Respectful Insolence

CAM usage and vaccination status

ResearchBlogging.orgI’ve often discussed how potentially misleading anecdotal evidence and experience can be. Indeed, I’ve managed to get into quite a few–shall we say?–heated discussions with a certain woo-friendly pediatrician, who, so confident in his own clinical judgment, just can’t accept that his own personal clinical observations could be wrong or even horribly mislead him. Sadly, I’ve never managed to persuade him just how easy it is for us humans to be deceived or even to deceive ourselves.

However, just because anecdotal evidence can deceive us does not mean that it is worthless. Contrary to the straw man argument that woo-meisters like to level against skeptics, we do not claim that anecdotal evidence is “worthless.” Rather, anecdotal evidence is the weakest form of evidence. In science, it is always only a starting point, never an end, at least not if stronger forms of evidence can be generated?

So why am I beginning with this rambling introduction, other than that’s the way Orac usually rolls? The reason is that it’s always been my anecdotal experience that people who tend to pursue “complementary and alternative medicine” (i.e., CAM) tend also to be anti-vaccine. True, there has been evidence that, for example, chiropractors tend to be hostile to vaccination, and that only a many naturopaths are highly skeptical of pediatric vaccination. This sort of anecdotal evidence and relatively small studies led to some curiosity over whether it was really true that CAM is associated with lower rates of vaccination, which is why researchers from the School of Public Health at the University of Washington and the Office of Health Services and Public Health Outcomes Research, University of Missouri decided to take a look at the question. In the process, they just published the largest series thus far to look at the relationship between pediatric vaccination and CAM usage1.

The results are, alas, not surprising.

The authors first start out laying out the background, pointing out the evidence for vaccination hesitancy among chiropractors but that there were conflicting studies. They also mention that only a minority of naturopaths support full pediatric vaccination. In order to try to clarify the issue, they undertook a study of a large sample of non-Medicaid pediatric enrollees in two large insurance companies in Washington State. What was unique about this sample is that these insurance companies pay for CAM because state law mandates it. (Geez, it’s worse than I thought if Washington state mandates insurance coverage of provider-based CAMtherapy.) They then looked for correlations between CAM usage and vaccination. In another twist, they also looked for correlations between CAM usage and vaccine-preventable diseases. Specifically, they looked at five predictors of vaccination outcomes (naturopathic physician, chiropractor, acupuncturist, massage therapist, or conventional care provider) and whether other members of the enrollee’s family used CAM. They then used logistic regression models, correcting for a variety of potential confounders, in order to look for correlations in the 11,144 children studied, using the healthcare effectiveness data and information set (HEDIS) to determine vaccination adherence.

Two tables say it all. First, CAM usage and vaccination status (click for a larger version of the table):

i-deba584d50c0daad3060691269f6599a-table3-thumb-450x201-19453.jpg

In other words, children using CAM who saw a chiropractor were between 25% and over 40% less likely to have had the four major vaccines studied, against the MMR, chickenpox, diptheria/tetanus, or H. influenzae type B. It was even worse for children who had been under the care of naturopaths. These children were over 75% less likely to have been vaccinated. But that’s not all. Take a look at this next table:

i-a4d5eb2786c983dabfe1c917c56d0eab-Table5-thumb-450x511-19456.jpg

To boil it down, there is an association between being cared for by a naturopath and a higher likelihood of acquisition of vaccine-preventable disease, as well as an association between family members undergoing any CAM care and vaccine-preventable disease. The authors boil it down:

To our knowledge, this is the largest study to date of CAM provider use and immunization rates among young children enrolled in private insurance plans.We found that,among non- Medicaid pediatric enrollees in two Washington State insurance companies, those who received care from naturopathic physicians or chiropractors during the years of their first or second birthdays were significantly less likely to havemet the HEDIS schedule for vaccination against measles/mumps/ rubella, chickenpox, or H. influenzae type B than were their counterparts. Additionally, children who received care from naturopathic physicians were significantly less likely to have received timely protection against diphtheria/tetanus. Diagnosis with vaccine-preventable diseases among children through age 17 years was rare. However, pediatric use of naturopathy was associated with significantlymore diagnoses, and chickenpox was the diagnosis most frequently made.

