As I wrote about at Forbes today, PBS Frontline aired an updated version of their 2010 documentary “The Vaccine War” last night, including information about the current measles outbreak that started at Disneyland and the legislative effort in California to roll back personal belief exemptions for vaccines that allow parents to opt out of getting recommended vaccines for school attendance. During the show, discussion on Twitter followed the hashtag #VaccineWar. Most of those participating had been invited to do so by the digital content manager at Frontline.
I had also been invited to participate, but I declined. For one thing, spending my time, unpaid, to provide free marketing to a documentary airing on a publicly funded medium is inappropriate in my opinion. But above and beyond that, the email invitation mentioned that PBS Frontline was seeking people “from all sides” of the issue. So I asked for clarification about what that meant. The first response was not specific enough, so I spelled out my question in my second email: “I’m sorry to belabor the point, but I’m still not clear on what kind of diversity you have invited. I suppose I should be more blunt. Have you invited people who explicitly believe that the risks of vaccines outweigh the benefits? Have you invited [list of four known anti-vaccine activists who propagate misinformation] or similar individuals?”
I received the following response: “I guess my email wasn’t to the point enough. Yes! We are looking to include more people who specifically believe that the risks of vaccines outweigh the benefits. We are still reaching out and adding to our list.”
Those who follow my work know my deep concerns with false balance in the media on scientific issues. Therefore, I wrote the following response back:
“Thank you for the clarification. I will have to decline participation in the event because it sounds as though it will be counterproductive and confusing to parents who see it, and I am not comfortable in participating in something that can cause damage to public health. You mentioned in your original email that you were seeking informed discussion on Twitter about the film, but specifically seeking individuals who hold a non-science-based belief that is counter to the evidence to participate would not lead to an informed discussion. It will only lead to the confusing back-and-forth “debate” that further confuses and isolates parents, and that is not something I can participate in in good conscience. I have spent a great deal of my writing discussing the perils of false balance — see the links below — and I will not participate in a program specifically designed to contain false balance. When you present “both sides” as equally valid despite a consensus of scientific evidence on one side and a combination of cherry-picked, misunderstood, non-representative papers or anecdotes on the other side, you do a disservice to parents and to public health. In fact, as Curtis Brainard excellently covered at the Columbia Journalism Review, the media has already played a pernicious role in the current levels of vaccine hesitancy: “Sticking with the truth: How ‘balanced’ coverage helped sustain the bogus claim that childhood vaccines can cause autism”: http://www.cjr.org/feature/
Peer reviewed research has further shown the damaging effects of inaccurate or misleading comments made online which reflect beliefs instead of facts, which is exactly what will be brought by those who believe incorrectly that vaccines’ risks outweigh their benefits: http://www.sciencedaily.com/
The tenor of comments can play a role as well, and when those who refuse to accept the scientific consensus on vaccines participate, the tenor often becomes unpleasant, which can also influence parents’ perception of vaccine science. See: http://www.nytimes.com/2013/
Why Is Katie Couric Promoting Vaccine Skeptics?: http://www.politico.com/
Discussions about vaccination have always been fraught, particularly over the past decade, but the tenor of the national discussion has intensified since the Disneyland outbreak this winter has jumpstarted the nation toward what’s likely going to be a record year of cases since measles was eliminated in 2000.
Yet measles cases aren’t going to stop occurring because we’re shouting at one another. Much of the anger and vitriol spewed in both directions is likely only to further polarize the discussion about vaccinations and leave sincerely concerned, confused, uncertain parents in the middle left without any sense of what they should do to protect their children’s health. In fact, many of the misconceptions that exist about parents who don’t vaccinate or delay vaccinations can do as much damage when it comes to “fence-sitting” parents as anti-vaccine misinformation that may lure those parents in when they feel alienated by the “pro-vaccine” groups.
