Monday, March 19, 2012

Vermont Steps Toward Improved Public Health

Vaccination requirements for entry to day care programs and schools tend to be a bit of a touchy subject among those who, for one reason or another, are opposed to immunization. They tend to view such requirements as violations of their personal rights, all the while ignoring the rights of their own children, to say nothing of the rights of the other people around them, to not be infected with diseases that can be quite serious. As I recently wrote, the state of Alaska Section on Epidemiology came out with several recommendations following a chicken pox outbreak at a day care facility, which started after an unimmunized child infected their infant sibling who attended the day care. In my post, I suggested that the recommendations did not quite go far enough, arguing that philosophical or religious exemptions should require speaking to a physician before being granted. Personally, I don't think that there should be exemptions for anything other than legitimate medical reasons, but that's a topic for another post. In the meantime, requiring discussion with a medical professional seems, to me, to be a reasonable compromise for the time being.

The issue of philosophical exemptions came up last summer, as the Massachusetts state legislature considered a proposal to add philosophical exemptions to that state's immunization laws. It's a proposal that pops up just about every year in Massachusetts and is consistently, and, in my opinion, correctly shot down. Well, it looks like the state's neighbor to the north, Vermont, is considering making its laws similar to those of Massachusetts. A bill was recently passed by the Vermont state Senate, in a vote of 25-4, to remove philosophical objections as a reason to forego immunization, leaving only medical and religious exemptions. As the bill goes to the House for consideration, there is, not surprisingly, a vocal few who see the legislation as a Bad ThingTM.

Take, for example, Charlotte Gilruth, who wrote in to the Barre-Montpelier Times Argus with her opinion in a letter titled "'Herd immunity' is misleading". From the second sentence, her letter is a treasure trove of errors and misinformation. Before I delve into it, go ahead and click on her name above to read her thoughts. See how many mistakes you can find.

"It Takes Away Rights!"

Remember how I said that anti-vaccine activists tend to view vaccine requirements as dealing with personal rights? Ms. Gilruth wastes no time framing her argument that the bill removing philosophical exemptions is a human rights violation:
If passed, parents would be stripped of the right to informed consent for an invasive medical procedure on their children.
In her world, it seems, saying that a philosophical exemption will not be accepted prior to school entrance equals blocking parents from obtaining information about vaccination. This does not jive with reality. You see, there is this Federal law called the National Childhood Vaccine Injury Act which requires that anyone who administers a vaccine must provide a vaccine information sheet to the recipient or their parent/guardian prior to administering the vaccine. The law requires that the information include:
(1) a concise description of the benefits of the vaccine,
(2) a concise description of the risks associated with the vaccine,
(3) a statement of the availability of the National Vaccine Injury Compensation Program, and
(4) such other relevant information as may be determined by the Secretary.
The Vermont bill does not, and cannot, counter this Federal law. Parents' rights to being informed about vaccines are not being stripped away, Ms. Gilruth's claims notwithstanding.

"Herd Immunity's a Myth!", or, If Vaccines Work...

Ms. Gilruth's biggest beef, at least in her letter, appears to be with the concept of herd immunity. She states:
[P]eople are quick to blame outbreaks of contagious diseases on those who are unvaccinated for a given disease. This happened when the cases of pertussis (whooping cough) were being diagnosed this winter here in central Vermont.

In reality, the great majority of those who become infected in most pertussis outbreaks have already been vaccinated for the disease.
This idea, that the majority of individuals in an outbreak are actually vaccinated, rather than unvaccinated, is one that those opposed to vaccines enjoy bringing up. Basically, it boils down to "if vaccines work, then why do the vaccinated still get sick?" On its surface, it seems like a good question. But it fails to recognize a couple details. First, falling victim to the Nirvana fallacy, essentially believing that if something works, then it works 100%, and since some vaccinated still get sick, then they must not work at all, they do not realize that while most will be protected, there will still be a small portion for whom the vaccine just doesn't work. The second error in play is the failure to consider the numbers involved. In most areas of the U.S., vaccinated individuals significantly outnumber those who are not vaccinated.