This study did have some limitations, the most glaring of which is that it relied on insurance company claims instead of definite diagnoses. This could conceivably underestimate the vaccination rate if children received any vaccinations outside of the system. However, it’s unlikely that it would underestimate vaccination rates enough to account for a four-fold difference between children seeing conventional practitioners and naturopaths or even the nearly two-fold decreased vaccination rates among patients of chiropractors. Another problem is that this is a rather select population. It includes insured children not on Medicaid in a very woo-friendly state, with relatively low vaccine uptake rates. Indeed, it should also be noted that Washington is the home to one of the biggest naturopathic schools there is, and it has a high proportion of naturopaths, along with an obnoxious “every category of
provider
” law, the aforementioned law that requires insurance companies to pay for CAM. More importantly, this study cannot show causality. As the authors state:

Lower vaccination rates among pediatric CAM users may reflect either a tendency for parents who prefer natural approaches to health and who are already vaccine-hesitant to seek out CAM professionals, or a pattern of direct influence by CAM providers on parents’ attitudes. Some researchers have suggested that vaccine-hesitant parents may prefer CAM practitioners, in part, because they are less likely to introduce pro-vaccination pressure [32]. Washington State, where our study took place, has demonstrated strong acceptance of chiropractic and naturopathy into mainstream medical care [44]. Although pediatric vaccination rates in the state have increased dramatically in recent years, Washington currently lags behind 40 other states in childhood vaccination [45]. Our data were not sufficient for evaluating whether these two factors are related.

And it’s true. It’s probably a combination of factors: parents who are already suspicious of vaccines being of the type who prefer “natural” cures and distrust scientific medicine plus chiropractors and naturopaths either not encouraging vaccination or even actively opposing it. In other words, parents with anti-vaccine views tend to prefer quacks, and quacks tend to oppose vaccination. Not that chiropractors are necessarily quacks. The ones who stick to physical therapy-like interventions can be as useful as, well, physical therapists. It’s the ones with delusions of grandeur, who think that chiropractic can treat allergies, asthma, and all sorts of other conditions unrelated to the musculoskeletal system. Either way, though, chiropractors do tend to be either indifferent or hostile to vaccination. Naturopaths, however, are worse. Vaccination, in fact, tends to go against the very tenets of naturopathy, which tends to be based not so much on the germ theory but rather an updated and tarted up variant of primitive vitalism. Aside from some sensible recommendations about diet and exercise, naturopathy is mostly quackery.

Unfortunately, the authors stumble in that they fall into the all too frequent trap of being excessively tolerant and deferential to quackery:

Our findings suggest that interventions with CAM practitioners and parents may be needed to increase support for pediatric vaccination. Future research aimed at developing successful interventions must include in-depth studies of parents and CAM providers to assist in understanding more precisely the important provider-related deterrents to vaccination. Intervention protocols will need to be responsive to the extent to which CAM providers are directly instrumental in reducing immunization or merely incidental to the patient population served.

This is in essence an admission of defeat. Basically, the authors are saying that, rather than reforming the system to prevent, for example, naturopaths from performing primary care functions that would allow them to hinder the vaccination of children, the best we can do is to try to educate those who are, for the most part, uneducable when it comes to vaccines, given that what they are taught in their training mostly denies the need for or efficacy of vaccination. On the other hand, if society as a whole devalues science-based medicine to the point where it has decided that naturopathy is a valid specialty, even though, as PalMD has shown, naturopaths are clueless when it comes to primary care, then we have no one to blame but ourselves for this sorry state of affairs. It is a testament to the sad state of medicine in this country, with its increasing acceptance of so-called “complementary and alternative medicine,” that it would even be necessary to propose such an education campaign in order to protect children from vaccine-preventable disease.

Such are the wages of quackademic medicine.

REFERENCE:

Downey, L., Tyree, P., Huebner, C., & Lafferty, W. (2009). Pediatric Vaccination and Vaccine-Preventable Disease Acquisition: Associations with Care by Complementary and Alternative Medicine Providers Maternal and Child Health Journal DOI: 10.1007/s10995-009-0519-5

Comments

  1. #1 MikeMa
    September 22, 2009

    Think we can get Oprah to host the study authors? I should live so long.

  2. #2 Kristjan Wager
    September 22, 2009

    Interesting study – thanks for sharing it with us Orac.

    I find it depressing that people get denied proper treatment by insurance companies, even when they should be fully covered, yet the legislators force the insurance companies to pay for CAM. There is something wrong with their priorities.

