Angry Toxicologist

(Alternate title: jerks aren’t always wrong).

Over at Moms Speak Up, Cristina shares her angerat a doctor that doesn’t want to go along with a “modified” vaccine schedule that she made up herself. Over at Enviroblog (which I usually like) they chime in with a “good for you”. While I share the loathing of doctors with a “how dare you question my good sense” attitude, in this case, he sounded much better than most do when questioned about their practices. And secondly, Christina’s wrong. Now, people are wrong all the time, but ini this case, I can’t let it sit in the open on a well-read website without a response.

For one, Pediatrix doesn’t have any perservative in it (see here and here). The doctor was a bit off about the Hep B because the vaccine can be broken up, but they may not have them at their office.

Regardless, without getting into the weeds, let me tell you why you should get your kids vaccinated and vaccinated according to schedule. Let’s take the issue she brought up about rotavirus as an example. So, rotavirus every year leads to 400,000 doctor visits, > 200,000 emergency room visits, 55,000 to 70,000 hospitalizations, and 20-60 deaths in kids under 5 (CDC). That, to be techical, is a bad thing. The risk (rare, but a risk) of the old rotavirus vaccine was intussusception, where the bowel telescopes into itself and can be deadly. The new one has no evidence of increased intussusception, but let’s say that all cases of intussusception in the US were caused by the vaccine (a ridiculous thought). There are about 14,000 hospitalizations for intussusception every year. About 80% are treated with a barium or air enema, the other 20% have to be surgically fixed. So, even if you use the ridiculous hypothesis, it still saves lives (not to mention a lot of hospitializations and illness).

From a pragmatic standpoint (where the neddle hits the arm so to speak), vaccines save lives and prevent illness. Even if you read some book and believe everything in there, the risk benefit works out in the vaccines’ favor. As to the schedule, doctors have to have a schedule so 1) they don’t forget so you don’t forget, and 2) so everything is done in a safe manner (i.e. every doctor can’t sit down for each patient and figure out what would be a safe and efficacious alternative schedule. That’s why they use 1 that is safe and efficacious).

PS A facinating part about all this is when the doctor said: “Just because a doctor writes a book doesn’t mean he knows what he is talking about”. Absolutely. Everyone should keep this in mind. Parents who read too many quack books and doctors who think they are a genius. As the quote says, just because you’re a doctor doesn’t mean you know what you’re talking about (same goes for reading the books). For instance, 80-75% of the time, a child with autism spectrum disorder had parents that thought something was wrong by 15 months. For those same kids, primary peds Drs thought thought something was wrong about 50% of the time. No data on the false positive rates for parents, but it really doesn’t matter since a real screening will settle things; it’s the false negatives you want to drive down in this situation.

Comments

#1 Orac
October 30, 2007

You like Enviroblog? Just looking at the post referencing Cristina’s article, I saw a heapin’ helpin’ of ignorance:

I’m not about to get into the science of vaccination on a Friday afternoon (except to say that injecting babies with mercury sounds like a bad idea to me, and the burden of proof should be on demonstrating that it isn’t hazardous, not proving that is a risk).

“Sounds like a bad idea”? That’s nice, but she seems utterly unaware of all the studies that fail to find a link between thimerosal and autism.

Maybe it’s just a misstep, but the post about Cristina was really, really bad.
#2 sailor
October 30, 2007

When you look at populations you are right. But with the efficacy of the herd vaccination effect with nearly all the other kids vaccinated, it is possible that if you did not vaccinate your kid and everyone else did, you kid may actually take a marginally lesser risk in the case of some diseases. On the other hand that he should get this protection, standing as it were on everyone else’s shoulders, seems somewhat immoral.
#3 Amanda
October 31, 2007

Thanks for the commentary, AT – I’ve noticed in the past that your views on vaccination differ from EWG’s.

Orac, I didn’t mention autism at all (in fact, that’s exactly what I didn’t want to get into). I only meant to point out how ridiculous it seems that anyone ever thought it was okay to use thimerosal in vaccines for children. Doesn’t it seem counterintuitive?
#4 AngryToxicologist
October 31, 2007

Orac,
I’d agree that the post was pretty bad. I would point out that, although I don’t think that thimerosal is associated with autism, the safety and lack of alternative justification for using thimerosal in the first place was and continues to be thin, at best, especially when compared to justification that has been made for other FDA approved perservatives/excipeints in other circumstances (and what is there was done in ways that would never pass muster today). While I wouldn’t ascribe any disorders to its use, it’s a grandfathered molecule that never got an adequate second look and now we’re all playing defense (and it never looks good when you’re playing defense, regardless of what the truth is).

