Vaccines: The Debate Continues

Do news reports and online chat about vaccination risks--and particularly the MMR's supposed link to autism--give you pause?

Research published in the April issue of Pediatrics suggests that parents don't seem to be swayed by media reports of vaccination's potential risks.

Michael Smith, a pediatric infectious disease specialist (at the Children's Hospital of Philadelphia when he did the study, now at the University of Louisville School of Medicine) found that immunization rates for U.S. kids ages 19 months to 35 months from 1995 to 2004 remained fairly steady, despite spikes in media coverage of claims that the measles, mumps, and rubella vaccine can cause autism.

Smith found that vaccination levels dropped in the two years following the initial publication in February 1998 in the British medical journal The Lancet of a later-discredited study proposing a link between the MMR vaccine and the onset of autism. But, he notes, there was little mainstream media coverage of that study until two years after its publication; by that time, vaccination levels had returned to normal and remained that way.

Smith's study is especially compelling in light of the latest spike in media coverage of events stemming from the purported MMR/autism link:

* Last month, the federal government agreed to pay an Atlanta family whose daughter developed autism after receiving vaccines against five diseases (including the three MMR covers) at one time.

* Around the same time, Sen. John McCain said there was strong evidence supporting a link between autism and vaccines. He pinpointed thimerosal, a mercury-containing preservative that used to be part of the MMR vaccine and others but has been virtually eliminated from vaccines since 2001. The medical community has voiced its disagreement with McCain's view--and with the ABC drama "Eli Stone," whose first episode, aired in early February, featured a storyline in which a court finds that a vaccine preservative caused a child's autism.

* The February issue of the British Medical Association journal Archives of Disease in Childhood published results of a good-sized study that showed, as have several studies before, that there's no connection between the MMR vaccine and autism. And a study in the January Archives of General Psychiatry revealed that autism diagnoses continued to increase in number in California after thimerosal was removed from vaccines.

You may not have read about rash of recent measles outbreaks: The U.S. Centers for Disease Control and Prevention reported in February that in August 2007 an unvaccinated Japanese boy participating in the Little League World Series in Williamsport, Penn., came down with the measles; six people in three states subsequently caught the disease. An outbreak in January stemmed from an unvaccinated San Diego boy's travel to Switzerland, where he apparently contracted measles. He brought it home with him; 11 other unvaccinated kids were sickened. There have also been recent outbreaks in New Jersey and Arizona.

Those small outbreaks were contained, health officials said, because so many people are vaccinated. Had more people shunned the MMR, the disease could likely have spread farther and wider.

I don't remember actually making a decision to vaccinate my own kids. I certainly wasn't guided by anything I read in the news. But nowadays, as a recent New York Times article explained, some parents--often clusters of like-minded ones--are opting out.

Before the measles vaccine was introduced in 1963, half a million Americans a year got measles; 500 died from the illness each year. In an odd way, wiping out that disease has made room for us to worry about other ones.

I sympathize wholeheartedly with people who fear causing their kids harm when trying to do them good. And I know it's hard to keep the interests of society at large in mind when you're worrying about that precious babe in your arms.

But aren't parents who opt not to vaccinate banking on others' willingness to vaccinate their kids to keep measles at bay? It isn't fair for only some of us to shoulder that risk--even if it's just a perceived risk.

By Jennifer Huget |  April 9, 2008; 2:00 PM ET  | Category:  Family Health
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Comments

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I agree. Some kids will not be able to be vaccinated because of health reasons that clearly contraindicate the vaccine. Parents who chose not to vaccinate their children because they believe unfounded claims about autism or immune system damage are putting those kids at risk. They are also putting at risk babies who benefited from their mothers' immune systems in utero but have not been vaccinated post-birth yet. Save the "herd immunity" for those who really need it.

Posted by: Angela | April 9, 2008 4:15 PM

The only way to truly begin to sort out what kind of neurological damage the current U.S. vaccine program may be doing would be, first of all, to conduct a controlled study comparing the rate of neurological disorders (e.g. autism, ADD, other learning disabilities) in vaccinated vs. unvaccinated kids. Then, if the rates of disorders were found to be higher in vaccinated kids, scientists could begin to drill down and figure our which ingredients, or combination of ingredients, are causing the problems. So far, the CDC refuses to do such a study, and Congress refuses to authorize it. Initially the CDC said they couldn't do such a study because most kids are vaccinated; therefore, they wouldn't be able to create a big enough control group. Now, however, the CDC is actually complaining about the large number of unvaccinated kids living in the U.S. But still the agency refuses to do the study. What reason could there be for this? Hmmmm.... let's see. Could it be that the drug companies don't want such a study to be funded because they know something you don't know about the risks of vaccines, and they intend to keep it that way? Ask your congressman.

