the general public.

The first vaccination western medicine used, starting in the 17th century, was, to use the technically proper name, variolation. This involved harvesting the pus from a smallpox sore, and introducing some of this pus into a shallow gash in the arm of the patient. I don’t know about you, but I find the idea of putting any sort of pus, much less that harvested from a smallpox sore, under my skin, to have a much greater fear factor than your list of modern vaccine ingredients. And I am justified in my fears, because one of the first studies that used statistics to address a medical question, found that 1 in 27 children subjected to such variolation died from smallpox. However, because the comparison group of children who weren’t variolated had a 1 in 4 chance of death, this was good enough for people at a time when they were still trying people for witchcraft.

The faith in empiricism displayed by people who had their children variolated in the early 18th century is even more striking when you consider that people at that time had no generally accepted idea of what caused smallpox, or any other infectious disease. The resort to inoculation with pus from a smallpox victim was pure empiricism, unsupported by any sort of theoretical structure, beyond some vague invocation of the homeopathic principle, of what was going on with the disease or how variolation might prevent that process. The sole and only reason to try such an obviously risky intervention was that the Turks did it first and showed empirically (roughly, it isn’t known that they did anything like the statistical study the British did) that it was less risky than not doing it. People who remained so fixated on the very well-grounded theoretical risks of how pus as a vaccine ingredient might cause harm, did not get their kids variolated, and 1 in 4 of them died. People who ignored causational theory and just looked at observed results had their kids vaccinated, and “only” 1 in 27 died.

It is true that I should not have thrown around the figure of 50% child mortality in a context suggesting that our vaccination program is responsible for all, even most, of the decline from 50% dead by the age of six, to our current much lower levels. But it is true that the higher end estimates of rate of death by age 6 was approx. 50% in the early 18th century in England (this is one of those questions that has a pretty wide uncertainty because of methodological uncertainty, but I don’t think anyone would put it under 30%). Most of the decline has almost certainly been due to water sanitation, carefully separating the incoming stream of drinking water from the outgoing stream of sewage. Diarrheal illness caused by not separating these streams — or not doing this effectively enough because of reliance on less strict standards that worked at the village level but resulted in cholera in a big city — caused a very high infant mortality especially, death in the first year of life. Vaccination is probably second though, if likely a distant second. Antibiotics and medical interventions other than vaccination are almost certainly a far distant third. The role of generally improved nutrition is much harder to assess, as there is evidence that child mortality was 35% (higher than among the general population in the English countryside, with London being a significant data hole) in the families of 18th century English peers, whom we should probably assume were well-fed. Some have suggested that we really don’t have to worry about measles in the developed world — it’s only a third world problem because of their poor nutrition — but I wouldn’t count on it.

So, yes, the risks of not vaccinating children, don’t come up to 50% child mortality. We would also have to let the sewage and water purification systems decay completely (we seem to be working towards that goal lately) to get back to near 50%. But the argument still holds. What rate of child mortality do you propose as the threshold risk that, when compared to the very low measured risks of vaccinating, justifies the vaccination program? Justifies making that program mandatory? 50% is a slam dunk in favor of the program, but I would think that even 0.01% still clearly exceeds the risks involved in vaccinating by several orders of magnitude, and is therefore still a slam dunk. My bad for ideological overkill on a question that even a much more modest claim of benefit would still have left a slam dunk.

56

TM 02.02.15 at 4:54 pm

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 02.02.15 at 5:38 pm

@56

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.

58

J Thomas 02.02.15 at 9:31 pm

#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.

59

Neil 02.02.15 at 10:01 pm

Inchoate intuitions about things having been around for thousands of years may explain why people believe bollocks but it doesn’t justify their beliefs. People are willing to take all kinds of ‘natural’ preparations because they’re ‘natural’, regardless of whether they have a good safety record or not, regardless of whether anyone’s had thousands or dozens, of years of experience with them or not. And in any case, thousands of years of experience doesn’t add up to genuine data, because if you don’t have various controls you run a high risk of getting rubbish – post hoc, procter hoc, and all that. European and Chinese folk medicine both contain lots of genuine remedies, though you wouldn’t want to take them because dosage is uncontrolled. They also contain lots of placebos and nor a few noxious substances. Their practitioners didn’t know which is which.