For example, if you have 1,000 people who are all old enough to be vaccinated with a vaccine that is 80% effective and 5% refuse the vaccine. In an outbreak where the disease prevented by the vaccine spreads to 20% of the population, you'd end up with 38 vaccinated individuals and 10 unvaccinated individuals who are infected. With only those raw numbers, it seems like the vaccine is useless. But when you add in the denominator, you find that those 38 vaccinees that were infected represent 4% of all vaccinated people (38/950), while the 10 unvaccinated infected represent 20% of all unvaccinated people (10/50).

Although the raw numbers in an outbreak might make it seem like you're more likely to get infected and become sick if you are vaccinated, the reality is that the vaccinated are significantly less likely to be infected.

"Natural Immunity Is Better!"

After attacking herd immunity and suggesting that vaccines are useless, Ms. Gilruth next turns to the ol' "natural immunity is better than vaccine immunity" trope:
Immunity conferred by immunization usually fades by five to 10 years after a shot, whereas permanent immunity is achieved only after natural infection. This means that herd immunity can’t exist now and hasn’t existed for at least 50 years, because the majority of the American population is baby boomers, whose protection from childhood vaccines wore off decades ago.
First, let's get one thing out of the way: herd immunity is not only being immunized. It is the combination of those who are immune from vaccination and those who are immune due to having been infected, if the disease produces lasting immunity. Which brings us to the meat of why her statement is wrong. Starting with pertussis, since it's the disease she brought up, natural infection does not provide lifelong immunity. Surviving a pertussis infection will provide immunity, but only for about 4-20 years. While this is longer, on average, than the 3-12 years of immunity from the vaccine, natural infection also carries with it the risk of complications, including increased susceptibility to other diseases.

Then there are those diseases which only produce permanent immunity by killing you, like tetanus. Surviving a tetanus infection does not produce lasting immunity at all, while the vaccine provides immunity that lasts about 10 years. And, of course, there are vaccines which do provide lifelong immunity, like the measles vaccine.

In every case where we compare the risks and benefits of the currently approved vaccines to the risks and benefits of the diseases that they prevent, the balance comes down squarely in favor of the vaccines. In large part, this is due to the vaccines' ability to induce immunity to the diseases without suffering all of the negative complications that come with infection. While adverse reactions to vaccines can occur, the occur at rates that are orders of magnitude rarer than complications from the diseases they prevent (e.g., risk of encephalopathy is about 1 in 1,000,000 from the MMR vaccine, while the risk is about 1 in 1,000 from being infected with the measles virus).

In Conclusion

This is Charlotte Gilruth's conclusion, based on erroneous reasoning and flawed logic:
The argument of vaccine-induced herd immunity is flawed and does not justify an attack on parents’ rights.
She failed to demonstrate that herd immunity is "flawed" and also failed to show how removing philosophical exemptions is an attack on parents' rights. Her argumentation in this letter demonstrates a lack of rigorous, scientific reasoning and logic. (As an aside, my opinion of her reasoning abilities has since been reinforced by finding out that Ms. Gilruth is also a homeopath.)

Philosophical exemptions, in far too many cases, provide a means for getting out of vaccine requirements for, quite simply, stupid reasons. It can encompass everything from "I'm ideologically opposed to vaccines" to "I read something scary on the internet" to "I just forgot to take Jimmy in to see the doctor". For anti-vaccine advocates, philosophical exemptions empower selfishness and a disregard for the well-being of their children and the well-being of the people in their community. I have yet to see a legitimate philosophical reason to opt out of the vaccines that are required to enter schools and day care, where a large number of individuals come into regular, close contact with each other, a prime environment for disease transmission.