Sailor, That’s a good point I hadn’t thought of (what responibility do we have to the community,…etc). Although, that wouldn’t apply to things like tenanus which have a life cycle outside of humans.

Does anyone know of a good book/article that looks at the history of vaccinations and why they have achieved such a bad reputation? I understand the issues early 90s and on but this seems like a more deep-seated issue. This is quite bizarre because vaccines are one of the few medical accomplishments that I would consider a major achievement (most of medicine is still rather poor at actually curing/preventing something outright).
#5 Orac
October 31, 2007

Why is it “ridiculous” to have thought that it was OK to use thimerosal in vaccines as a preservative?

Also, you said more than just commenting on the “counterintuitiveness” of using thimerosal as a preservative in vaccines. You said, “Burden of proof should be on demonstrating that it isn’t hazardous, not proving that is a risk.” While that may be essentially true, if you couple that statement with your “it seems like a bad idea to me” bit on thimerosal, the statement reveals a profound ignorance of all the studies and data to date that have failed to find even a correlation between thimerosal-containing vaccines and neurodevelopmental disorders in general (or autism in particular). The burden of proof has already been met. There was a concern in 1999 that perhaps the vaccine schedule had allowed the mercury exposure to get higher than may have been safe, but subsequent studies have failed to find a link between thimerosal as it was given even when mercury exposure was the highest and adverse outcomes.

So, although individual parts of what you said aren’t so bad, when you put them together they sound like the credulous parroting of mercury militia propaganda.
#6 Phil Boncer
October 31, 2007

I think the bad reputation of vaccines is,in a way, due to their high effectiveness. After a couple of generations, most people no longer remember how bad those diseases were, so they no longer see the benefits of the vaccine. To them, any side effect (or even a rumored one) is a bad risk, because no one they know has ever gotten the disease that the vaccination is for. Thus they feel safe enough to have the luxury of fretting and worrying about possible side effects, and to go agitating about them.

Also, there is a strain of “thought” that has become fairly popular that holds that Western medicine in general is bad, unfeeling, “unnatural”, etc. and that alternative therapies are superior. This strain of belief has a strong bias against doctors, against pharmaceuticals companies and anything they do, against pharmaceuticals in general, and against vaccines in particular.

PhilB
#7 MartinM
November 1, 2007

Doesn’t it seem counterintuitive?

About as counterintuitive as putting chlorine on your dinner.
#8 ozzy
November 1, 2007

Could this belief in the power of alternative medicine be a form of natural selection? I just hate to see parents subject their children to this “thinking” because the children have no say in the matter.
#9 researchgirl
November 7, 2007

A good book on the past and future of the vaccine controversy is “Vaccine: The controversial story of medicine’s greatest lifesaver” by Arthur Allen

And one note to parents who have ANY global ties or that live in any sort of city with international travelers. Fine if you choose not to vaccinate your child – they MAY be just fine. But to send them off to university after 18 years and to have them face a measles or other outbreak – would be a total bummer. To die of measles in 2007 or anytime is silly and yet it happens. Please look carefully at the real statistics and risk/benefit ratio VERY carefully before making a lifelong choice. Please take no offense – but chiropractors, midvives and nutritionists are great at what they do but they should NOT be counseling parents on whether to vaccinate a child – you need to speak to a public health expert or a well trained/practiced pediatrician or family practitioner before making a final decision.
#10 Looking for reason
December 6, 2007

You need to understand that rather large amounts of heavy metals have been removed from the bodies of thousands of autistic children using a couple of different protocols. Perents report that this results in significant gains in their children’s development. Is that a proper study? No. Does it indicate that there is likely some link between autism and heavy metal accumulation in the body? Yes. Should proper studies be done? Yes. What does this say about thimerosal? I don’t know. Even if all those children still would have become autistic without being vaccinated, it may still be possible that additional mercury in human bodies is not a good thing and that some people may be vulnerable to it and unable to process it. People need to look at all the information we have and stop calling the other side of the issue stupid.
#11 geciktirici
December 22, 2007

with the efficacy of the herd vaccination effect with nearly all the other kids vaccinated, it is possible that if you did not vaccinate your kid and everyone else did, you kid may actually take a marginally lesser risk in the case of some diseases.
#12 kamerali chat
January 26, 2012

There was a concern in 1999 that perhaps the vaccine schedule had allowed the mercury exposure to get higher than may have been safe, but subsequent studies have failed to find a link between thimerosal as it was given even when mercury exposure was the highest and adverse outcomes.