60

Rich Puchalsky 02.02.15 at 10:18 pm

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.

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Bruce Wilder 02.02.15 at 10:31 pm

Think about the kinds of concerns anyone who has been listening to cable news for the last 20 years might begin to think are plausible. No one has the time or training to sort them all out, and they add up to an increasingly scary world “out there”, which only moves people, attitudinally, to a place where they are less considered and rational in their beliefs and, more importantly — because, remember, no one has the time or expertise to sort everything out for themselves — uncertain about who and what authority to trust.

It would be really convenient if the anti-vaxxers were completely nuts, but they aren’t. They are just a symptom of a society in which solidarity and trust-in-authority are breaking down. Their concerns may be incoherently conceived and expressed, but their concerns are not wholly unfounded.

We really are introducing all kinds of things into the environment with too little attention to the consequences. Lead in gasoline caused a crime wave. Freon in hairspray cans punched a hole in the ozone layer and nearly caused a mass extinction event. Cigarettes endorsed by medical doctors on teevee caused an epidemic of lung cancer that took a toll that dwarfs anything associated with measles.

Trust in science is being eroded along with trust in authority in general by a torrent of controversy concerning the emergence of very real problems on an accelerating scale and schedule.

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Bruce Wilder 02.02.15 at 10:47 pm

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?

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J Thomas 02.02.15 at 11:24 pm

#59 Neil

People are willing to take all kinds of ‘natural’ preparations because they’re ‘natural’, regardless of whether they have a good safety record or not, regardless of whether anyone’s had thousands or dozens, of years of experience with them or not.

Agreed. Lots of people are stupid about “natural” remedies.

And in any case, thousands of years of experience doesn’t add up to genuine data, because if you don’t have various controls you run a high risk of getting rubbish – post hoc, procter hoc, and all that.

Agreed. However, if you eat the kinds of foods that people have been growing for a long time, and you don’t put new chemicals on them, chances are they will do you the kind of damage people have been getting from them for a long time. People mostly accept that damage, they think it’s just old age or something. New chemicals potentially have new risks. Maybe big risks. We don’t know ahead of time.

Does Alzheimer’s come from new chemicals? Or did a fraction of people always get it, and they called it “senility” and they used to die of it quicker than they do now? I don’t know.

European and Chinese folk medicine both contain lots of genuine remedies, though you wouldn’t want to take them because dosage is uncontrolled. They also contain lots of placebos and nor a few noxious substances. Their practitioners didn’t know which is which.

Agreed. I have some concerns with modern pharmaceuticals, where to my mind we are giving the foxes way too much control over the whole chicken industry. But folk medicine is no substitute.

But I’m mostly not so concerned about medicine as about just stuff people get exposed to. Stuff in automobile exhausts. Stuff in crashed cars. Stuff that leaks out of old batteries batteries. Out of broken game transformers. Rubber handles on kitchen implements that get burned. Etc.

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TM 02.03.15 at 1:51 pm

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.

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Neil 02.03.15 at 1:56 pm

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.

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J Thomas 02.03.15 at 2:07 pm

#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.

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TM 02.03.15 at 2:19 pm

Ok Neil, you are trolling. Do as you wish.

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Neil 02.03.15 at 2:29 pm

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.

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Rich Puchalsky 02.03.15 at 2:44 pm

The two main worldwide regulatory regimes for chemical toxicity and exposure are, basically, American and European, with most other countries incorporating those by reference in some way. There are very significant differences between those two regimes in terms of how much chemicals are tested before they are allowed into commerce. The U.S. in particular is stuck with TSCA, which is very unprotective, a classic example of an early adopter of something getting stuck with an early version of something while later adopters are able to start out with a more advanced version. (“Early” and “advanced” here have to do not with technical capability, but with the way in which determined industry resistance and resulting political paralysis froze major American environmental laws at early versions.)

I don’t see any inherent separation between synthetic chemical testing regimes in general and testing of chemicals in vaccines. As far as I know, thiomersal was in vaccines because it was introduced in the 1930s, and a contemporary version of testing wasn’t done until the late 90s. As such it was pretty much in the same category as the “natural” ingredient that someone assures you must be fine because people have been taking it for a long time.