Posted by: clara | April 9, 2008 5:15 PM

Clara, it's more complicated than that. The study you are proposing would have no scientific validity.

Scientists would need to have it be double-blind, and not have a selection factor. That is, a truly rigorous scientific experiment would not take the children who are not being vaccinated (who, in my experience, are more likely to homeschool, cloth diaper, eat differently, etc.). It would have to find parents who did not care whether their kids are immunized or not, and randomly assign half the kids to get saline injections, and the other half to be immunized. And you'd have to make it large enough for some of these low-incidence diseases have some statistical significance.

Good luck recruiting parents who don't care either way about the immunization of their child.

Posted by: scientist | April 9, 2008 5:36 PM

Dear Scientist:

I hope you truly are not a scientist, because your comment is ridiculous. Of course there ill be potentially confounding variables with this study, as there are with any study. That is no excuse not to do it. You simply have to do your best to control for other variables. This does NOT mean you have to randomly assign kids to each group. What it does mean is that, as you collect the data on vaccinated vs. unvaccinated children, you must examine and record other variables that may be relevant. What we know so far about parents who are choosing not to vaccinate their children is simply that they tend to be well-educated. They are not, as a group, all homeschooling their children, putting them in cloth diapers, feeding them only organic food, and never letting them get dirt on themselves. That is a myth created by the pro-vaccination media. Rather, they are simply parents who don't take the government's word on everything but choose instead to do research for themselves, and then decide against vaccinating. Thus, you could compare these unvaccinated children to the vaccinated children of other similarly well-educated parents, living in the same geographic region, feeding their kids roughly the same type of diet, allowing them to attend public schools, etc. This would not be a difficult study to undertake at all. It is only the will that is missing, not the means.

Posted by: clara | April 9, 2008 7:07 PM

Actually Clara, it is you who is wrong. The "gold standard" in research is the blinded randomized controlled trial-- blinded so as to make it unbiased. You cannot actually prove beyond a shadow of a doubt that vaccines do not absolutely trigger autism in some children without an RCT study that directly compares the two populations and the study has to be done properly to provide the right answer. While "Scientist" alludes to the methodological problems with observational and retrospective cohort studies, there is another issue. Ethics. We know that vacccines protect people from deadly diseases so to conduct a study that witholds an intervention that prevents death, is not ethical. So we must be satisfied with the data we have which is pretty good.

The studies you propose have been done (comparing unvaccinated with vaccinated) in other countries and they show that vaccines do not trigger autism (the one case of the girl with a mitochondreal disorder nonwithstanding--that issue needs to be studied). In fact, in places where vaccination is not as good, the rates of autism have risen like they have everywhere else.

I believe that these "educated" parents who withold vaccination from their children are doing them harm. I wonder what other wacky parenting practices are going on in these communities. G-d help those children.

Posted by: a doctor and scientist | April 9, 2008 7:18 PM

If there are people who want to do studies of vaccinated versus unvaccinated, they should seek funding for such a study. Or, alternatively, since there are few investigators interested in initiating such a study, perhaps some of the anti-vaccine groups could fund one and select or solicit their own investigators. They could do it for the same cost of a couple of anti-vaccine, conspiracy theory USA Today advertisements. But the reality is that such a study is not only unwarranted (as there is no credible evidence of a link between vaccines and autism, and hence no reason for the government to try and conduct such a study) but probably impossible to do. There are very, very few unvaccinated people in this or any country. There is a myth of unvaccinated people in Chicago, and among the Amish. But that has not been borne out under investigation. There are groups that don't vaccinate as much as others, but usually they have a few shots. How many vaccines would one have to have to be considered "vaccinated?" One interesting study in Canada screened 10,000 Inuit for autism and found no cases. Wow. Maybe they don't vaccinate? Alas, it turns out they are highly vaccinated. Maybe the diet? Alas, they have an extremely high intake of mercury through fish and whale blubber. The key to understanding autism is genetics and an analysis of how the changing methods of diagnosis and epidemiology have yielded higher rates. "Scientist" is correct that the complexity of a vax versus unvax study is overwhelming. I wanted to add the point about it being unfeasible and impractical as well.

Posted by: albert | April 9, 2008 7:27 PM

Actually, there have been no studies, to date, in this or ANY other country comparing vaccinated vs. unvaccinated children for rates of autism and other neurological disorders. And yes, of course the "gold standard" is a double-blind study, but as you note, that is not considered ethical right now because everyone has been brainwashed to think that there are no risks, only benefits, to the plethora of vaccines now mandated for children before the age of three. Nany, many scientific studies are undertaken that are not "gold standard" (due to ethical or other considerations), but are still extremely valuable in uncovering scientific mysteries. And actually, according to a NY Times article just published last week, there are now thousands of school-age children living in the U.S. who have received no vaccines. This is not a myth. It is a fact, as per the CDC (which is complaining about it!). Me thinks I am encountering people from the pharmaceutical industry on this thread, who are hired to scour the internet and post anti-research, pro-vaccine messages wherever any debate is going on about the subject. Parents, please don't be fooled by thes pro-industry posts. There are billions of dollars at stake for the pharm. industry if even a single vaccine is taken off the market.

