The Doctor Weighs In

By Dov Michaeli MD, Ph.D

Sometimes, When I read something extraordinarily egregious or stupid I catch myself shaking my head in disbelief. I even mutter to myself a few choice expletives. Here are 2 items from the New York Times appearing on 2 consecutive days.

“ The New Jersey Public Health Council is expected to vote tomorrow on a rule that would require flu vaccines for any child entering day care or preschool. If it is approved, New Jersey would become the first state in the country to impose that mandate.

“The flu vaccine is one of four that the council will consider. There is a vaccine that would be given to children entering day care or preschool to protect against pneumonia and two others that would be given to those entering sixth grade: one to guard against meningococcal disease, a fast-killing strain of meningitis, and the other an additional booster of a three-part shot already administered at a younger age against tetatanus pertussis and diphtheria.”

I thought “Hooray”, finally states are recognizing that vaccination is the most cost effective therapeutic modality we have. Sometimes, the only modality we have. A short trip to other industrialized nations around the world would reveal that we are woefully behind on this issue; all children are vaccinated annually, and barring allergy to eggs--no exceptions. The mortality rate in children who contract the flu is astounding. The decision to propose the additional vaccines, especially the one for the flu, was based on recommendations by the federal Centers for Disease Control and Prevention and the FDA. Each year, 108 of every 100,000 children 5 or younger are hospitalized with complications from the flu, and about 100 die, according to the C.D.C.

Would you expect anything but praise for the public health authorities of New Jersey ? In fact, I would have asked what took them so long. But the article goes on to tell us that

“At a public hearing in January, about 30 people complained about the proposed vaccines, citing possible side effects and insufficient evidence that they help prevent disease. On Friday, a group opposing the new vaccines held a news conference at the State House in Trenton . And people will have a chance to speak at tomorrow’s meeting, at the health department building in Trenton . ’

And then, today’s item from Maine :

PORTLAND, Me., Dec. 7 — “Hundreds of students at the University of Southern Maine have been barred from its campuses here and in nearby Gorham over mumps vaccination. Skip to next paragraph

The Maine Center for Disease Control and Prevention recently issued an emergency order that full-time or resident students at the campuses — 5,996 people — must have had a second vaccination for mumps. The order came after two cases of the virus were confirmed at the university; other cases are suspected.

“I shouldn’t be here right now,” said Caleb Field, a junior who has not had two shots but was studying at the university’s student center Friday afternoon. “I’m waiting until they drag me down there. I don’t like shots. If I don’t have to get it, I’m not going to get it.”

Caleb Field, whatever your major is, they should flunk you for poor judgment. If you get it, it’s really your problem alone. But what if you spread it around? What if a person who comes in contact with you is for some reason immunosuppressed? You may very well cause her death.

Twelve mumps cases have been confirmed in Maine since September, the largest outbreak in Maine in 25 years. Last year, more than 1,000 cases of mumps were reported in an outbreak in eight Midwestern states. Most of those affected were college students.

Vox populi

What does the voice of people say on the subject? A recent study published in JAMA and cited in WebMD is instructive.

In February, University of Toronto researchers screened 153 vaccine videos posted on YouTube. The videos included clips for and against immunization, and some of the videos showed anxious parents or crying babies.

About half of the videos didn't explicitly support immunization: 48% were positive about immunization, 32% were negative, and 20% were ambiguous about vaccines. Negative videos tended to get higher ratings from YouTube users.

Vaccines and autism

The scare mongering by various religious sects about vaccines has a history as long as vaccines themselves. But it has got its present momentum in the 1990’s, when a pediatrician at the Royal Free Hospital in London published a paper purporting to show that children who were vaccinated with the MMR vaccine (mumps, measles, rubella) had an inordinately higher rate of autism. He attributed this “epidemic” growth to the presence of thimerosal, a mercury-based preservative. The scientific methodology used by the investigator was woefully deficient. Every respectable pediatric professor in the UK expressed outrage that such poor science should be published.

But the damage was done. Within weeks autism support groups latched onto the new information. More fuel was poured into the fire by a variety of religious groups and just plain kooks opposed to vaccination, or to “establishment medicine” in general. And believe or not, even libertarians of the political right weighed in with the bizzare argument that vaccination is not a function of the state, and children should not be “coerced” as a matter of principle.

Litigious America

In 2004, the prestigious Institute of Medicine concluded that neither the preservative, known as thimerosal, nor the measles-mumps-rubella vaccine was associated with autism and that various hypotheses about how they could trigger autism lacked supporting evidence. Even after thimerosal was phased out of pediatric vaccines, autism rates did not fall. This opinion was based on reviews of literally hundreds of studies—not one of them offering even a scintilla of suspicion that autism is in any way related to vaccination.

So what is an advocate to do? Sue, of course. This is from a New York Times editorial, June 4, 2007 .

“A federal vaccine court in Washington is confronting the contentious and highly emotional issue of whether early childhood vaccinations might have caused autism in thousands of children. Virtually every major scientific study and organization that has weighed in on the issue has seen no link. But many parents of afflicted children remain unconvinced. Their lawyers will try to prove that some 4,800 children were harmed by the mass vaccination campaigns that protect the nation’s youngsters from potentially devastating childhood illnesses . “

One of the obvious, and most common, fallacies in cases like this is a matter of simple statistics. Assume that childhood autism in all its manifestations has a prevalence of 75 /10,000. If we examined a cohort of 100,000 children who received MMR vaccination, you could predict that 750 of them would also have some form of childhood autism. This is just a coincidence, however unfortunate: children are diagnosed as autistic at a young age, and they also get vaccinated at a young age. But there is no cause and effect relationship here.

The lawyers’ argument? Mercury suppressed the plaintiff’s immune response. There is not a shred of scientific evidence for this claim, but that never stopped anybody from going to court. In fact, even the plaintiffs’ lead attorney acknowledged that mass immunization programs are “a great public benefit” that have prevented tens of thousands of deaths and serious injuries. Go figure.

The case of the leaky breast implants

Remember the uproar caused by the claim that women whose silicon breast implant sprung a leak developed all kinds of bizarre symptoms that were lumped together as ‘autoimmune’? Well, scientists got to work immediately when these claims were made, and found absolutely nothing—silicon had no effect on the immune response, and when examined carefully, most of the individual claims were found to be without merit. But by then it was too late. High powered class action lawyers (some of them are today under Federal indictment for fraud) extracted a huge settlement from the manufacturers of the implant, and even from the manufacturers of the silicon. The outcome? Companies went out of business leaving thousands of people jobless.

More seriously, Dow Chemicals, the manufacturer of silicon, refused to supply the material to pharmaceutical device companies. One such device was artificial heart valve. How many patients with heart valve defects, or with bacterial endocarditis, had to go without an implant? How many lost their lives? Who speaks for them?

Dov Michaeli MD, Ph.D is in the biotech industry