  3. #3 Laurel
    September 22, 2009

    I saw my first chiro-quackery in the copy shop biz in the very late 1980s. Someone brought in a leaflet from a sleazy discount pediatric chiropractic clinic (that flipped my wig right there). It stated very boldly that kids who went to this ped. chiro. office would not need shots. Or rather, “‘SHOTS’.” It didn’t even rise to the level of vaccine denial; it just played on the notion that, because some kids cry when you stick needles in them, needles are patently unacceptable.

    I refused to run the copies because I really believed (I was 23) that it couldn’t be legal to make such preposterous claims.

  4. #4 embertine
    September 22, 2009

    Orac, have you seen this?
    http://news.bbc.co.uk/1/hi/health/8268302.stm

    Good to see it on the front page; this will be on all the major news channels in the UK tonight. I have no real hope that those firmly ensconsed in woo will be winkled out from their barnacles of superstition, but maybe a few fence-sitters will be persuaded.

  5. #5 Janet Camp
    September 22, 2009

    Have you seen the NY Times piece on allowing Hmong shamans into hospitals in California and elsewhere in order to get the immigrants to better accept doctors and medical interventions? I think I can support it because the shamans have to do a basic training course where they learn germ theory and actually look through a microscope, and mostly because they cannot accept fees (not at the time anyway). The article likens the practice to the visit of a priest or pastor (not something I would want either, but most would).

    It all sound harmless and worldly in the context of respecting other people’s cultural beliefs, but I see a very slippery slope.

    With that as a preface, I want to confess here in the company of my skeptic friends, that I did not vaccinate my youngest child (the only for whom it was available) for chicken pox, but rather took him to play with some kids who had it. He did not get it and I think I eventually had him vaccinated as I was worried he’d get shingles as an adult. My point is, that at the time I was being exposed to a lot of “woo” and felt that it was more “natural” for my son to “catch” the disease than to be vaccinated. I am happy that my own education has progressed, but most people’s has not and that is why I so agree with your conclusion. As I have moved on, 99% of my friends and acquaintances have NOT; no amount of education will move these people–it is blind faith for them and the medical establishment must not cave and try to “integrate” medicine. This brings me back to the NY Times piece on the Hmong shamans which leaves me with a very large question mark.

  6. #6 JoeBlow
    September 22, 2009

    Orac claims his medicine is superior. Everyday the news reports something that proves he is wrong.

    The story below is about how doctors misdiagnose 1 in 6 patients. I personally think the 1 in 6 figure is too low. I have been through 4 or 5 doctors that were unable to deal with a health problem I had. 4 or 5 of them said “I don’t know what is causing your problem”.

    Something doesn’t make sense. Orac claims his medicine is the best, but when I go to Orac’s fellow doctors for help, they all tell me “I don’t know”.

    Are you sure your medicine is the best Orac? Or do you just have faith that your medicine is the best?

    If your medicine is the best, why have 4 or 5 of your fellows all told me they don’t know what is going on with my health problem?
    ——–

    “One in six NHS patients ‘misdiagnosed’

    As many as one in six patients treated in NHS hospitals and GPs’ surgeries is being misdiagnosed, experts have warned.

    Doctors were making mistakes in up to 15 per cent of cases because they were too quick to judge patients’ symptoms, they said, while others were reluctant to ask more senior colleagues for help.

    While in most cases the misdiagnosis did not result in the patient suffering serious harm, a sizeable number of the millions of NHS patients were likely to suffer significant health problems as a result, according to figures. It was said that the number of misdiagnoses was “just the tip of the iceberg”, with many people still reluctant to report mistakes by their doctors”

  7. #7 Janet Camp
    September 22, 2009

    Orac claims his medicine is superior. Everyday the news reports something that proves he is wrong.

    The story below is about how doctors misdiagnose 1 in 6 patients. I personally think the 1 in 6 figure is too low. I have been through 4 or 5 doctors that were unable to deal with a health problem I had. 4 or 5 of them said “I don’t know what is causing your problem”.

    Something doesn’t make sense. Orac claims his medicine is the best, but when I go to Orac’s fellow doctors for help, they all tell me “I don’t know”.

    Are you sure your medicine is the best Orac? Or do you just have faith that your medicine is the best?

    If your medicine is the best, why have 4 or 5 of your fellows all told me they don’t know what is going on with my health problem?
    ——–

    “One in six NHS patients ‘misdiagnosed’

    As many as one in six patients treated in NHS hospitals and GPs’ surgeries is being misdiagnosed, experts have warned.

