Influenza Vaccine Has Been Studied in Pregnant Women

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Summer is very nearly over in the Northern hemisphere. Fall and winter creep ever closer. As the temperatures drop, we begin to think about pulling out our warmer clothes. We shake out our jackets. Those with oil heat make sure their tanks are filled. Others stock up on firewood. The really forward thinking might ensure that their shovels are in decent shape for any snow that may be coming their way.

We're also heading into flu season. Influenza rears its ugly head from fall, through winter, and into early spring. It's one of those diseases that people tend to underestimate and have a lot of misconceptions about. A lot of illnesses people think are the flu are actually different illnesses caused by bacteria, parasites, or different viruses. A lot of people think that it is a fairly benign disease, even though it kills thousands of people in the U.S. every year, and hundreds of thousands worldwide. Then there are the myths about the flu vaccine. Probably the most common mistaken belief is that the vaccine can give you the flu, even though it can't. The available vaccines use either inactivated virus or a severely weakened form of the virus, neither of which will give you the flu.

Suffice it to say, there is a lot of misinformation out there about the flu and the flu vaccine. But there is one population that is more seriously affected, both by the disease itself and by the myths: pregnant women.

Colorado's Non-Medical Vaccine Exemption Form Ruffles Anti-Vaccine Feathers

Back to school time. Show your child you care about their health.
Image Source: South Florida Caribbean News

Note: see update at the end of the article.
 
School is nearing (or already upon us) in many states. Parents are out buying notebooks, pens and pencils, folders, and new clothes for their children to make sure they're ready for the first day. It's also the time when many parents need to make sure that their children are up to date on their vaccinations in order to attend school. Naturally, this is also a time that anti-vaccine activists absolutely hate, especially in states where public health officials have taken efforts to ensure parents are better informed about vaccines and the diseases they prevent, as well as making opting out of vaccinations closer to the same burden that exists for those who choose to protect their children from diseases.

One of the latest battlegrounds is Colorado. Anti-vaccine activists and organizations, like the National Vaccine Information Center, are really upset with Colorado. Nothing has changed with regard to the law in that state, though. Non-medical exemptions haven't been removed, like they have in California. Parents aren't required to sit through an educational session on the benefits and risks of vaccines and the diseases they prevent. All that changed is this year's vaccine exemption form and the rules around its use.

69 Doses and Matters of Trust

The other day, I wrote about the incorrect claim that there are 69 doses of vaccine on the U.S. recommended childhood immunization schedule. That claim has morphed into 71 (or 72 [Edited to Add (2/24/15): apparently, anti-vaccine groups are now dishonestly claiming 74!]) doses since the publication of the 2016 schedule, which added the Meningococcal B vaccine for at-risk individuals, as well as those for who would like to get the vaccine and their doctor agrees it is indicated. The MenB vaccine has not yet been added as recommended for all individuals. At any rate, I had hoped that my post might help those repeating the "69 doses" claim realize that they were mistaken and misled by whomever they heard the claim from (e.g., @VaxCalc has been quite busy on Twitter, spouting out that claim on an almost daily basis, despite being told that it is incorrect). I've share the post with a number of people on Twitter that have repeated the claim. As yet, I have not had a single person admit that the claim is wrong. Mostly, they try to come back with rationalizations, which really misses the point of my post.

So what's behind the misunderstanding? What point was I trying to make?

69 Doses...or Is It 53? Or Even Fewer?

Please note additional edits to this article, particularly those added after 2/3/16, with the publication of the new 2016 recommended schedule.
 
My deepest apologies to my readers for this rather long spell without any new posts. Work and real life both got rather too busy for me, and I just did not have the time or energy to write. It certainly isn't for a lack of topics. I have a couple that I would really like to get to, including at least one request. But to get back into the swing of things, I thought I'd start with something pretty easy.