Posted by: clara | April 9, 2008 8:19 PM

Question: If double blind studies are the only ones to give a valid result, and if such studies are impossible when it comes to vaccination, doesn't it mean that vaccines are not tested for safety?

Also, flu vaccines still contain Thimerosal and are happily injected into children every year. So much for no more Thimerosal in vaccines.

Posted by: Maurice | April 9, 2008 8:32 PM

In 1900 before the measles vaccine came out, there were 13.3 measles deaths per 100,000. By 1955 the death rate was 0.03 per 100,000 a decline of 97.7% eight years before the 1st vaccination.
There have been two other studies besides Dr. Wakefield's study published in the Lancet showing the Measles virus- the same strain as in the vaccine in a very large percentage of children with autism. The latest was a 2006 study by New York University where they found the vaccine strain of the measles virus in 85% of the children with autism.

Posted by: Mary | April 9, 2008 9:31 PM

Enjoy! One of many. Please check out www.pubmed.org for many other population-based studies.

A population-based study of measles, mumps, and rubella vaccination and autism.Madsen KM, Hviid A, Vestergaard M, Schendel D, Wohlfahrt J, Thorsen P, Olsen J, Melbye M.
Danish Epidemiology Science Center, Department of Epidemiology and Social Medicine, Arhus, Denmark. kmm@dadlnet.dk

N Engl J Med. 2002 Nov 7;347(19):1477-82

Posted by: An epidemiologist | April 9, 2008 11:40 PM

Vaccines contain numerous toxic agents other than mercury, such as formaldehyde, MSG, and aluminum, which could feasibly create the right conditions for children to develop autism. Vaccinations in theory may be good, but the number of shots given in the tender first few years of the developing child's life could well be problematic and could explain why the autism numbers have continued to rise, despite the removal of thimerosal. The medical community is doing a grave disservice to parents and children by refusing to investigate the possibility that innoculations could be related to the spike in autism cases. The fact is that we don't know, and no one is funding reliable studies to find out. The three most well-funded entities that could pay for reliable, unbiased studies on the possible links between vaccines and autism--that is, the federal government, the medical community, and pharmaceutical companies--have a serious disincentive to do so because of the litigation that would ensue if a link were discovered. Parents, most of whom do not have enough medical or scientific training to do so, are then forced to wade through the murky waters of the debate and decide which game of Russian roulette they want to play with their children. It is an awful position to be in, and it is disgraceful that the medical community is sticking its head in the sand instead of taking responsible action. The reality is that we are repeatedly injecting babies with immature immune systems with a soup that is in many ways untested for long-term safety and may not only adversely affect children's neurological systems and brains but also their immune systems. And, by the way, it doesn't help anyone to heap scorn on people who choose to try to protect their kids from as many of the pervasive environmental toxins in our world as possible by choosing cloth diapers and natural/organic/unprocessed foods. You can't lump a whole group together like that, either. For example, I have a son in public school and a daughter in private school; my babies wear disposable diapers; and we consume as many whole grains and organic foods as possible and do not eat any processed foods. The goal is health, not going off-grid. My children, however, are vaccinated. Still, as I prepare to take my fourth baby in for several more shots on Friday, I have serious doubts about the wisdom of doing so and resent the fact that I am forced to try to figure all of this out with so few doctors willing to question the almighty CDC, FDA, and AAP and provide me with balanced, critical information on vaccine safety. And you can bet that I will approve far fewer shots for my fourth baby than I have with my others, after all that I have recently read. This nation has the most advanced medical technology in the world, but we can't find a way to create safe vaccines or set up unbiased, scientifically sound studies to find the origin of autism? I think the word is "won't," not "can't." What a scandalous disgrace.

Posted by: milwmom | April 10, 2008 12:12 AM

Um, Clara, what planet are you from? Do you think that simply asserting that no such studies have been done will make it true? The other two comments were correct. Such studies have been performed. Some have been rather large-scale. They did what you wanted them to do and found no relationship between whether kids were vaccinated and rates of autism.

In general, I have found that the proponents of the vaccine-autism link have crossed the threshold from scientific thinking into faith-based thinking. That is, regardless of evidence to the contrary, they simply BELIEVE that there is a link. Scientific thinking, on the other hand, may start with a hypothesis but must be willing to discard such a hypothesis when the evidence disagrees. Clara, you appear to be part of the "just believe" folks.