    Doctors were making mistakes in up to 15 per cent of cases because they were too quick to judge patients’ symptoms, they said, while others were reluctant to ask more senior colleagues for help.

    While in most cases the misdiagnosis did not result in the patient suffering serious harm, a sizeable number of the millions of NHS patients were likely to suffer significant health problems as a result, according to figures. It was said that the number of misdiagnoses was “just the tip of the iceberg”, with many people still reluctant to report mistakes by their doctors”

  8. #8 Karol Urkel
    September 22, 2009

    Keep talking about how you guys are about health care and not money. No one believes you.

    “In the capitalist haven of Hong Kong, my adopted home, anybody who can scrape together the equivalent of US$13 can receive generous, timely and usually first-rate health care in an emergency ward.

    By contrast, US hospitals are turning away the sick, the injured and the dying, even though they might be carrying a lot more than $13 bucks in their pockets.

    The US is the only advanced nation without some form of comprehensive health care covering all of its citizens.”
    —————

    USA medicine practitiioners prey on the sick for money.

    If the poor country of Hong Kong can provide health care for $13, why do greedy USA medical people need thousands just to perform tests? Then thousands more for treatment?

    Greedy. Nothing more than greed.

  9. #9 MikeMa
    September 22, 2009

    Karol Urkel,
    Project much?
    Medical care is expensive in the US.
    We do not (yet) have universal care.
    For the money we spend, we should (maybe) get better care.

    But to claim that all medical practitioners are greedy is ludicrous. The costs associated with maintaining a practice are, in many cases, enormous. Insurance is forcing many OBGYNs to fold up shop. For that I blame lawyers and greedy individuals, not docs.

  10. #10 Kitty
    September 22, 2009

    If the poor country of Hong Kong can provide health care for $13

    Hong Kong poor? Good grief, get an education – or at least learn to Google.

    ECONOMY
    Hong Kong is one of the world’s most open and dynamic economies. Hong Kong per capita GDP is comparable to other developed countries.

    from http://www.state.gov/r/pa/ei/bgn/2747.htm

  11. #11 Kausik Datta
    September 22, 2009

    Are the Janet Camps at #5 and #6 the same person? Hmmm…

    The Hmong as a group are rather distrustful of modern medicine. What I thought from the NY Times article was that the so-called Shamans could perhaps be trained to help assuage the irrational fear of modern medicine that many of them have. In the same vein, apropos of the article Orac has indicated, perhaps engaging the CAM practitioners to spread a vaccine-friendly message may bolster the low vaccination rates in WA (Oregon is no less woo-friendly either!).

    I have thought about it, and have not been able to reach a conclusion. On one hand, engaging the CAM practitioners may enhance vaccination rates in a vaccine-hesitant or outright anti-vaccine population – which would be good in the long run. OTOH, this engagement may provide the CAM practitioners with a legitimacy (that is much-sought after by the CAM crowd) in mainstream medicine, giving them a further free-hand to disperse their woo-woo. That would be bad in the short and long run.

    About Janet Camp’s strange question about diagnostics in modern medicine, let me ask Janet: what would you rather have – a physician who tells you the truth (that s/he did not know at first glance what disease or disorder you have, and finding the root cause of your ailment may take more sessions, more tests – after all, diagnostic medicine is a lot like detective work), or a CAM quack who doesn’t give a rat’s arse for your ailment, but would smilingly spout a lot of fact-free garbage, telling you that s/he can ‘heal’ the ‘whole you’ – by aligning your qi or chakras or meridians, or giving you water that ‘retains memory of the drug once present in it’?

    For deep-seated or complicated ailments, a proper diagnosis takes a lot of thought, time, effort, as well as money. Some physicians, unfortunately, may be unwilling or unable to do that. It is often not impossible, Janet, to find a physician within the current system who would be able to connect the dots and take the time to give you a proper diagnosis. Not a perfect system, but still better than the empty hand-waving and ineffectual woo-woo that you get by the shitload from a CAM practitioner.

    In fact, Janet, to you I would recommend the book, “Every Patient Tells a Story”, by Lisa Sanders, MD, a Professor at the Yale Med School and writer of the popular column ‘diagnosis’ at the NY Times.

  12. #12 Mandrake
    September 22, 2009

    @6

    Orac claims his medicine is superior. Everyday the news reports something that proves he is wrong.