The other day, I got into a discussion on Twitter with a naturopath by the name of Stephen M. Gibson. He caught my eye because he appeared to be using my post about package inserts to suggest that they are evidence that vaccines cause harm. Now, vaccine package inserts do list adverse reactions (i.e., something known to be caused by the product) discovered during clinical trials. They also include adverse events (i.e., something that occurs after using the product, but may or may not actually be caused by it) reported to the manufacturer after it has been put on the market. I tried to get Mr. Gibson to let me know which specific injuries he was concerned about. The best I got was him referring to Section 6 of the inserts (which, again, includes reports of things that are not necessarily caused by the vaccine) and that he's opposed to "Any. And every" bit listed in Section 6.

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But it wasn't his misuse of my post that really grabbed my attention and prompted this post. Rather, it was his claim that he has "read and studied the 69 vaccines package inserts in the Feds recommended list":

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Sixty-nine package inserts? Really? Where did he get this number?

Stand Up for Parents' Rights to Accurate Information on Vaccines

A few years ago, California's legislature took steps to ensure that parents who wished to opt out of getting their children immunized for school or day care understood what their decision meant. Assembly bill AB 2109 required that before a philosophical exemption could be granted, parents had to get a health care provider to sign the exemption form, indicating that the parent received information on the risks and benefits of vaccination. In order for parents to make an informed choice, they ought to have good, science-based information on which to base that choice. SB 2109 seemed like a bill that should have had unequivocal support from the anti-vaccine, sorry, "pro-vaccine-choice" movement. Instead, they vehemently opposed it, led by the National Vaccine Information Center (NVIC). Despite NVIC's lobbying, AB 2109 passed.

The latest unprecedented outbreak of measles, starting in California and up to 132 cases in that state as of March 6, has led several state legislatures to consider bills that would tighten up school vaccine exemptions and improving parent education regarding immunizations. Naturally, this led to claims that government was trying to remove choice and personal belief. Some of those complaints are against bills aimed at removing non-medical exemptions. And some oppose bills similar to AB 2109, like Minnesota's SF380/HF393.

A Confession

This post was very hard for me to write. For four years, now, I've been writing this blog. Four years putting out post after post refuting the claims of "anti-vaxers". For several years before that, I was active in the comments of a few different sites, trying to be quick to respond anytime someone questioned vaccines. All this time, so many hours pushing the pro-vaccine angle. But I just cannot, in good conscience, continue. Not any more. The little bit of income I earn for my efforts just isn't worth the guilt. Not after this past weekend.

What happened? What changed my mind? Last weekend, I attended the Pharma-sponsored Midwest Conference on Vaccines. This is the first time I've been to this conference, now in its sixteenth year, and the first time I've met many of my blogging colleagues face-to-face. Normally, all of my dealings with the inner workings of the pro-vaccine machine have been through email or snail mail. I get my orders. I write. I get paid. Simple, easy money. To say that this conference was an eye-opening experience is an understatement.

An Honest Flu Ad

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Last week, the National Vaccine (mis-)Information Center ran an ad in a New Hampshire newspaper designed to make people fear the flu vaccine. I wrote about why the NVIC ad is misleading, as did Moms Who Vax and Epidemiological. In short, the NVIC ad played to the myth that the flu vaccine makes you sick (it doesn't) and promoted the idea that the vaccine doesn't work (it does). It also played on fears of adverse reactions to the vaccine ("know the risks"), but did not so much as hint at the benefits.

At any rate, I though I'd put together a somewhat more honest ad. Here's my take on the NVIC ad. Please feel free to share this, unaltered, far and wide. I also have a higher resolution version of it that should be good to print. E-mail me (contact info's in the sidebar) if you would like a copy.

NVIC? Know the Omissions (Part 2)

Those of you who read this blog regularly know some of the common tactics that anti-vaccine activists use. They're fond of the Pharma Shill Gambit, in which they accuse those with whom they disagree as being paid by pharmaceutical companies. This allows them to blissfully dismiss anything their detractors have to say. If you're paid by pharma, after all, you're hopelessly biased and nothing you say can be taken as true or honest. Of course, it doesn't matter whether you actually get paid by pharma or not. Facts don't tend to matter much to those using the pharma shill gambit.

