News came out recently that someone with measles hung out at the Super Bowl Village in Indianapolis with about 200,000 people. Public health alerts went out here in Massachusetts to be on the lookout for the illness in football fans that went to the game. Now that would be a bummer: spending all that money to watch the Patriots lose and coming back with a case of measles.
There was a flurry of media about it, and then it faded away. This surprised me; I thought that maybe the exposure of so many people would get us talking about how measles cases are increasing here in the U.S. I thought there would be more discussion about the dangers of this incredibly contagious disease, and about immunization and why some people don't want their children to get the vaccine. But within days, the story was gone.
This got me thinking: what's it going to take to really get us talking?
Most parents I see in our practice are fine with immunizations. But here and there, I meet parents who aren't. They are all loving parents, and generally very thoughtful and well educated. We talk for a long time, but the problem usually is that they believe their sources of information more than they do mine. The measles, mumps, and rubella (MMR) vaccine is one that often particularly worries them, even when I point out that we are seeing cases of measles here in Massachusetts.
I don't know everything there is to know about anything, let alone vaccines. I am the first to admit that. But from everything I've read, I really do believe that the MMR vaccine is safe (we are very careful when it comes to treatments we give to children). And I am very certain that it doesn't cause autism. Study after study has failed to show a connection. The only study that reported a connection, the one by Andrew Wakefield (who has since lost his medical license) that was published by the Lancet, was retracted when it was discovered that data in it was falsified.
We give the MMR vaccine at a year, right when kids are supposed to start talking, right when the diagnosis of autism can begin to become apparent. When they don't start talking, or they start talking less when they should be talking more, I totally get how parents could look at the MMR vaccine as a possible cause -- but it's not.
Yet some parents are still more afraid of the vaccine than they are of measles.
According to the Centers for Disease Control, our childhood immunization rate for MMR here in the U.S. is around 90 percent. That sounds good, and it is certainly better than many countries around the world (it's visitors from or to those other countries that cause most of the US measles cases), but it still leaves a lot of children unprotected -- not just the ten percent who don't get immunized, but the babies less than 12 months who are too young for the vaccine. And kids who only have one dose may not be fully protected.
What if the next exposure happens at a daycare in an infant room where nobody is immunized? What if lots of infants get sick, spreading it through the daycare? What if some die? It is totally possible, in fact, with the way cases are increasing in the U.S., I worry that it's not just possible but probable that we are going to have an outbreak like this.
It might be enough to make parents more afraid of measles than the vaccine. But I don't want it to happen. Nobody does.
So what can I do for parents who are afraid of vaccines? This is an honest question, not a rhetorical one. I want kids to be healthy and not end up with complications of vaccine-preventable diseases. Parents want the same thing, no matter what their stance is on immunization. Given that we are on the same side, really, is there a way to have a conversation that doesn't end up as a standoff? This isn't about forcing people; I would never refuse to see a family who doesn't want to vaccinate. I just want to be able to talk about why they believe their sources of information more than mine, and see if we can at least find a middle ground. I'd like to find a way for them to trust me and believe that I would never, ever, do something to hurt a child.
If there's anything we should be able to unite around, it's the health of children. I really want to know: what can we do?
Follow Claire McCarthy, M.D. on Twitter: www.twitter.com/@drClaire
Dr. McCarthy:
Are you going to dismiss the severe reactions as "necessary for the herd?" What about the studies showing damage from vaccines? Are you going to dismiss those as well, and tell us we should rely on the manufacturer's (aka profiteer's) studies instead?
Are you still going to treat parents as though they are too stupid and childish to know any better, instead of as intelligent, caring, and educated adults who have done serious research on the results of injecting chemicals into children, and concluded that not enough TRULY scientific studies exist to show safety/efficacy, while those that do exist point to the lack of said safety/efficacy?
Perhaps we need an article titled, "Doctors, We Really Want To Know: What Can We Do For Doctors Who Are Afraid Of Mild Diseases?"
And as to vaccination against "mild diseases"?
Now I am really worried. Are diseases like pertussis, polio, meningitis, measles, diphtheria, tetanus, cervical cancer, Hepatitis B "mild"?
What vaccines would you recommend I give my child, Taximom?
Welcome all to the antivax alternative universe, where diseases are utterly harmless, and all mankind's ill health is due to evil toxic vaccines.
Dr. McCarthy, you chose "I Really Want to Know: What Can I Do For Parents Who Are Afraid Of Vaccines" as the title for your article.