I don’t consider myself pro-vaccine, and I never have. I consider myself pro-science, pro-evidence, and pro-science-based and evidence-based data and information. Now, in one of the most vitriolic settings for vaccine discussions, there is finally a place for parents to get accurate, science-based, evidence-based information about vaccines without risking mockery, snide comments, sarcastic jokes, judgmental advice or any of the other turn-offs that make it difficult for parents just to ask a question: The Vaccine Page.
As the page’s description states, “We have seen a need for a place to come with questions and concerns where parents can trust that they will not be mocked, bullied, criticized or intimidated.” As this attitude is something I’ve promoted for a long time, it won’t surprise any readers here to hear I’m involved with The Vaccine Page. The pretty bluntly named page came out of discussions with three other moms who find the bitterness of vaccine discussions as frustrating and damaging as I do, and we joined together to change that. We recruited one heck of a team, if I do say so myself, that runs the gamut of clinicians, moms, researchers and advocates. And we offer something unique that, to our knowledge, doesn’t exist anywhere else in social media: a page providing accurate information with all disclosures and qualifications, in plain language, without judgment — and we don’t allow others to pile on either. Read the rest of this entry »
At last, the book has been written (and the editing process has begun), so I will soon be able to return to regular posts. Today I’m sharing a great infographic about measles and the MMR vaccine, developed by Sylvia Wood. Her original graphic, where she also lists references, can be found here.
No naps. Period. No matter what. Not even for 15 minutes. That was the guideline we conveyed to my son’s childcare center starting sometime around his second birthday. It had nothing to do with any research we had read. In fact, we didn’t know much at all about children’s naps at all. All we knew that was that bedtime became even more, let’s say “challenging,” than usual (and it was already practically a 2-hour ordeal, despite following a set routine each evening) when our son napped during the day.
Each time he moved up to a new class at the childcare center, we would convey this information as firmly as we could during parent-teacher conferences. The teachers would remind me that they were required by company policy to have all children sitting on their cots during nap time, even if they didn’t nap. I said that was fine – as long as my son didn’t sleep. Could they give him some books? Let him play with some cars? Let him work on something the kids had done earlier before I’d dropped him off? And if he happened to fall asleep, could they please, please, please wake him up?
We knew every single time when they didn’t. I suppose they didn’t realize, despite our attempts, how important our request was, or else they just didn’t believe us. It would happen a couple times in each new classroom. I would come in the day after and casually ask, “So, do you remember if D happened to fall asleep during nap yesterday?” They would think back. “Um, yea, come to think of it, I think he did nap yesterday.” Or, “Um, yea, I think he fell asleep for just 15 minutes at the tail end of nap time, that’s all.” I would smile tightly. “That’s all.” Sigh. “Yes,” I would say. “I thought so. He went to bed at 1 a.m. last night.” Their face would contort into disbelief. ONE?! ONE A.M.?! Yup. 1 a.m. If our son fell asleep, even for 15 minutes, during the day, we knew we were in for it, and if he slept without our knowledge, we found out the hard way and lost four or five hours to the battle. (And this was even while using melatonin.) Sometimes we were lucky and it was midnight, but that was always the early side if he napped during the day. Even for 15 minutes.
And so, that’s my massively long anecdote to introduce the study out today that – Hallelujah! – actually provides some evidence for our experience! It was so lovely to discover it wasn’t just us – this is actually a “thing.” What makes this study all the more interesting is that it’s a systematic review, not a single study. The authors reviewed 26 studies about daytime naps in children up to 5 years old, looking at all kinds of outcomes: cortisol levels (stress hormone measurement), nighttime sleep, behavior, obesity, frequency of accidents, and cognitive skills. But only one finding consistently popped up across the studies: daytime naps were linked to falling asleep later, sleeping less time overall at night, and sleeping more poorly, particularly among children older than 2. Read the rest of this entry »
Hello readers! It probably seems odd for me to be so quiet in the midst of the current measles outbreak, but I’ve been immersed in book writing until the past few days. As I continue wrapping up loose ends after finishing up the writing of the book, I’m publishing a guest post by occupational medicine doctor Donald Bucklin. The post below represents only Dr. Bucklin’s perspective. I have not paid him to write the post, and he has not compensated me for publishing it. Enjoy!