That brings us to another tactic: dishonest or misleading rhetoric. The less, shall we say, sophisticated anti-vaccine activists aren't all that subtle about it. They will brazenly state as truth claims that are easily shown to be wrong (e.g., the false claim that MMR has the preservative thimerosal in it, or that vaccines contain antifreeze; they don't). The more skilled among the anti-vaccine movement, however, use insinuation. They imply certain claims using language that, on the surface, is technically true or could be classified as opinion, but the unstated claim is at best misleading and at worst dangerously wrong.

The National Vaccine Information Center (a more Orwellian-named organization would be hard to find) falls into that latter category, for the most part. Take, for instance, their latest ad, placed in a local New Hampshire newspaper:

A Snapshot of the Deep Pockets of the Anti-Vaccine Movement

Research is expensive. Lab techs, study coordinators, grad students and post-docs have their salaries (often a pittance compared to the importance of their work and the skills required); primary investigators (PIs) have theirs. Then there are the costs for materials - drugs or other substances under investigation, reagents, etc., as needed. Statisticians, equipment. The expenditures add up.

And PIs spend a considerable amount of their time just seeking out grants to support their research. Many rely heavily on government entities like the National Institutes of Health, one of the largest funders of research in the United States. Some research funds come from industry sources, the results of which need somewhat greater levels of attention to suss out the valid results from the bias. Others find support from private donors and foundations.

This latter source is the bread and butter of cranks and pseudoscientists (well, with the addition of the NIH's National Center for Complementary and Alternative Medicine, but that's a whole other post). For example, Mark Geier (who has had his various medical licenses stripped for unethical conduct) and his son, David (who has no medical licenses and was found by the Maryland Board of Physicians to have practiced medicine without a license), essentially fund themselves through their non-profit corporations CoMeD, Inc. and Institute of Chronic Illnesses, Inc. Other anti-vaccine researchers, perhaps lacking their own wealth, rely on other individuals and families devoted to the "vaccines cause autism" myth who happen to have significant assets to fund their dubious research.

Such is the case with a new study by Christopher Shaw and Lucija Tomljenovic, titled Administration of aluminium to neonatal mice in vaccine-relevant amounts is associated with adverse long term neurological outcomes (back in December 2011, Orac pointed out the flaws of the study [Edited to add February 5, 2015: the study Orac discussed formed the basis for the 2013 study I discuss here.]). This study received significant funding from The Dwoskin Family Foundation and the Katlyn Fox Foundation, both of which have funded previous studies by one or both of this duo.

NVIC? Know the Omissions

The National Vaccine Information Center is at it again. They have launched a two-month, multi-state billboard advertising campaign to spread their misinformation and fear about vaccines. They are calling this the "Know the Risks" campaign. For the months of March and April, billboards like this will "grace" the landscape around Austin, TX; Chicago, IL; Phoenix, AZ; Portland, OR; and Tucson, AZ:

Something seems to be missing...
Image credit: Voices for Vaccines

According to the press release, they claim their goal is to "encourage well informed vaccine decision-making". However, as we've seen before, NVIC's founder, Barbara Loe Fisher, appears to have little problem promoting blatantly incorrect information regarding vaccines. The first thing I noticed when I saw the above billboard was that something rather important to being "well informed" was missing: knowing the benefits of vaccinations. Yes, making an informed choice requires knowing the risks and failures, but the benefits are also needed. It also helps to put the risks into context by knowing how likely it is to occur, and how that compares to similar risks from the diseases that are prevented by vaccines.

Leaving important information like that out (or even just the fact that there are benefits) strikes me as a dishonest tactic. But let's take a closer look at this.

Why Do I Do This?

