Vaccines and Infants

July 22, 2005

The Arguments Against

Milo was born June 7 and we were quickly faced with the question of whether to vaccinate him. We didn’t even consider it a question. Of course we would vaccinate. But then a co-worker told me that he had not vaccinated his two boys, and gave me several good reasons:

1. Vaccination has been strongly associated with SIDS, the Sudden Infant Death Syndrome. SIDS is vaguely related to breathing difficulties (from the mattress, smokers in the house, etc.) and vaccines significantly affect the breathing of infants for several weeks.
2. It’s never been shown that vaccines actually reduce the chance of getting the disease in question. It’s said that vaccines cured polio, but in fact the “curing” was caused by the lack of double-blind tests. Doctors who previously would have diagnosed a set of symptoms as polio instead diagnosed them as meningitis because of the vaccination on the patient’s chart. In fact the sum of polio and meningitis remained the same before and after the vaccination.

I started doing Internet searches for “vaccines”, and most of the top hits were websites that were either overly or covertly anti-vaccines. Here is a sample of the hits you’ll get on the first or second page of web searches:

• http://www.vaccinationnews.com/
• http://www.vaclib.org/
• http://www.avn.org.au/
• http://www.vaccinationdebate.com/
• http://www.whale.to/vaccines.html
• http://www.909shot.com/
• http://www.vaccination.co.uk/
• http://www.vaccination.inoz.com/

Some look unprofessional, some look quite nice and put together, and some are only up some of the time. They offer several more anti-vaccine arguments:

3. There’s never been an independent study that shows that vaccinated children are healthier than unvaccinated children, and in fact many pediatricians are observing the opposite.
4. Polio was on its way to being eradicated in the 1950s anyway, so the vaccine cannot take credit. Polio was eradicated in other areas of the world where the vaccine was not widely deployed, and other diseases were eradicated even though no vaccine was ever found. (Note that this contradicts point 2 above.)
5. Vaccines are typically given at two and four months, and SIDS is bi-modal, with bumps right after two and four months.
6. When vaccines were made optional in Japan, the incidents of SIDS dropped dramatically.
7. In the U.S. doctors and drug companies are protected against lawsuits from side-effects of vaccines, so they have no real responsibility to making them safe.
8. For a long time drug companies used mercury as a preservative in vaccines, and there was a very high correlation between use of vaccines with mercury and autism.
9. The company that makes the mercury that goes into vaccines (thimerosal) donated $1.6m to politicians last year. Vaccines are a $1b a year business. There’s a lot of pressure to keep believing that they’re effective and safe.
10. Last year, because of complications arising from price controls, there were far fewer people (adults) vaccinated against the flu, but there was not a significant increase in people getting the flu.

We have a book called How to Raise a Healthy Child in Spite of Your Doctor by Dr. Robert S. Mendelsohn, a pediatrician. It was written in 1984 and in many ways was ahead of its time. He has a whole chapter on vaccination and argues very strongly against them.

The Arguments In Favor

The arguments against vaccination were strong, but I was perfectly willing to ignore them as either biased (e.g., in order to sell a book or sue a drug company) or just paranoid. What I needed was good pro-vaccination arguments and evidence. It was very hard to find this with web searches. We sent an alarmed letter to Milo’s pediatrician, who left us a voicemail saying that of course we should vaccinate him, that vaccines were established science, and that we should look up articles distributed by the Center for Disease Control.

He said that the people questioning vaccines are like the people who question evolution. I think that’s a great analogy because with evolution I can go to the religion section of the bookstore to read the arguments against and to the science section for the arguments in favor. I can then make up my mind. I can’t do that for vaccines because I can’t find arguments in favor.

We finally did look up the CDC website and read several articles there:

• Vaccine Beliefs & Concerns
• Six Common Misconceptions

Be sure to read the second one.

Our Decision

We went back and took a closer look at the anti-vaccine websites and books. Although they claimed a lot of things, they didn’t really back it up with any hard data. The closest I got was this “Health e-Alert” by Jenny Thompson:

• Forest? What Forest?

This paragraph is quite alarming:

Last year, a study published in the Journal of the American Association of Physicians and Surgeons examined extensive data on vaccines in children. The astonishing conclusion: Children who receive just three vaccines containing the mercury-based preservative thimerosal are 27-times more likely to develop autism, compared to children who get vaccinations containing no thimerosal.