I was listening to National Public Radio (NPR) one morning and they were giving an update on the Ebola epidemic in Guinea.
That epidemic has killed thousands of West Africans in the past year, and superstition and misinformation still rule the country. Many in Guinea still believe Ebola doesn’t exist, or the vaccine is part of some CIA plot that western countries are pushing.
Others believe the sick are carted away and quietly dispatched. People hide when they’re sick because of these beliefs. No one wants to expose their family and friends to the very real possibility of Ebola and death.
Living in the modern world, a wealth of scientific information is just one click away, and yet some people are effectively making choices based on superstition and mumbo-jumbo.
How could that be? Very easily is the answer. It’s happening right now in the U.S. where a measles outbreak, that started in Disneyland, has resulted in more than a 100 cases in at least seven states and stirred up the controversial issue of mandatory vaccinations.
Measles is nothing to take lightly. It’s a viral disease that is pretty bad, and is highly infectious. Approximately 90 percent of unvaccinated people living in a house with someone with measles becomes infected.
Neither Ebola, HIV nor TB have anywhere near that kind of infection rate. Measles is hard to avoid because an infected person spreads the virus for several days before they are even sick.
And sick you are – highlighted by a fever up to 104º F, cough and head congestion, and a rash all over your body that itches like crazy. Welcome to Dante’s 7th Circle of Hell!
Pneumonia and meningitis are common complications from measles, and otherwise healthy people sometimes die of it. In the past (pre-vaccine days) measles killed tens of thousands of people in the U.S.
Unlike smallpox, measles has not been eradicated from the planet; it is still around.
We have had a good and very effective measles vaccine for 40-plus years, thanks to a guy named Maurice Hilleman, who developed the vaccine. He saved more lives in the 20th century than any other scientist (including doctors).
That whole theory is based on a totally discredited British Lancet study released in 1998. It was simply bad science and has been proven wrong numerous times. Every scientific organization has renounced this supposed vaccine-autism link.
The MMR/autism link is simply the black glove in the OJ Simpson trial. It’s a distraction and not the truth.
They are now testing two vaccines against Ebola that look pretty promising. That leaves many of us optimistic that we can stop this deadly disease and halt its epidemic nature.
Fortunately, we’ve already found the right vaccine for smallpox, measles, mumps and many other once dangerous diseases. Let’s hope we can add Ebola to the list, but let’s also hope we can continue to keep vaccination rates high for those diseases we can already protect against.
Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic.
I’ve been so immersed in finishing up the book that I’ve been unable to devote much time, attention or writing to the ongoing measles outbreak that stemmed from exposures at Disneyland. BELIEVE me I have a lot to say, and my mind has been swirling, but I’ve been forcing myself to remain focused on the book. That said, one of the pieces going around that is especially poignant is something I couldn’t pass up sharing. You’ve likely already seen it, but just in case you haven’t, you need to read the letter famed children’s author Roald Dahl wrote in 1980 as children were dying from measles – a disease for which a highly vaccine had been available for decades. In fact, the vaccine became available the year after Dahl’s oldest daughter died in 1962 from a complication of this illness. Dahl is author of Willy Wonka and the Chocolate Factory, James and the Giant Peach, and other favorites you’ve likely read.
“Olivia, my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything.
“Are you feeling all right?” I asked her.
“I feel all sleepy,” she said.
In an hour, she was unconscious. In twelve hours she was dead.
The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her. That was twenty-four years ago in 1962, but even now, if a child with measles happens to develop the same deadly reaction from measles as Olivia did, there would still be nothing the doctors could do to help her.
On the other hand, there is today something that parents can do to make sure that this sort of tragedy does not happen to a child of theirs. They can insist that their child is immunised against measles. I was unable to do that for Olivia in 1962 because in those days a reliable measles vaccine had not been discovered. Today a good and safe vaccine is available to every family and all you have to do is to ask your doctor to administer it.