I applaud the Vermont state senators who voted in favor of eliminating the philosophical exemptions, and I sincerely hope that the state representatives and governor follow the Senate's lead. And, should the bill fail, I hope that, at the very least, those seeking philosophical exemptions will be required to discuss their decision with a medical professional first.

If any of my readers live in Vermont, please contact your senators to applaud them (if they voted for the bill) or to express your disappointment (if they were one of the 4 that voted against the bill), as well as to encourage your representatives to uphold public health and pass this bill (PDF).

6 comments:

  1. This comment has been removed by the author.

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  2. I do understand where you are coming from however you are not taking into account the full story.Frankly the removal of the philosophical exemption is just another step toward forced inoculations. Can vaccines be help, of course but unfortunately in their current form they tend to do more harm then good. Have you looked over the various ingredients of vaccines?

    • Stray viruses and bacteria from the animal cell cultures that vaccines are made in.

    • Mercury, a well‐documented neurotoxin, is still in the multi‐dose flu vaccines throughout the world. Trace amounts remain in several other vaccines.

    • Aluminum, a poison that can cause bone, bone marrow and brain degeneration.

    • Animal cells from monkeys, dog kidneys, chickens, cows, and humans.

    • Formaldehyde (embalming fluid), a known carcinogen.

    .Polysorbate 80, known to cause infertility in female mice and testicular atrophy in male mice

    • Gelatin, from pigs and cows, known to cause anaphylactic reactions, is found in large quantities in the MMR, chickenpox and shingles vaccines.

    • Monosodium glutamate (MSG) in inhaled flu vaccines, is known to cause metabolic disturbances (e.g. diabetes), seizures and other neurologic disorders. And many many other problematic ingredients.

    How can you say there isnt a problem when these ingredients are used? Fact of the matter is there is a difference between vaccinated and unvaccinated children. Case in point, The Cal‐Oregon project surveyed parents of vaccinated vs. unvaccinated U.S. children. Of the 17,674 children included in the survey, the results showed:

    • Vaccinated children had 120% more asthma.
    • Vaccinated boys had 317% more ADHD.
    • Vaccinated boys had 185% more neurologic disorders.
    •Vaccinated boys had 146% more autism.
    (www.generationrescue.org/pdf/survey.pdf)

    We can also look at overall effectiveness and see all is not as we are told it is, the CDC reports that in the United States as a whole, cases of whooping cough have increased approximately 10-fold in the last twenty years, despite an increase in infant vaccination rates from 61% getting at least three doses of the pertussis vaccine in 1991 to 96.2% getting at least three doses in 2008.

    Secondly, not only is the effectiveness of the vaccination questionable but in actuality it has the potential to do more harm then good. For example, there are studies showing that the DTaP vaccine itself is actually causing the whooping cough outbreak, "A 2010 Penn State study found that DTaP vaccination actually enhances the growth of parapertussis bacteria, which can cause a typically milder strain of whooping cough. The DTaP vaccine only vaccinates against pertussis, not parapertussis. Counts of whooping cough include the total of cases caused from pertussis bacteria and parapertussis bacteria. This study indicates that the DTaP vaccine has caused a rise in overall whooping cough cases (due to the rise in parapertussis) since its introduction in the USA in 1996"- this information can be found here http://www.smartvax.com/index.php?option=com_content&view=article&id=56&Itemid=43.

    Bottomline is there are many many aspects of vaccinations we should look into further. The drug companies arent improving the safety of vaccines mostly because the market isnt able to force improvements due to the strong arm of government willing to force vaccines down the vains of the American citizen. Why make costly improvements when big brother will force everyone to take vaccinations regardless. Again the market has to dicate to the drug companies that improvements must be made and that will never happen with the loss of your Right to refuse them.

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  3. Number one, you need to cite all those claims.
    Number two, you need to really take a look at the amount of those "toxins" vs actual facts about them and how much of it naturally occurs in, well, the environment, is consumed in food, and what the human body naturally produces.

