Tuesday, October 15, 2013

Vaccines (again)

(updated 17th October)

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I've covered the anti-vaccine stuff before - here.

I thought I'd leave it at that, but then I saw this posted to Facebook yesterday:

Cards on the table. I have only had the flu vaccine once - last year - because I am not entirely convinced that I am in a "high risk category" and I am relatively unimpressed by the vaccine's efficacy in any given year (more details on that below). But I will now have the shot regularly because I have a young child who is in a higher risk bracket and I don't want to feel responsible if she gets the flu. My concerns are now of lesser importance than her well-being. But, as the header on this blog suggests, I feel an obligation to add to the sum of accurate information in the world and I would like people to be able to make important decisions based on that.

If you wish to waste your time with (or have a laugh about) the details of this list of 11 reasons to which this image linked on Facebook - it is here. Of course, it is a list full of half-truths, misrepresentations, scientific ignorance and plain lies. But let's break it down and start with what this particular vaccine - the influenza vaccine - DOES achieve.

Some background - why do we even need a vaccine?

Each year, an average of 5 to 20% of the U.S. population has symptomatic influenza - that can be up to around 60 million people. 226,000 are hospitalized and 24,000 DIE due to influenza-associated illness. 90% of deaths are in folks age 65 and older, but deaths also rarely occur in otherwise healthy children and young adults.

I think it would be safe to assume that only a crazy person would believe the influenza vaccine hospitalizes around a quarter of a million people or kills more than 24,000 people a year, so we can at least start from the obvious observation that the vaccine is absolutely NOT "more dangerous than the flu itself". But is the vaccine effective?

Well, the most up-to-date scientific data (2013) suggests that the flu vaccine is moderately effective in those who receive it and that it prevents about half of influenza-associated symptomatic illness, outpatient visits, hospitalizations and deaths. This is, of course, a quite deliberately vague number (about half), because it is dependent upon the particular year, particular age groups, the particular health status of individuals, and how well the vaccine of that particular year matches the particular strains of the influenza virus circulating. Some years are good, some are not so good.

But think about that term "moderately effective" for a moment. …  The flu vaccine "prevents about half....." - meaning that thousands more people might have died in an average year if it wasn't for that terrible, awful vaccine. Yes, if it wasn’t for those evil scientists and the horrors of modern medicine and its dastardly flu vaccine program (that SAVED the lives of thousands and prevented another few million people from getting the flu), the world would be a better place!!!

Or not.

So, with that in mind, let’s look at these "11 reasons" why you apparently SHOULDN’T vaccinate.

I have provided the first line of each of the items in the list of "11 reasons" in quotation marks and in bold. Underneath each quote, I give a refutation based on Science. You know, that stuff that allows you to read a blog on the internet; that stuff that eradicated small pox and has helped improve human health and increase longevity. That stuff that put a man on the moon. Yes, that science thing. You'll see that there are plentiful links to other sources to support my wild and crazy sciency 'claims' (something that the list of "11 reasons" didn't provide - I wonder why not?)

So - let's go!

1. “Have you ever noticed how vaccinated children get sick almost immediately following a vaccination?

D'ya know, I HAD noticed that. Good heavens – you mean to tell me that the vaccine elicits an immune response???? And there was me thinking it was all magic! All smoke and mirrors! I thought it was the best New Orleans Voodoo!

And then this is possibly my favorite 'lack of scientific understanding' statement from the entire list:

the fact that it causes individuals to get ill following a shot indicates immuno-suppression”..

Bull. And sh*t. This is utter hogwash. Getting ill does not indicate immunosuppression. Immunosuppression is a very specific form of “getting ill”. Some types of “getting ill” involve the opposite of immunosuppression (inflammation, for example, or auto-immune diseases like lupus erythematosus or multiple sclerosis). Immunosuppression CAN be an issue for patients undergoing long-term treatments that involve multiple vaccines. This is why there is a lot of concern over the potential for therapeutic cancer vaccines to be poorly tolerated. But people vaccinated with the flu vaccine are not immunosuppressed - they are mounting an immune response. Their immune system is being stimulated. Think Sesame Street - "One of these things is not like the other"!

Strike one. Poor understanding of science.

2. "It is now a known fact that flu vaccines contain mercury”.

Oh Really?? Well it is also now a known fact that this statement is bunk. Or at least very misleading. It is as accurate as claiming that "cars run on electricity". Why, yes - some cars DO run on electricity - and SOME flu vaccines contain mercury. However, while multiple dose vaccine bottles contain thimerosal (a preservative that produces ethyl mercury when it breaks down), there is no mercury - ZERO - in individual-dose bottles of the flu vaccine. NONE. And every single year, manufacturers produce far more of this thimerosal-free (mercury-free) vaccine than people use. If you want you or your child or your frail great great step-uncle to get the vaccine with ZERO mercury, just ask your provider for a single-dose bottle and then you avoid this boogy-man ethyl-mercury compound that has, in any case, NEVER been shown to be harmful as a vaccine preservative (Andrew Wakefield and his thimerosal/autism "hey let's make some money out of scaring people" circus was a FRAUD)!!