It is not yet generally accepted that measles can be a dangerous illness. Believe me, it is. In my opinion parents who now refuse to have their children immunised are putting the lives of those children at risk. In America, where measles immunisation is compulsory, measles like smallpox, has been virtually wiped out.
Here in Britain, because so many parents refuse, either out of obstinacy or ignorance or fear, to allow their children to be immunised, we still have a hundred thousand cases of measles every year. Out of those, more than 10,000 will suffer side effects of one kind or another. At least 10,000 will develop ear or chest infections. About 20 will die.
LET THAT SINK IN.
Every year around 20 children will die in Britain from measles.
So what about the risks that your children will run from being immunised?
They are almost non-existent. Listen to this. In a district of around 300,000 people, there will be only one child every 250 years who will develop serious side effects from measles immunisation! That is about a million to one chance. I should think there would be more chance of your child choking to death on a chocolate bar than of becoming seriously ill from a measles immunisation.
So what on earth are you worrying about? It really is almost a crime to allow your child to go unimmunised.
The ideal time to have it done is at 13 months, but it is never too late. All school-children who have not yet had a measles immunisation should beg their parents to arrange for them to have one as soon as possible.
Incidentally, I dedicated two of my books to Olivia, the first was ‘James and the Giant Peach’. That was when she was still alive. The second was ‘The BFG’, dedicated to her memory after she had died from measles. You will see her name at the beginning of each of these books. And I know how happy she would be if only she could know that her death had helped to save a good deal of illness and death among other children.”
Today is a super-short post because I’m deep in bookland, but I wanted to direct readers’ attention to the post I wrote at Forbes about the most recent outbreak of measles, “Disneyland Measles Outbreak: It Is Indeed a Small World After All.” Since I wrote that on Tuesday, the number of cases have grown to 52, as I covered in a follow-up today on the five things you need to know about the update.
That number is almost certainly going to continue climbing given how incredibly infectious the disease is and how low the southern California vaccination rates are. A running tally of the cases is regularly updated at the California Department of Health website, and I’ll be posting an update at Forbes tomorrow that addresses the increase in cases as well as the misconceptions about measles that persist on comment threads and in social media. Hopefully, the outbreak will be contained soon, but it doesn’t bode well that it’s made it to several states and that the California cases are climbing so quickly. And it’s just January of the new year.
I won’t be able to put up long or analytical posts until after the book deadline, but I’ll try to at least post links to work elsewhere that readers may be interested in checking out. Three pieces I’ve written in the past week or two relate to autism news that I want to highlight, plus a fourth piece that addresses the (utterly ridiculous) study trying to link circumcision and autism.
The first is a post up at Forbes regarding a recent study that found the majority of increase in autism cases in Denmark was directly a result of changes in the diagnostic criteria of the developmental condition and the way the cases are tracked. A variety of studies have come to similar conclusions regarding the increase in autism incidence in the U.S. and elsewhere. The short version is that we don’t know how much – if at all – a “real” increase in autism is occurring at all. A combination of increased awareness, increased diagnoses, increased access to healthcare, and changes in how the condition is identified and diagnosed have all contributed tremendously to the increase and may even account for all of it, though that’s still unclear.
The next bit of news, written up at HealthDay, reported on study purporting to show how owning a pet can help autistic children develop stronger social skills. In reality, however, the study, which was very, very small, didn’t really show that at all. If I had the time, this would be one of those studies I break down in depth to show the various weaknesses and how the media ran with a fun-sounding headline without doing the critical work of really looking at what the findings actually said. The study was worth publishing, but not to show that pets help autistic kids. Rather, it was important to publish to show that we DON’T have much evidence at all that pets help autistic children, or at least not any more than they might help any other child without autism.
Then, a particularly important, if unsurprising, study in Pediatrics, also at HealthDay focuses on the difficulty health care providers have in identifying children who need further assessment for autism, at least during short well-child visits. A typical well-child visit lasts just 10-20 minutes with the doctor, and in that short time, the signs of autism can be easy to miss. Autistic children show plenty of typical behavior, and that typical behavior can obscure the couple instances of atypical behavior. That’s why it’s important for care providers to ask parents autism screening questions, as recommended by AAP, and for parents to be on the lookout for autism signs. A full checklist is here (pdf).