Many, many parents have responded, giving you clear and valid reasons why they fear vaccines. You have now read about parental experiences with severe vaccine reactions; you have now learned that these reactions are not nearly as rare as you were taught in medical school. You have been shown many peer-reviewed, scientific studies showing neurological, developmental, and autoimmune damage caused by vaccines; in medical school, you were never taught that this can happen. You have been shown the latest independent research that shows that vaccine efficacy is nowhere near what the manufacturers had promised, particularly flu, MMR, pertussis, and Gardasil vaccines (and isn't it interesting that these are the most heavily marketed vaccines in the US?). You have also been shown that the children who do have severe reactions to vaccines have not only NOT been studied, but that the medical community has put an enormous amount of effort into AVOIDING studying them.
How do you respond to this?
That's the flaw in your argument. "Valid reasons" are clearly a perception not based on all the available scientific literature, but instead based on cherry-picked, misrepresented, and misunderstood studies that contain a few key words that you pretend to understand.
"With regard to nine of the eleven children (2,1, 3, 4, 6, 9, 5,12 and 8) considered by the Panel, it determined that Dr Wakefield caused research to be undertaken on them without Ethics Committee approval and thus without the ethical constraints that safeguard research. Ethical constraints are there for the protection both of research subjects and for the reassurance of the public and are crucial to public trust in research medicine. It was in the context of this research project that the Panel found that Dr Wakefield caused three of these young and vulnerable children, (nos. 3, 9 and 12) to undergo the invasive procedure of lumbar puncture when such investigation was for research purposes and was not clinically indicated.
This action was contrary to his representation to the Ethics Committee that all the procedures were clinically indicated. In nine of the eleven children (2,1, 3, 4, 9, 5,12, 8 and 7) the Panel has found that Dr Wakefield acted contrary to the clinical interests of each child. The Panel is profoundly concerned that Dr Wakefield repeatedly breached fundamental principles of research medicine. It concluded that his actions in this area alone were sufficient to amount to serious professional misconduct."
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The Walker-Smith quashing indicates quite clearly that the children were being clinically investigated and treated.
The implications for the case against Professor Simon Murch and also Andrew Wakefield are quite self evident then.
We have a Pediatrician that is very much the same way, he wants his patients vaccinated but will do a delayed vaccination schedule.
My oldest child had a reaction to her 4 month DTaP and that really scared me, so I delayed all her vaccines after, but now at 7 she is caught up. I was more afraid of her actually getting a disease than the vaccines. We also finally found out why she had special needs and it wasn't the vaccine.
With our second child I didn't do the at birth vaccine, but everything else is on schedule.
The one thing our Ped. said when I talked to him about spreading out the vaccines for our son, he said that he thought it was worse for the child because they get many more shots that way. It made sense to me and I have always had a great relationship with him so I didn't take it as him being patronizing.
IT'S STILL THE SAME 4 SHOTS.
If your doctor can't do simple math, I wonder what else he doesn't understand.
I came across a comment and an article today that described these concerns.
the comment:
http://www.ageofautism.com/2011/12/from-the-editor.html
the article:
Only trusted research will quell vaccine fears
http://portlandtribune.com/opinion/story_2nd.php?story_id=133116709614327300
we've done the research and feel comfortable with our decision. why is this so hard for a physician to understand that people are capable of making educated decisions about the medical treatment they and their children receive even when it may not be just what the doctor ordered? not all people who choose alternative vaccination or no vaccination are afraid of autism.
If you keep your own kids away from possible exposure, they should be fine. But that's not practicable in today's society. And of course, the more kids around them who are vaccinated, the greater their protection will be thanks to remaining hidden within the herd. Some would label you a freeloader, relying on the community efforts of others to gain a greater margin of safety for your own kids. But I think that term is too soft, since people like you ultimately put everyone at risk, and the more of you there are, the sicker we risk becoming and not just the weak/vulnerable/infants who can't be vaccinated and have no protection of their own against the diseases your kids might catch and spread.
Yet of those 30 thousand measles cases, around 20% were hospitalised, hundreds suffered pneumonia and other infective complications, dozens suffered neurological damage and 9 children died.
I am careful and don't use words I don't know the meaning of.
Perhaps you could do the same, and check the meaning of the word "never" in a dictionary sometime.
"You know, it is very important just to set the record straight about this paper, because I think there has been a lot of nonsense written and spoken about it. One particular piece of nonsense is that this was a study which set out to prove a cause or an association between the vaccine and this syndrome. In no way did it do so. So to judge the paper as some kind of attempt to prove cause and effect was utterly wrong."
John Walker-Smith
A doctor found guilty of serious professional misconduct over the MMR controversy has won a High Court appeal against being struck off.