And by the way, if you want to jump in now and complain about how we've all been told how mercury in fish is bad for us, so OBVIOUSLY mercury in vaccines MUST be bad for us....well can I suggest that you look up the difference between mercury (the element), ethyl mercury (C2H5Hg+) and methyl mercury ([CH3Hg]+). Then Google this man: Philippus Aureolus Theophrastus Bombastus von Hohenheim, who once most famously said "Alle Dinge sind Gift und nichts ist ohne Gift; allein die Dosis macht, dass ein Ding kein Gift ist." And he was correct!

Strike two. Lying by omission.

(Update: It is a generality, but the "mercury in vaccines" scare tends to be perpetuated by people of a "Whole Foods persuasion" - healthy folk who don't like the idea of putting anything "unnatural" into their bodies. I'd just like to point out that the sea salt they use instead of processed table salt is precipitated by evaporating sea water and thus contains a lot of other trace elements - some of which may be good for us. But it also contains mercury - along with arsenic, cadmium, fluorine, lead, dioxins, PCBs and anything else that has been dumped into the ocean since the dawn of the industrial revolution. The trace amounts - a few parts per million - probably won't do you any harm, even if you consume it every day, but it is worth pointing out the inconsistency when it comes to freaking out about trace amounts of mercury in SOME vaccines that you might get once a year).

3. "The flu shot can cause Alzheimer’s disease”. 

This is as ludicrous as claiming that bad spirits cause headaches. Or that NASA faked the moon landings. It is absolute nonsense. In fact, a 2001 study of more than 4,000 adults in Canada showed that past exposure to several vaccines, including diphtheria, tetanus, polio, and influenza, was linked to a DECREASING chance of developing Alzheimer's. The false statement in this list of "11 reasons" can be traced back to one man - Dr. Hugh Fudenberg – a "researcher" whose license was suspended in 1995 for dishonorable, unethical and unprofessional conduct. It is not based on any scientific work whatsoever. In short, he made it up. Just pulled it out of his old, retired ass. And, by the way, he now makes a living selling alternative therapies for autism. No obvious conflict of interest there, is there? His "patented" therapy (with his partner ANDREW WAKEFIELD!!) is apparently based on rolling-out cells from his own bone marrow on the kitchen table. I kid you not. Yuk!

Strike three. Pure horse puckey - but let's continue.

4. “The very people pushing flu vaccinations are making billions of dollars each year”.

Oh my gosh! I'd never thought of that.

Then again, so are the people pushing gasoline to fuel our cars. Welcome to Capitalism. You expected them to do it for, what, peanut butter cookies?!!!

Strike four. Meaningless.

5. “Lack of real evidence that young children even benefit from flu shots”.

There is also a lack of "real evidence" that the statement above is true...

This is “cherry picking” of the worst kind.

Let's see - if I perform a quick PubMed search using the search terms "influenza vaccine efficacy", I can see 2088 scientific studies. The list of "11 reasons" above mentions just 51. So the problem here is that important details about the “studies” being cited are missing. When and where were these particular studies conducted? Was this a single retrospective study looking at 51 previously published studies (what we call a "meta-analysis")? How many of the 2088 studies I found show the opposite effect? Were the studies performed in “good” years or “bad” years? In a study conducted in 2003-2004, for example, 99% of circulating influenza strains were due to the influenza A virus, and only 11% of influenza A specimens were similar to a strain included in that year's vaccine. This would have been a “bad” year and would have skewed the data in the “ineffective” direction. Studies published in a “good year”, where there is a good match between circulating strains and the vaccine, would skew the data in the “effective” direction.

Another question - which type of vaccine was being investigated in these selected “51 studies”? This is important because live-attenuated vaccine has been shown to be more effective for young children than inactivated vaccine. If these “studies” were performed before this fact was known (pre-2007), or if these folks deliberately picked 51 studies that looked at inactivated virus vaccines, they would undoubtedly have skewed the data in an "ineffective" direction. You see, scientists need details in order to form an informed and educated opinion. In this list, there is no real evidence of any detail.

If you really want to get into the complexities of epidemiology, here's a starter. Warning - it isn't as simple as we'd like..

Strike 5. More lying by omission.

6. "Makes you more susceptible to pneumonia and other contagious diseases".

This is an interesting hypothesis and it seems quite plausible - if you believe the other stuff about immuno-suppression and if you ignore the fact that flu itself also makes you up to 100-times more susceptible to pneumonia and other contagious diseases. But anyway, until you show me a series of science-based clinical trials that demonstrate its veracity, then this claim is mere conjecture - it is guess work. Someone pulled it out of their ass (and see 5 above).

Strike 5. Not supported by scientific data.

7. "Vascular disorders -  Medical research shows flu shots are associated with an increased risk of vascular inflammation”.