That’s pretty incriminating! (“Last year” is 2004.) But upon closer inspection, you’ll notice that this study is not one of the references at the bottom of the article. This implies that Ms. Thompson did not have the study in her hand, and has probably never read it. In fact, what is this American Association of Physicians and Surgeons? Their website looks shoddy and is full of broken links. Their journal’s website (The Sentinel) hasn’t been updated since 2002. If you google them, you find surprisingly few hits, and many are Jenny Thompson’s article! Milo’s pediatrician has never heard of this organization.

Our pediatrician also said that there was an anti-vaccine article published in the Journal of the American Medical Association (or similar) a few years ago, but the article later had to be retracted when it was found out that the author was in the employ of a lawyer who made a living out of suing drug companies over vaccine-related problems.

(This reminds me of an acquaintance of ours who, in 1990, had gone to Saudi Arabia and got the following proposition from a local resident: bribe an Indian doctor to publish a study saying that Americans troops are bringing deadly flies to Saudi Arabia, then get the media to jump on this study, then sell fly paper.)

We also looked more closely at the book mentioned above, How to Raise a Healthy Child in Spite of Your Doctor. He’s got passages like these:

. . . consider this: in a 1978 survey of 30 states, more than half of the children who contracted measles had been adequately vaccinated. (p. 238)

“30 percent of our whooping cough cases are occurring in vaccinated patients. This leads me to believe that the vaccine is not all that protective.” (p. 242)

The above statistical reasoning is bogus. It’s irrelevant what percentage of sick infants were vaccinated. What matters is, “Of the infants who were vaccinated, what percent got sick, and of those who weren’t, what percent got sick?” Then you can determine whether being vaccinated reduces your chances of being sick. This section of the CDC website explains this well:

• Misconception: The majority of people who get disease have been vaccinated.

In the section on SIDS, Dr. Mendelsohn writes:

. . . two-thirds of 103 children who died of SIDS had been immunized with DPT vaccine in the three weeks before their deaths. (p. 250)

Twenty-seven died within 28 days of being immunized [with DPT]. (p. 251)

Vaccines are given regularly over several years. Each vaccine is given roughly at the same time in the infant’s life. SIDS happens roughly at the same time in infants’ lives. So it’s not surprising that so many SIDS victims should have been immunized less than a month before. The above statistics are basically meaningless. You’d have to show that infants who are not immunized have lower incidence of SIDS. I haven’t seen any study showing that this is true.

Finally, much of the anti-vaccine literature is stories of infants who died shortly after being given a vaccine. My parents’ neighbor has a granddaughter who was healthy until she was given a vaccine at 18 months of age, then started regressing and showing signs of autism. They blame the mercury. But a single case proves nothing. Maybe autism only starts showing itself at 18 months. (I’m forever fascinated by people’s eagerness to use a single example as proof of a larger pattern.)

So we’re going to vaccinate. We can’t find any compelling and trustworthy reason not to.

The End of Trust

For a century scientists have done medical studies, published these in medical journals that only doctors read, and doctors have acted on those studies. Everyone just trusted their doctor. Now, the opposition (in this case anti-vaccine people) “publish” their studies, such as the one in the possibly-bogus American Association of Physicians and Surgeons, and bloggers like Jenny Thompson of Health e-Alert jump all over them. As someone who’s trying to learn about the topic and make up my own mind, all I have access to is the side that publishes most freely! Had the CDC or AMA made their studies public, I would gladly have read them. Instead I have to take my doctor’s word that these studies exist.

A Wall Street Journal article called From Web-Savvy Patient To a “Cyberchondriac”, written by a doctor, has this great paragraph:

My impression is that people believe more of what they read than what I tell them. It seems that traditional Western medicine based on scientific evidence is less and less trusted by the general public. Meanwhile, some dubious theory from the Internet will be swallowed hook, line and sinker nine times out of 10.

It’s all too easy on the Internet to dominate a topic simply by publishing more, and people like the AMA will have to learn that and do the same. They can no longer rely on patients blindly trusting doctors because the opposition does not require trust.

(As I write this, Google is releasing Google Scholar, which may help. I’ve already found a few vaccine-related articles, one of which refutes the flu vaccine accusation above.)