The judge quashed a GMC finding of professional misconduct.
Mr Justice Mitting called for changes in the way General Medical Council fitness to practise panel hearings are conducted in the future saying: "It would be a misfortune if this were to happen again."
Prof Walker-Smith, who is now retired, said: "I am extremely pleased with the outcome of my appeal. There has been a great burden on me and my family since the allegations were first made in 2004 and throughout the hearing that ran from 2007 to 2010. I am relieved that this matter is now over."
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The simple power of Social Justice Advocacy by colleagues, parents and supporters.
Thus comes to an end the journey I started some 1467 posts again when I read a small article in the Washington Post and sought to play my small part in clearing the allegations against a man of quiet integrity.
Best wishes to all those parents and children involved.
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Hopefully this is the middle ground that Claire McCarthy wished for ...
Judge says:
"There is now no respectable body of opinion which supports (Wakefield's) hypothesis, that MMR vaccine and autism/enterocolitis are causally linked'.
So I guess that's final then.
And what does this say about the general quality of adjudication from the infamous 5-panel GMC tribunal made up of two lay members and three doctors: a psychiatrist, a retired physician, and a GP. There was not a gastroenterologist (no less a leading pediatric gastroenterologist) anywhere on the panel.
Mrs. Sylvia Dean (Lay)
Ms. Wendy Golding (Lay)
Dr. Surendra Kumar, Chairman (General Practitioner)
Dr. Parimala Moodley (Psychiatrist)
Dr. Stephen Webster (retired Geriatrician)
Interesting.
...there are lots of differing hypotheses that need to be explored in regards to this issue. Hopefully this will "clear the air" to some degree and we can all move forward and look particularly at what those actual children were presenting in terms of their 'disease' and physiology.
The link between GI issues and regression has been confirmed in independent studies. Febrile seizures and epilepsy are also on the table as is viral infection ...
Robust evidence clearly indicates immune system dysfunction ... where does it head I'm not sure ... but hopefully now researchers have the opportunity to look in all areas without fear.
The ruling was odd in many respects, not least because of the muddle Justice Mitting seemed to get himself into over the distinction between what constitutes research and what doesn't, and his assumption that if one was acting in a child's interests then that meant one was doing a clinically justified medical action (which must therefore not be "research" - this ignores the overiding principle that one must always act in a child's best interests even [and especially] when one does research - the 2 things are not mutually exclusive). The doctors on the GMC would have known that, but it got lost on Mitting, who seems to have reclassified himself as a medical generalist by his own admission.
The decision was in essence saying that the GMC had not presented legally persuasive evidence to show that in the GMC panel hearing WS had acted in the way he did because of his clinical concerns rather than for research purposes. Without that explanation the finding of unprofessional misconduct could not stand.
Read more: http://www.foxnews.com/health/2011/02/22/supreme-court-rules-vaccine-makers-lawsuits/#ixzz1oQVOh7Qi
"Vaccine manufacturers fund from their sales an informal, efficient compensation program for vaccine injuries; in exchange they avoid costly tort litigation and the occasional disproportionate jury verdict. Congress enacted this deal to coax manufacturers back into the vaccine market," Scalia said.
http://www.foxnews.com/health/2011/02/22/supreme-court-rules-vaccine-makers-lawsuits/#ixzz1oQVOh7Qi
http://sfari.org/news-and-opinion/in-brief/2012/genetics-maternal-and-paternal-age-increase-risk-of-autism
Interesting research found over at SFARI and interpreted by Research Editor Jessica Wright
"The odds of having a child with autism begin to rise at age 35 for both men and women, but that risk does not increase further when both parents are over 35, according to a large study published in the March issue of Annals of Epidemiology1.
Several studies have shown that advanced paternal and maternal age can increase the risk of having a child with autism. But results have been inconsistent about whether one parent’s age has more of an effect than the other. It is also unclear whether genetic factors alone, such as the increased risk of mutations as a result of aging, are responsible for the effect.
This suggests that environmental and genetic factors that impact both siblings and are unlikely to change over time, such as inherited genetic mutations, are also not likely to account for the parental age effect.
Other factors, such as long-term accumulation of environmental toxins, medications or inflammation associated with autoimmune disorders might partially account for the observed effect, the researchers say. Social factors, such as older parents being more likely to seek out a diagnosis for their children, are also possible."
http://www.ncbi.nlm.nih.gov/pubmed/8667923
"Epidemiological studies have led to speculation that infections in early childhood may prevent allergic sensitisation but evidence to support this hypothesis is lacking. We investigated whether measles infection protects against the development of atopy in children of Guinea-Bissau, West Africa.