Apart from the fact that "vascular inflammation" and "vascular disorders" are not the same thing (Sesame Street again), this statement might be almost true - with the caveat that the inflammation is temporary and not serious (see 1 above). This is called “eliciting an immune response” and is part of the reason why vaccines work. In some people, these symptoms can be quite severe, but in the vast majority they are not.

Note that inflammation is an immune response. If you were immunosuppressed, you might not get inflammation. In fact, doctors sometimes prescribe immune suppressing drugs (e.g., methotrexate) to people who have inappropriate inflammatory conditions such as rheumatoid arthritis. This is more evidence that the whole "immunosuppressed" thing above (in item number 1) was clap-trap. Inflammation shows that your immune system is working. Importantly, if you have a pre-existing "vascular disorder" or if you have heart disease, you really should consider getting a flu vaccine as it might minimize the risk of complications.

Strike 7. Poor understanding of immunology and scientific terminology.

8. “Children under 1 years of age are highly vulnerable to a neurotoxic breach of the delicate nerve center surrounding the brain and central nervous system”.

What a wonderfully evocative statement. And this sentence - in isolation - may actually be true. But - yay! we have our inevitable classic "straw man" argument. This is like saying you shouldn't get the flu vaccine because you might get brain damage if you drop a hammer on your head. Babies are vulnerable to all kinds of things - which is why scientists and healthcare providers would NOT inject a neurotoxin into a baby (see 2 above). Lead is a neurotoxin. Whisky is a neurotoxin. Botulinum toxin is a neurotoxin. Attenuated viruses are NOT neurotoxins. And single-dose vaccines DO NOT CONTAIN MERCURY (just thought I’d stress that fact again)!

Strike 8. Informal fallacy.

9. "Increased risk of narcolepsy".

Hooray! This is the item on the list that is closest to being scientifically accurate. However, it doesn't quite get there because the devil - as always - is in the detail. There was indeed a particular flu vaccine linked to narcolepsy. It was in Europe in 2009 and that vaccine (Pandemrix from GlaxoSmithKline) has not been used since. It was also NEVER licensed for use in the USA because it contained a particular adjuvant (a substance that stimulates a local inflammatory response), and the CDC and FDA don’t want that particular adjuvant here. So, for USA citizens (and anyone else who lives in 2013 and isn't lost in a pre-2009 time warp) – this point is irrelevant. No vaccine used ANYWHERE since carries any such risk. So this "reason" is like saying you shouldn't go to the doctor for a headache because he might drill a hole in your head to let the bad spirits out. We don't do that anymore.

Strike 9. Completely irrelevant to any vaccine developed before or after 2009.

10. "Weakens immunological responses".

We went through that in 1 and 6 above. Hog and wash. Vaccines work by eliciting – not weakening - immunological responses. To claim otherwise is silliness.

Strike 10. More scientific ignorance

11. "Serious neurological disorders"

It is true that almost 4 decades ago (in 1976) an increased prevalence of Guillain-Barré Syndrome was noted in populations receiving a particular flu vaccine. The rate was 1 in 105,000 above “background rates”. This "background rate" at the time in the USA was between 80 to 160 cases each week – regardless of vaccination. Scientists have multiple theories on why this slight increased risk may have occurred, but an exact reason for the association remains unknown, meaning that the vaccine may – but also may not – have been directly responsible. Correlation is NOT the same as causation. Of note – and demonstrating how complicated such numbers are - a more recent study of 90 million people in China who were vaccinated during the 2009–2010 flu season found that only 11 people - yes just 11 out of 90 million people, or 0.00000012% of the vaccinated population - were subsequently diagnosed with Guillain-Barré Syndrome, which was at a LOWER level than in the population that was NOT vaccinated. So IT WAS PROTECTIVE (well, not really - as I said above, correlation is NOT the same as causation). There is also the 2001 Canadian study (mentioned in 3, above) that showed lower levels of Alzheimer's in vaccinated populations. As these studies involved more recent vaccines, perhaps there is actually a DECREASED risk of serious neurological disorders, and we should all run out and get an EXTRA flu shot just to keep the old Alzheimer's away??!!

One more detail to take into account is that people who get the flu are 40- to 70-times more likely to develop Guillain-Barré Syndrome than the uninfected population. Maybe you should take that detail into account when deciding whether you want to minimize your risk of "serious neurological disorders".

Strike 11. Lying by omission and poor grasp of statistical methods.

So, there you have it. That was the 11 reasons why the flu vaccine is supposedly "more dangerous than the flu itself". And if you still believe any of those reasons, well I have a natural cure for cancer I'd like to sell you (it is good for tennis elbow, acne and athletes' foot, too). Seriously, whether or not you get the flu vaccine is entirely your choice, but make that choice based on whether or not you want a slightly increased chance of getting the flu and/or passing it on to a loved one by NOT being vaccinated. If you decide not to based on ANYTHING on this ludicrous list of anti-science poop flying around the intertubes, then you deserve the flu and absolutely no sympathy when you get it!

And if you choose not to get the shot and you end up having to cope with a miserable, sick child, well just put it down to bad luck. I mean, it's not like you could have done anything to prevent it, is it?

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