    Number three, when you do cite, please use actual scientific sources. smartvax.com and Generation Rescue don't count, since they don't actually follow any sort of scientific reasoning, and their "studies" are more like cherry picking polls that are self-administered. No double-blind studies, no scientific method, nothing to back up their claims.

    So please, give us real sources.

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  4. B.E. Jones:• Mercury, a well‐documented neurotoxin, is still in the multi‐dose flu vaccines throughout the world. Trace amounts remain in several other vaccines.

    Except, this is about a law in Vermont. In case you are not aware is a state in the USA, where every single vaccine on the pediatric schedule are available thimerosal-free. Even at least four of the influenza vaccines.

    Aluminum, a poison that can cause bone, bone marrow and brain degeneration.

    And is also the most common metal on this planet's crust. It is in the air, soil and your food. If you have a source of food that is not grown in soil with feldspars and is guaranteed aluminum free, please share.

    And the clutching at pearls about parapertussis is akin to being upset that the MMR vaccine does not protect against Fifth disease (Parvovirus B19). A disease similar to measles, but much milder, but most importantly: not measles. Just like parapertussis in not pertussis.

    Your cites do not show that vaccines are more dangerous than the diseases.

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  5. B. E. Jones's comment is a cut and paste from a document, "Vaccines: Get the Full Story" from the fringe, anti-vaccine organization "International Medical Council on Vaccination", which also argues that vaccines do too cause autism.

    Let's just take two points:

    *Aluminum is present in the body naturally, as it is one of the more abundant elements in the earth's crust. The amount of aluminum in aluminum-containing vaccines so small it doesn't change blood levels of aluminum (Hem SL., Elimination of aluminum adjuvants. Vaccine. 2002 May 31;20 Suppl )3:S40-3, http://www.ncbi.nlm.nih.gov/pubmed/12184363_

    *That "Cal-Oregon Project" was an unvalidated phone survey of parents by Generation Rescue. The uselessness of the survey was discussed by life-sciences professor Prometheus Survey Says Nothing; cancer researcher and surgeon Orac at Fun with Phone Surveys; at LeftBrain/RightBrain Generation Rescue Survey Resultsand by Joseph (a data analyst) at Natural Variation Simple Selection Bias Model Explains Survey Results.

    The rest of the "points" argued by the base document are equally baseless.

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  6. Dearest BE:
    - Vaccine viruses are grown in sterile cell media. If they weren't, they could never guarantee that the vaccine was against what they claimed it was, or the bacteria would kill the viruses through competition for nutrition or by killing the cells themselves in which the viruses are being grown. So, no, that's not a good one.
    - Mercury, like any other "toxin" is only bad in high concentrations. When you look at the actual amount of mercury - and if you know toxicology - you'd laugh at the claims that the tiny amounts in a vaccine are enough to make anyone of any age or size sick. You get more mercury in a can of tuna than you would ever get in all the vaccines you'll ever have. Ever.
    - Aluminum? See what I wrote about mercury. It's all in the amount. (Drink enough water, one of the safest most non-reactive things in the world, and you could get hyponatremia and die from brain inflammation.)
    - Animal cells? Uh. No.
    - Formaldehyde? See what I wrote about doses. I just now, right this minute, made more formaldehyde in my liver as a product of metabolism than all the formaldehyde I got in the flu vaccine last October. I have a big liver.
    - Polysorbate 80? Again with the doses. Also, it is included in dairy products such as ice cream to keep them smooth and delicious.
    - Gelatin? You do know that your tendons have that stuff, right?
    - Other stuff? Again. How much? Very little. It's okay.

    A survey by generation rescue will never outweigh any of the epidemiological investigations done by actual epidemiologists like me and my colleagues. It's subject to bias.

    Finally, not secondly, it's cute how you're trying to come off as all educated and scientific while using words like "then" instead of "thank" and, well, "secondly"... Oh, and using links to anti-vaccine sites to prove scientific claims. That last one makes you look the most foolish of all.

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