The other day, I received an email from someone via my other site, asking why I do this. Why do I speak out against anti-vaccine myths and put so much time and effort into that site (and this blog), when I state I have no financial ties to any pharmaceutical companies. Is it just a "labour of love because [I am] concerned for humanity"? Where does my passion come from? What intrigued me about this was that it came shortly after my experience with the Vermont Digger and the Vermont Coalition for Vaccine Choice, the latter of whom, along with Laura Condon of the National Vaccine Information Center, accused me of being a Pharma Shill^TM and/or paid by Dr. Paul Offit. And certainly there are hints that the non-vaccinating individual who emailed me suspected that, my honest statements notwithstanding, I really was paid to write and comment.

Just to reiterate, I receive no money or any other compensation from a pharmaceutical company to write about vaccines in any manner. I hold no stocks (unless there happen to be some in the mutual funds in my retirement account, over which I have no control). I receive no checks, dinners, or quid pro quos. A kind fellow by the moniker Eric TF Bat kindly provided me with hosting space on his domain for my AntiAntiVax site for free after several fellow commenters at Phil Plait's Bad Astronomy blog recommended I turn one of my comments into a web site so people would have a permanent place to point people to when countering anti-vaccine myths. I don't know Eric outside of that context. As for my blog, well, it's hosted by Blogger (clearly), which is also free. I have paid for my domain name out of my own pocket. And I use my own free time to write. Some people garden. I blog. So there's my financial situation regarding my countering of myths and misinformation regarding vaccines. I don't get squat, and I would not accept any money from a pharmaceutical company, either, even if they offered it to me.

So, if I don't get paid, why the hell do I do this?

Liar, Liar, Pants on Fire

There is a certain lie that floats about anti-vaccine groups. Before I go on, let me be clear about my use of that word: "lie". Because of certain, um, frivolous proclivities among some of the folks who perpetuate this lie, I feel it behooves me to define just what I mean. In this post, I am going to use the term "lie" with it's definition of "a falsehood". It should not be construed, unless I explicitly state otherwise, that I am implying an intention to deceive on the part of the person uttering this lie. Suffice to say that, whether through deliberate action or mere misunderstanding, many among the anti-vaccine movement persist in forwarding this lie, this falsehood, as if it were truth.

Now what lie am I going on about? This: "the Supreme Court of the United States has completely shielded vaccine manufacturers from product liability". You've no doubt heard some version of this before, often in the form "parents can't sue vaccine manufacturers". As it is frequently stated by those opposed to vaccinations, this simply is not true. Some parents just repeat this because they read it somewhere and believed it. They haven't actually read the relevant documents to find out for themselves what's really going on. I don't blame them for that. It's sloppy thinking and intellectually lazy, but I'm not going to harp on it. I'd just recommend that they (temporarily) put aside their blinders, read the actual source documents and think for themselves. Don't even take my word for it.

Then there are those who ought to know better, and, I suspect, probably do. Whether they just really do not understand or are knowingly misrepresenting facts, there are those who hold themselves out as fierce advocates of informed consent who, if they were truly devoted to that, would actually present truth, rather than falsehood. People like Barbara Loe Fisher.

One Size Fits All Vaccination

There are a number of frequent refrains heard from those opposed to vaccines. There are too many. Oh, the toxins! If vaccines work, then what are you worried about? Vaccination laws take away parents' rights. The list goes on and on. They get repeated so often that it becomes very easy to just gloss over them and ignore the strident ululations of anti-vaccine activists. Between posting here and commenting on various blogs and news stories, I feel like I've addressed these arguments (if you can call them that) more than enough times. But then I remember that as long as the noise keeps going, there will be a need for reality-based individuals to speak out against them.

Recently, one such complaint caught my interest a little more than usual. Perhaps it was because I happened to be rereading the CDC Pink Book at the time. Much is made among anti-vaccine types of personal liberties and how each person is different. Every little snowflake is precious and unique, they opine, so how can anyone support a "one size fits all" vaccination schedule?