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J Thomas 02.03.15 at 3:14 pm

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.

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Neil 02.03.15 at 3:20 pm

I thought this *was* about vaccines. See the OP. See every comment by me.

There has already been discussion about why the experiment you propose is unethical: if herd immunity falls, the costs are not borne solely by those who are unvaccinated but by lots of other people too. Those with suppressed immune systems or who cannot take the vaccine, those under 12 months, those who are vaccinated and unlucky.

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TM 02.03.15 at 3:21 pm

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.

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Neil 02.03.15 at 3:30 pm

I’m certainly sympathetic to the claim that we need better regulation of industrial chemicals.

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J Thomas 02.03.15 at 3:48 pm

#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.

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Rich Puchalsky 02.03.15 at 3:58 pm

Or, to phrase what I wrote in another way, thiomersal is more or less from the same era as lead in’ gasoline and Freon. Read the wiki page for Thomas Midgely Jr. for a quick popular version.

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Main Street Muse 02.03.15 at 8:11 pm

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

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Collin Street 02.03.15 at 8:42 pm

> They have no reasons (other than reclassification of autism) for the increase

Assortative mating.

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temp 02.03.15 at 9:05 pm

“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.

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Lynne 02.03.15 at 9:15 pm

MSM @76.

Yes. Great post.

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afeman 02.03.15 at 9:24 pm

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.

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Rich Puchalsky 02.03.15 at 9:35 pm

temp: “Vaccines are not viruses.”

Measles, mumps, and rubella vaccines (as in the MMR vaccine) are all attenuated vaccines that contain, as the vaccinating ingredient, live viruses. I don’t see the point in this kind of on-its-face contradictable statement.

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The Temporary Name 02.03.15 at 9:52 pm

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.

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MPAVictoria 02.03.15 at 9:55 pm

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

Yep. Especially when what they sell doesn’t even contain the things they claim it does:

http://well.blogs.nytimes.com/2015/02/03/sidebar-whats-in-those-supplements/?_r=0

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temp 02.04.15 at 2:00 am

Rich, you are correct. Apologies for spreading misinformation.

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J Thomas 02.04.15 at 2:11 am

#82 TTN

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.

There are enough kids that don’t get vaccines now, to establish that just as many of them are autistic, right?

If they point that out it won’t convince parents who already believe vaccines cause autism, but it would convince me. I haven’t done a lit search on that, and I won’t decide it one way or another until I see the evidence.

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Main Street Muse 02.04.15 at 2:16 am

“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.

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ZM 02.04.15 at 2:44 am

Today’s paper has an heart rending piece written by Roald Dahl in the 80s in support of messes vaccinations , as one of his daughters died of measles encephalitis in the 60s before there was vaccinations

“Olivia, my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything.

“Are you feeling all right?” I asked her.

“I feel all sleepy,” she said.

In an hour, she was unconscious. In twelve hours she was dead.

The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her. That was twenty-four years ago in 1962, but even now, if a child with measles happens to develop the same deadly reaction from measles as Olivia did, there would still be nothing the doctors could do to help her.

On the other hand, there is today something that parents can do to make sure that this sort of tragedy does not happen to a child of theirs. They can insist that their child is immunised against measles. I was unable to do that for Olivia in 1962 because in those days a reliable measles vaccine had not been discovered. Today a good and safe vaccine is available to every family and all you have to do is to ask your doctor to administer it.

It is not yet generally accepted that measles can be a dangerous illness. Believe me, it is. In my opinion parents who now refuse to have their children immunised are putting the lives of those children at risk. In America, where measles immunisation is compulsory, measles like smallpox, has been virtually wiped out.

Here in Britain, because so many parents refuse, either out of obstinacy or ignorance or fear, to allow their children to be immunised, we still have a hundred thousand cases of measles every year. Out of those, more than 10,000 will suffer side effects of one kind or another. At least 10,000 will develop ear or chest infections. About 20 will die.

LET THAT SINK IN.

Every year around 20 children will die in Britain from measles.

So what about the risks that your children will run from being immunised?