Finally, primatologist Ava Neyer does a great job of pointing out the many flaws in a recent study that attempted to link autism to circumcision. The very idea that someone conducted this study is offensive enough, but it’s less surprising when you consider the ideological biases of the lead author, who has previously tried to link circumcision to impotence and to decreased sexual enjoyment in women. No. Just no.
I wrote yesterday about the MMR and varicella vaccines and noted that I frequently hear concerns about the MMR. In recent years, however, parents’ concerns about HPV seem to have eclipsed those about the MMR. Gardasil and Cervarix are newer vaccines, and they are given in older girls and boys to protect against a virus that is most commonly (but not exclusively) transmitted through sexual contact, so there are probably all sorts of cultural hesitations tied up in the usual safety concerns that people have about vaccines when it comes to this particular one.
Still, the HPV vaccine is the only one we have that was developed *specifically* to prevent cancer (though two strains in Gardasil also prevent genital warts). The hepatitis A and B vaccines also indirectly prevent a proportion of liver cancer cases since liver cancer can develop from hepatitis. But every single cervical cancer case is caused by one HPV strain or another, so preventing HPV means preventing cervical cancer directly. Further, HPV can cause penile, anal and head and neck cancers, which are rarer than cervical cancer – and can develop due to other causes – but are killers nonetheless that the HPV vaccine can partly prevent (and quite effectively).
But ah… safety concerns. In the not-so-distant future, I have a project planned to look at every HPV concern and misconception out there, but for now, I’m just focused on a new study in JAMA that looked at multiple sclerosis and other demyelinating diseases. I wrote about this study in depth over at Forbes, so I encourage you to read that piece for the raw numbers and specifics on risk, but I’m adding a few things here.
First, what’s a demyelinating disease? It’s any condition in which myelin, the protective sheath around nerves, starts degrading, which means electrical messages can’t travel from one nerve cell to the next as quickly as they should. Multiple sclerosis is the best known of these, but it’s not the only one. Others include optic neuritis, neuromyelitis optica, transverse myelitis and acute disseminated encephalomyelitis, among others.
A handful of case studies have reported on multiple sclerosis or another demyelinating disease starting after HPV vaccination, such as one describing five patients whose symptoms began within three weeks of vaccination. These are the sorts of case studies that anti-vaccine advocates cherry-pick in promoting fear and misinformation about vaccines. Such studies are actually very important to investigating vaccine safety because they alert the medical community to a condition that occurred around the same time as a vaccination and *might* be related – but it’s important to remember that they can’t actually show that there was a link at all. These reports aren’t canaries in the coal mine. Rather, they’re calling attention to something worth studying further. They’re a way to say, “Hey, here’s something interesting. Come check this out. Maybe we ought to look for this in other people too!” And then other researchers come along and design extremely large safety studies to see if there could be a link between the vaccine and that condition.
When looking for these conditions, the rarer they are, the larger a sample size you need in a study. Otherwise, researchers can’t detect enough cases to compare among vaccination and unvaccinated individuals and to compare to background rate – the usual rate of that disease in a population (the prevalence). So, having thousands of people to study is helpful. Even better is a sample that comprises an entire nation’s population, and that’s exactly what this study did. Read the rest of this entry »
Of all the childhood vaccines on the CDC’s recommended schedule, the MMR is one of the oldest, the most effective… and the most feared. That is, I hear more parents express concerns about the MMR, which protects against measles, mumps and rubella, than any other childhood vaccine, and it’s the vaccine once maligned by debunked concerns about autism (debunked literally dozens and dozens of times). I also hear a lot of hesitancy about the varicella vaccine, which protects against chickenpox, perhaps because parents don’t understand why it’s necessary and perhaps because of worries about possible but extremely rare breakthrough infections.
