Tuesday, April 15, 2014

Dr. Jay Gordon and "Irrelevant" Vaccines

This past weekend I was at the Northeast Conference on Science and Skepticism (NECSS). This was their sixth year, and the fourth that I've attended. I was going to work on my review of the conference last night, but something popped up that I just had to address. So, the NECSS 2014 review will have to wait a little longer.

I realize that I just wrote about Dr. Jay Gordon back on April 1 when he mistakenly tried to say that the incidence of measles in the latest outbreak in California could be calculated by dividing the cases by the total population of the state rather than by the susceptible population. But I made the mistake of checking Twitter to see if Dr. Jay Gordon had responded to a couple questions/comments I directed to him, as well as to see if anyone else said anything. I've noticed that he's taken to pretty much ignoring me when I point out his mistakes or clarify something he's said, so I wasn't surprised that he hadn't responded to me. What caught my attention, though, was a brief video shared by someone else.

Titled Are Vaccines Safe?, the video is by CCTV America and is hosted by Mike Walter, with Dr. Gordon and Barbara Dehn, NP engaged in a brief debate regarding the safety of vaccines.



First off, I have to give credit where credit is due. Dr. Gordon does say that vaccines are safe and that if you do not get the measles vaccine, you will be at a "much greater risk to get measles". Thank you, Dr. Gordon, for acknowledging that vaccines are safe and that if you don't get the MMR, you're putting yourself (or your child) at increased risk. However, I can't tell if he means it. Or at least means it enough that he would recommend that his patients receive the vaccine, since he has stated (but since removed from his web site) that he no longer gives or recommends MMR, except when parents ask him for it. I don't recall seeing him state that in light of the current outbreak (which as of April 11 was up to 56 cases this year in California) whether he has started recommending his patients get the vaccine. I hope he has, but given his track record and habit of downplaying outbreaks, I kind of doubt it.

There was also a minor mistake he made that could just be due to speaking off-the-cuff:
Vaccinations are safe. We don't give them as safely as we could. My Facebook picture is a picture of me getting a hepatitis A vaccine on my way to rural Ethiopia. That wasn't a debatable issue. But the idea of vaccinating everybody in America, every child in America, at six weeks of age with six or seven different vaccines, 'cause you know we're adding one, that's not the best medicine. We don't give six of anything else. We don't give six antibiotics.
We don't give 6 or 7 different vaccines at six weeks of age. If the current schedule is followed, a 6-week-old infant would receive, at most, 1 vaccine: the hepatitis B vaccine. It isn't until 8 weeks that an infant would receive multiple shots at once. If they did not get the hepB shot earlier, then they might get up to 6 shots at one visit. The seventh is the meningococcal vaccine, but that is only recommended for high-risk groups. And even then, the schedule allows for these to be spaced out among multiple visits, if the parents prefer that. Doing them at a single visit saves time and money, not to mention ensuring that the child does get their immunizations on time to give them the best chance of prevention. These vaccines have been studied for safety and efficacy when given in combination. Dr. Gordon's opinion that we do not give them as safely as we could is solely his opinion and has no basis in fact. Rather, the evidence strongly points to the current schedule being safe. The antibiotics bit is a non sequitur and false analogy. While six antibiotics might not be given at the same time on a regular basis, there are certainly cases where multiple antibiotics are used concomitantly, for example in the treatment of tuberculosis. But we're talking about entirely different classes of drugs: vaccines and antibiotics are very different. To say that we don't do X with one, therefore we shouldn't do X with the other is intellectually dishonest and a faulty comparison. It's like saying, "We don't ride bicycles in a river, therefore we shouldn't ride boats in a river."

One other little error he made toward the beginning was this:
The way that we give vaccines, without considering family history, without considering a child's development--early development isn't the best way to do it.
I'm not sure what pediatricians he knows, but family history and the child's development are taken into account. Or at least they should if doctors follow the detailed ACIP recommendations, which notes, for example:
A personal or family history of seizures is a precaution for MMRV vaccination.
The individual patient is taken into account. The schedule is a recommendation of the best period of time in which to give each vaccine to achieve the best and most effective protection from disease, while allowing flexibility dependent on the child's history and current state of health.

That out of the way, what really jumped out at me was when the discussion turned towards polio. Dr. Gordon said:
We in America do have the luxury of knowing that we have eradicated or nearly eradicated some diseases. And that these vaccines are no longer as relevant to us, and that the risk-benefit analysis-- Nobody questioned the polio vaccine in America in 1960 or 1970. If someone had said there are some side effects possible, we'd have said, 'Gimme the shot.' Now, with polio eradicated, ah, thirty-four years ago, thirty-five years ago we eradicated polio in the United States, we can discuss risks and benefits. I don't think that's a risky vaccine, by the way...There is no question, if you're going to Pakistan, get vaccinated.
The implication here is that unless you are traveling to a polio-endemic region, you do not need to get the vaccine. This is in line with what Dr. Gordon has said about vaccines for other diseases, such as measles, that have been eliminated from endemic circulation in the U.S. The focus is on the individual and ignores the impact on that person's family and community. The problem is that it's not only people from the U.S. traveling abroad that could bring diseases back. People from other countries can bring diseases into the U.S. and spread it among others who, following Dr. Gordon's advice, did not get vaccinated because they weren't traveling. It also ignores the fact that vaccines are not 100% effective. If a person is traveling abroad and gets the vaccine, there is still a risk that they will not develop immunity, get infected, and bring a disease like measles back to their family or community, thus starting an outbreak. We can reduce that risk by getting vaccinated even though we may not be traveling to a disease-endemic region.

These vaccines are not irrelevant. The ease of global travel ensures that, although we may eliminate a disease in our own country, it can very easily find its way back by land, sea or air. The more virulent the disease (e.g., measles), the easier it is. Even a small drop in vaccination uptake can lead to sizable outbreaks, at significant cost to the individuals and communities affected. Loss of health (and possibly life), personal financial burden, added burden on the health care system, loss of time and productivity. None of these need occur. But if we follow Dr. Gordon's philosophy, they will.

2 comments:

  1. "But the idea of vaccinating everybody in America, every child in America, at six weeks of age with six or seven different vaccines..."

    How many different microorganisms enter our body every time we eat, breath, brush our teeth, graze ourselves, shave... Far more than "six or seven". If our immune system can't cope with a mere six or seven vaccines, it couldn't cope with a day in the real world.

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    Replies
    1. The anti-vaccine "too many, too soon" argument can be broken down into two ideas. First, there's the "too many antigens" aspect, but as you point out, each day our immune systems encounter orders of magnitude more antigens than in any vaccine. That part also falls flat when you consider that the entire vaccine schedule today has far fewer antigens than the schedule of 20-30 years ago, which had fewer vaccines, but each vaccine had significantly more antigens.

      The other side of the argument is "too much 'other stuff'". This focuses on the excipients used in the manufacture of the vaccine. This is pure chemophobia based on a lack of understanding about what the various ingredients are, what they do, and what dose is required to cause an adverse reaction. Again, the evidence is against this notion both in terms of basic science establishing safe exposure levels and in terms of practical use in the form of safety studies of vaccines, both pre- and post-market.

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