I've also found that it's pointless to discuss such issues with people, just as it's pointless to explain why creationism is incorrect and evolution is correct.

Posted by: Ryan | April 10, 2008 10:32 AM

This debate reminds me of the Bush approach to inconvenient science: simply insist that results are inconclusive and repeat as necessary.
In fact, it would be unethical to conduct the large-scale studies some are recommending. All information...all available data...suggests that vaccines do not cause autism. Since studies cost $$, the $$ used for such a study which would certainly have negative results could be more productively spent elsewhere...especially since the anti-vaccine community will never accept negative findings.
Read up a little on one of the main architects of the "vaccine-autism" link and some of his ethics issues
http://en.wikipedia.org/wiki/Mark_Geier

Posted by: Angela (a scientist) | April 10, 2008 10:54 AM

I can't believe how harsh both sides of the debate can be. The fact is that we don't have any concrete answers, and, if, God forbid it, your child were suddenly struck with a mysterious illness with little treatment and no cure, you would be searching high and low for answers and looking for accountability in the medical community, too. Being condescending and hurling insults does nothing but add pain to a situation in which so many people are already suffering.

Posted by: milwmom | April 10, 2008 1:04 PM

Actually, milwmom, that's the point: We DO have some answers. Just look at the studies that have examined MMR vaccines and autism (that's the popular link in Britain) or thimerosal and autism (that's the popular link in the U.S.). They provide rather clear answers. (Who knows what you mean by "concrete" since you can't actually touch a study).

BTW, if anyone is interested in finding studies on ANYTHING, go to pubmed.gov and do a search. You'll find lots of stuff out there, including a lot of great reviews that examine all the studies done on particular topics, including vaccines and autism.

Posted by: Ryan | April 10, 2008 2:24 PM

Actually, Ryan, you are using exactly the condescending tone that is not helpful in this debate. We do not have concrete answers in that we do not know conclusively what does or does not cause or trigger autism. In my original post, I did not say that the MMR causes autism; I merely pointed out that other vaccine-related factors, such as the number of shots injected into immature immune systems or the other ingredients they contain, could contribute to the presentation of ASDs and merit further, unbiased study.

Posted by: milwmom | April 10, 2008 9:55 PM

Thought this was interesting. Here's a Washington Post "Animal Doctor" article called "Spread Out Your Pet's Potent Vaccine Injections." The author writes to say that her older cat died 10 minutes after getting a vaccine and asks whether the vaccine could have caused her cat's death. Here's what the columnist says:

"Your letter underscores the cavalier attitude of some veterinarians toward vaccinations. Vaccination means injecting an acute infection along with various adjuvants such as aluminum hydroxide (a World Health Organization-recognized carcinogen) that can trigger an almost immediate shock reaction called anaphylaxis. This is more likely to happen the more an animal has been sensitized by prior vaccinations.

In my opinion, no traumatic procedure... should be done on an animal that has just been vaccinated. The risks outweigh the inconvenience of making two appointments. Separate appointments should be made for the mandated anti-rabies vaccination and any other vaccinations that might be due."

So here we have a Washington Post syndicated Vet acknowledging that vaccines should be spread out because they might cause damage or even death, acknowledging that anaphylaxis can be caused by an ingredient called aluminum hydroxide (an ingredient that is in the human Hep B - given at birth - and DTaP - given at 2mths/4mths/6mths - vaccines, incidentally), and acknowledging that an ingredient is a known-carcinogen.

And yes, I realize the article is talking about a cat, but I can't imagine some newborn baby's reactions could be much different. Anyway, just wanted to share.

Posted by: Resident101 | April 15, 2008 11:46 AM

"But aren't parents who opt not to vaccinate banking on others' willingness to vaccinate their kids to keep measles at bay?"

Most parents who opt not to vaccinate ARE NOT banking on others' willingness to vaccinate. Most parents who opt not to vaccinate have done extensive research on the diseases themselves and realize that with proper nutrition (including breastfeeding and vitamins) and care, the vast vast vast majority of people live through measles with no problems (and did pre-vaccine). Most parents who don't vaccinate are more worried that their children WON'T get measles or chickenpox as young children (as everyone did in the past) and might then get it as older adults when it can be more dangerous. Most parents who don't vaccinate are worried about the older adults whose vaccine-created immunity is wearing off (unlike older adults who contracted measles and have life-long immunity). Most parents who opt not to vaccinate know that for most of the diseases that we vaccinate against (diptheria, tetanus, pertussis, etc), the vaccines don't even prevent transmission and therefore an unvaccinated child is not putting anyone else's child at risk or harming "society at large."

Posted by: Resident101 | April 15, 2008 12:00 PM

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