It’s true that both of these vaccines are associated with more reactions that parents would notice – and worry about – than most of the other vaccines on the schedule, but a recent study in Pediatrics should offer some reassurance to parents wondering whether there are rare, undetected side effects from the combined MMRV or from the MMR when given along with the varicella vaccine. Answer: there aren’t. The study confirmed the risk of the same adverse events that we already knew were linked to these vaccines, and the researchers ruled out the other studied conditions as possible outcomes and didn’t find anything new to worry about. (Though, it’s nice that they keep looking, just in case, right? This is what I love about vaccine research. It never ends, so we just keep gathering more and more data to support what we know or help us understand what we don’t. But I digress…)
First, you can read what side effects have been linked to the MMR, to the varicella vaccine and to the MMRV at the CDC website. The most serious ones for MMR and MMRV are high fever, a seizure with no lasting damage, low platelet count and, in the rarest cases, a severe allergic reaction. (The site lists other adverse events that have been reported to occur after the vaccine, but these haven’t been shown to be caused by the vaccine; they occur so rarely that it’s so far been impossible to determine. Given the millions and millions of MMR doses administered over the years, the fact of that rarity alone should be reassuring.)
This new study, published today in Pediatrics and funded through America’s Health Insurance Plans and the CDC, looked at seizures, fevers, low platelet count (resulting from a condition called immune thrombocytopenia purpura, or ITP) and allergic reactions (anaphylaxis), but it also looked for increased risk of ataxia (jerky muscle movements), arthritis, meningitis/encephalitis, acute disseminated encephalomyelitis (a neurological disease) and Kawasaki disease. The researchers compared the MMR and the MMRV from 2000 to 2012 in children aged 12 to 23 months old and enrolled in health care centers participating in the Vaccine Safety Datalink. The study involved more than 123,000 doses of MMRV and more than a half million doses of MMR plus varicella.
The good news: the researchers found no increased risk of any of these seven outcomes when comparing the MMRV to the MMR. In other words, the risk from the MMRV is no worse than the risk from MMR when it comes to the seven conditions they studied. I know, that doesn’t sound reassuring. But that’s what the point of the study was, to compare the MMRV to getting the MMR along with the varicella. And don’t worry – they also looked at the risk of these outcomes with each vaccine individually, and that’s where we get…
The better news: Other than the known link to ITP, no increased risk was seen for the other outcomes, and no new safety concerns were seen. “These estimates indicated that even if an increased risk for these outcomes exists, the risk is low and rare after either measles-containing vaccine,” the authors wrote. In fact, the risk of ataxia was actually significantly *lower* after both the MMR and the MMRV (though that’s probably a fluke and not a result of any protective effect from the vaccines).
The findings mathematically showed an increased risk for anaphylaxis (severe allergic reaction) after the MMRV, but this finding was based on only two cases, neither of which was confirmed as related to the vaccine and both of which occurred in children with a history of allergic reactions. So all this means is that two children with a history of severe allergic reactions had an allergic reaction following the MMRV that may or may not have been related to the vaccine. While the Institute of Medicine has established that the MMR and MMRV can cause a severe allergic reaction, it occurs in approximately 1.5 o 1.8 of every 1 million doses. An unvaccinated child has a much higher likelihood of catching the measles.
The bad news: The MMRV has about double the seizure risk of the MMR. But, we already knew this and the risk is still pretty low – 1 child out of 3,000 for the MMR and 1 child out of 1,250 for the MMRV, according to the CDC, which matches up with what was found in this study. The study also confirmed what we know in general: that the risk of fever and seizure is higher in the 7 to 10 days after getting either the MMR or the MMRV.
There was also an increased risk of ITP, particularly 14 to 28 days after the vaccines but also up to 42 days afterward. Yet again, we already knew that; the CDC estimates these low platelet counts occur in 1 out of every 30,000 doses. The condition goes away on its own within 6 to 12 months in 80 percent of kids and is rarely a serious or life-threatening condition.
So, today’s study is pretty unexciting, but then, that’s what we usually want from vaccine studies: nothing surprising and confirmation of what we already knew.