The Anti-Vaccine Crowd Shows They Are Anti-Informed Consent

"We want people to have informed choice when it comes to vaccines." These words, or at least something along these lines, are uttered by many anti-vaccine activists, like Barbara Loe Arthur (aka Barbara Loe Fisher) of the misnamed National Vaccine Information Center or the authors at Age of Autism. To hear them speak, you would imagine that they would be completely in favor of any efforts which strive to provide accurate, complete information to parents who are deciding whether or not to have their children vaccinated. Such efforts should be whole-heartedly embraced by these "pro-informed consent" warriors.

Just such an opportunity has arisen in California, with AB 2109. As I recently wrote, this bill would expand on California's philosophical exemptions regulations regarding immunization requirements for day care and school enrollment. If passed, parents seeking a philosophical exemption would need to obtain from a physician or other health care provider a signed statement that the doctor provided them with information on the benefits and risks of vaccines. Physicians are already required by Federal law to provide this information before administering a vaccine. This provision would provide an added opportunity for parents to receive sound information and advice regarding their children's vaccines.

Sounds like something Fisher and company would support, no? Surprisingly, no.

Does @VaxCalc Provide Valid Info on Vaccines? Not Really...

Twitter can be a really useful tool for getting information out to lots of people in a very short amount of time. The down side is that the 140-character limit on your message means there isn't a whole lot of space for nuance or detail. This leaves plenty of room for misinterpretation of messages. It also means that those with an agenda to drive can ignore nuance in favor of their own spin. For example, the Twitter account @VaxCalc, run by the Orwellian named National Vaccine Information Center (NVIC). @VaxCalc pumps out a steady stream of...uh...words (I refuse to call it "information," since it is nothing of the sort) that, while containing a speck of a grain of truth, aim to persuade people away from vaccines. Don't believe me? Have a look:

But I thought they removed it!

The link in the tweet takes you to a table on the FDA's web site about thimerosal in vaccines. Thimerosal, as most of you know, is a preservative that is used to prevent vaccines from being contaminated with bacteria, fungi or viruses, which can be very bad, indeed (as evidenced by the 1928 Bundaberg Disaster, in which 12 children died because a vaccine became contaminated). It caused a stir because it is metabolized into ethylmercury, which some erroneously linked to autism.

Anyway, is that tweet correct? Well, yes and no.

Pox by Post

Something came to light today that made me despair for the human race. I first read it at Mike the Mad Biologist's blog. It was also covered by Emily over at The Biology Files, where Emily took a look at just who the people were that were involved. Reuben wrote about it at The Poxes Blog and Tara discussed it at Aetiology.

What could have gotten the medical and skeptical blogosphere in such an uproar? This story.

A Little Bit of Poison in a Sweet, Inviting Wrapper

If you follow me on Twitter (and if you don't, why aren't you?), you have likely already heard about a PSA put out by the National Vaccine Information Center (NVIC) and Mercola.com, two slick anti-vaccine organizations. The PSA is being run on Delta Airlines flight. You can read more about it at Skepchick and Respectful Insolence. The Skepchick article includes steps you can take to combat the propaganda, including a link to a petition to get Delta to stop showing it on their flights.

The video is available on YouTube (Update: It looks like NVIC removed the video at that link, but it is still up here and here [Update: looks like it has been removed from Facebook, now, too]), but cannot be embedded. Comments have also been turned off, perhaps to avoid inconvenient critiques from science-minded individuals. On the surface, it appears to be pretty good advice, so why all the fuss?

Because the PSA includes some iffy information and, more importantly, directs people to the NVIC web site, which is rife with misinformation and distortions of fact.

Vaccine Awareness Week

As some of you have probably already heard, Joe Mercola and Barbara Loe Fisher (of the misnamed National Vaccine Information Center) have decided to declare November 1-6 "Vaccine Awareness Week". Well, I'm going to try to join the fun that Orac at Respectful Insolence suggested, along with Science-Based Medicine, Neurologica and whatever other blogs join the fun.

During that week, pay attention to Twitter, as well, with the #vaxfax hash tag.