They are almost non-existent. Listen to this. In a district of around 300,000 people, there will be only one child every 250 years who will develop serious side effects from measles immunisation! That is about a million to one chance. I should think there would be more chance of your child choking to death on a chocolate bar than of becoming seriously ill from a measles immunisation.

So what on earth are you worrying about? It really is almost a crime to allow your child to go unimmunised.

The ideal time to have it done is at 13 months, but it is never too late. All school-children who have not yet had a measles immunisation should beg their parents to arrange for them to have one as soon as possible.

Incidentally, I dedicated two of my books to Olivia, the first was ‘James and the Giant Peach’. That was when she was still alive. The second was ‘The BFG’, dedicated to her memory after she had died from measles. You will see her name at the beginning of each of these books. And I know how happy she would be if only she could know that her death had helped to save a good deal of illness and death among other children.”

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temp 02.04.15 at 2:45 am

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.

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The Temporary Name 02.04.15 at 2:50 am

Then the CDC is a huge part of why we have anti-vaxxers today.

No. If you’re an anti-vaxxer you’re not gonna trust Big Government, in league with Big Pharma to profit on the blah blah blah. (Not that there AREN’T troubles there but you know what I mean.) 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.

The parents might, however, come into contact with one of the organizations the CDC doles out cash to.

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ZM 02.04.15 at 2:53 am

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.””

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Matt 02.04.15 at 3:09 am

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.

When I was growing up my sister was chronically ill. My parents, fundamentalist Christians, blamed demons. I’m not sure there was any winning move to play against their belief that demons were at fault.

Fortunately, literal belief in demons hurting people is out of vogue in mainstream American society. A few people will blame medical problems on demons but mass media and mainstream parents’ groups are unlikely to raise or support notions that medical problems come from demons. You aren’t going to get a sympathetic reception at the PTA meeting if you start talking about how demons are causing autism. Unlike the people who spread fear about vaccines, my parents didn’t face a favorable cultural environment were they to attempt spreading fear about demons.

Calling parents who won’t vaccinate children over autism fears insane and stupid won’t persuade those parents. Relentlessly refuting and ostracizing anti-vaxxers isn’t to change the anti-vaxxer evangelists but to push the idea out of the respectable mainstream, rather as “demons did it” got pushed out. It might not work — the idea may be too deeply entrenched at this point — but I think the motivation is to keep new parents from signing on for anti-vaxxer nonsense, not to change the Jenny McCarthys of the world.

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Val 02.04.15 at 4:34 am

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.

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js. 02.04.15 at 5:00 am

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

I’m just curious about this. Because *is* the formaldehyde in vaccines the same as that in pears, or isn’t it?

(As someone who grew up in a time and place where polio was prevalent (relatively speaking) I have ridiculously little time for anti-vaxxers, and I have a hard time being sympathetic to fellow-travelers. But trying my best to not be offensive.)

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Rich Puchalsky 02.04.15 at 2:46 pm

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.

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protoplasm 02.04.15 at 10:54 pm

Maybe the way into the best tack would be by asking the question that Jamelle Bouie, among others I assume, tweeted the other day: do you know anyone who used to be anti-vaccine? Are they open to talking?

Not that we need to assume people always know why it is that they change their beliefs, but probably they do some of the time. Or if they don’t know one or more reasons for such a change, by investigating the converted maybe we can locate some mere causes, perhaps those in their social environment.

“To what extent can truth stand to be incorporated? – that is the question; that is the experiment.” (GS 110)

Where the “truth” isn’t simply “unless you have a legitimate medical exception, get vaccinated” but also the more substantial: empirical truths will always be attended by a degree of uncertainty, one not eliminable (actually, one amplified) after conferring with the experts.

How to become more comfortable with the inevitability of being somewhat uncomfortable? They say we wiped away the horizon, yet still—out, damned spot!

Or what about another tack: can we turn the growing distrust of public institutions and expert knowledge in on itself? We should be able to involute and short-circuit lay skepticism. Why not distrust the distrusting itself? “Trust no one” literally cannot be lived—and are your intuitions truly set up to favor your interests in the first place? Really? Is such a thing honestly believable? Who convinced you of that, and what were they selling? etc.

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