Methods
We conducted a historical cohort study in Bandim, a semi-rural district of Bissau, the capital of Guinea-Bissau.
Findings
After adjustment for breastfeeding and other variables, measles infection was associated with a large reduction in the risk of skin-prick test positivity to housedust mite (odds ratio for Dermatophagoides pteronyssinus 0·20 [0·05-0·81], p=0·02; D farinae 0·20 [0·06-0·71], p=0·01).
Interpretation
Measles infection may prevent the development of atopy in African children."
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Early BCG vaccination and reduction in atopy in Guinea-Bissau
http://www.ncbi.nlm.nih.gov/pubmed/10792355
"Of the children who had received BCG vaccine, 57 (21%) were atopic compared with 21 (40%) of the unvaccinated children [odds ratio, after controlling for potential confounding factors, 0.19 (95% CI 0.06–0.59)].
When atopy was defined using the 3-mm criterion, the reduction in atopy associated with BCG was greater the earlier the age at vaccination, and the largest reduction was seen in children vaccinated in the first week of life.
BCG vaccination given early in infancy may prevent the development of atopy in African children."
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That was interesting ...
Well, for starters, you can actually LISTEN to those who have had a severe reaction, or whose child has had one.
You can look at the peer-reviewed studies that do show a link between vaccines and autism.
You can look at the criticisms of the studies that supposedly "debunk" such a link.
www.14studies.org is a good place to start.
More importantly, you can realize that this isn't just about autism.
There are plenty of studies linking vaccines to all kinds of autoimmune disorders, including rheumatoid arthritis, MS, lupus, diabetes, autoimmune thyroid disease, asthma, eczema, psoriasis, inflammatory bowel disorders, celiac disease, and Guillaine-Barre.
If you only spout the dangers of disease and the importance of immunization without admitting the facts of the opposing viewpoint, then I fear that your title is misleading at best.
You're pretending that the vaccine-induced damage does not exist, when, in fact, it is far worse, and far more wide-spread than you believe.
"www.14studies.org is a good place to start."
Ah, yes, 14 Studies, brought to you by Generation Rescue and their crazed house organ Age of Autism, where autism is a vaccine injury even if the child wasn't vaccinated. Nothing like "evaluation" of scientific studies by somewhat deranged nonscientists who are basically just assigning a ranking based on how much they like the outcome, in the finest Bernardian tradition.
But, hey, let's not stop there. There's also an analysis of the analysis to be had!
http://www.sciencebasedmedicine.org/index.php/14-studies-later/
HTH. HAND.
Please take note JRSmith. If you wish to discuss your pet topic, find a suitable vehicle for it and forum for it elsewhere.
http://www.frontiersin.org/synaptic_neuroscience/10.3389/fnsyn.2010.00136/full
"The relationship between the immune and nervous systems is much more complicated than once thought
Immune molecules mediate essential nervous system functions during healthy development independent of immune and inflammatoryprocesses.
The immune system appears to influence the nervous system during typical functioning and in disease.
Chronic infection or severe illness may disrupt the balance of normalneural–immune cross-talk resulting in permanent structural changes in the brain during development, and/or contributing to pathology later in life.
...the sheer number of immune molecules that couldbe important for nervous system development and function is staggering. Although much progress has been made in the past 10 years in our appreciation thatimmune molecules play critical roles in the healthy brain, the large majority of immune molecules have not yet been studied for their presence and function in the brain.
For the immune molecules thatwe know are important, almost nothing is understood about their mechanisms of action. There is no doubt that many immune molecules will change their functions over development and will affect one another, but how this will affect neural function and development is also completely unknown.
Rapid progress in this newly energized and exciting field holds tremendous promise not only for enhancing our understanding of typical development, but also for elucidating and potentially even treating neuropsychiatric disorders."
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One outcome unsurprisingly could be the development of safe and efficacious vaccines for vulnerable children / mothers.
It's full title for those interested is ... Novel roles for immune molecules in neural development: implications for neurodevelopmental disorders
Quite a mouthful really I thought my headline was more succinct.
I've tried to summarise the article by providing the section - Final Thoughts.
But you'll gain a lot by taking your time going through the article as a whole.
Lots of interesting insights that are leading us to a deeper understanding on the varying interactions that are evident in neurodevelopmental disorders.
The implications are to my mind quite profound. It's a pity that there will be dissenting voices that have not yet been able to assimilate this new information into their existing dogmatic schema.
I hope this small commentary alleviated any confusion.