    The rest of the post does not support the contention. For something to be superior, it must be better than something else. The posted article does not compare types of medical treatments in any way. It merely provides the NHS’ findings regarding the rate of diagnosis mistakes in NHS hospitals and GP’s surgeries. Therefore, it does not prove that Orac or “his medicine” is inferior or, for that matter, superior.

    Nor do you provide anecdotal information about the superiority of conventional vs. CAM. For example, you could have said, “Four or five ‘conventional’ doctors could not diagnose my medical issues, but I went to one chiropractor who, with one adjustment, brought me back to perfect health.” While that would also prove nothing, some (not I) might accept that as evidence that CAM is superior.

    Finally, the findings in the article you posted basically report that the doctors screwed up, not that conventional medicine failed. It does not address the advantages or disadvantages of conventional treatments or CAM.

  13. #13 The Detector
    September 22, 2009

    Now H*appeh is using others’ names to post his gibberish. That’s low, you loon.

  14. #14 Mandos
    September 22, 2009

    Friendliness to CAM is strongly informed by a belief that there are perverse institutional incentives embedded in the mainstream medical system, a suspicion that doesn’t seem entirely unfounded. In the specific case of the USA, the continuing failure of systemic health care reform can only exacerbate that. This is very obvious when you read AoA. Of course, Andrew Wakefield practiced in the UK…

  15. #15 Mandrake
    September 22, 2009

    It *did* seem like Janet @5 and @6 aren’t the same person.

  16. #16 Orac
    September 22, 2009

    Are the Janet Camps at #5 and #6 the same person? Hmmm…

    Methinks it was delayed spam filter action. Janet responded to a post by one of the very few banned commenters, and it disappeared. I found it in the spam trap.

    Which makes me wonder why the spam trap didn’t catch it and prevent it from ever making it to the comments in the first place. And, no, it doesn’t look like Happ*h to me.

  17. #17 T. Bruce McNeely
    September 22, 2009

    Urkel:
    US primary care physicians make approximately the same as Canadian primary care physicians, from what I can tell. Poor people in Canada don’t pay a dime for medical care.
    What is your point?

    “the poor country of Hong Kong”?
    Hahahahahahahahahahahaha.
    You don’t know jack about Hong Kong, do you?

  18. #18 David
    September 22, 2009

    Not that chiropractors are necessarily quacks. The ones who stick to physical therapy-like interventions can be as useful as, well, physical therapists.

    That’s an insult to physical therapists. As a profession, they follow science-based practices and adapt their practice according to studies comparing the outcomes associated with different interventions. And PT’s honestly report complications, unlike quack-o-practers.

  19. #19 MikeMa
    September 22, 2009

    A wee bit OT but AoA has a lead article by young Jake Crosby, willing foil for the anti-vaxxers. Seems he doesn’t like SEED or ScienceBlogs very much. Lots of complaining about corporate sponsors – another version of Big Pharma runs everything.

    I know Orac has claimed his millions from blogging here and that PZ’s mansion in Morris is ‘to die for’ but I really think Jake is jealous because he has to work for free while Jenny gets all the dough….

  20. #20 Ranson
    September 22, 2009

    One thing that has to be discussed as far as Hmong communities go is that there is a generation gap in this belief. There’s a small community of Hmong around here (relocated from the West Coast, mainly), and I’ve worked with several. I work at a small pharma company. The younger Hmong are no different, really, than any other young person in the USA. They’ve got a lot of “cultural heritage” going on, but they know the drugs we make from top to bottom, often regardless of their part in the chain. However, older Hmong that come into the company (mainly on the production side) carry a lot more “old world” ideas, and don’t care so much about what makes a product a drug.

    Anecdotal, but very consistent in my experience.

  21. #21 gaiainc
    September 22, 2009

    The article doesn’t surprise me. People in the PNW have some very strange views about vaccination and medicine in general. I will say that my mom was a naturopath and my brother and I got all our vaccines including BCG when we were living abroad. Heck.. she was the one who gave me Tdap before I left for med school because that’s what she had in her office. There may be some hope in education, but I’m not holding my breath.

    Off-topic: “The Spirit Catches You and You Fall Down” or something really close to that is a book about a Hmong child in Southern California who has/had epilepsy and the challenges faced by her clinicians and her family in understanding what that means to each and how to treat if one treats at all.

    My understanding is that Hong Kong’s health care system is heavily subsidized by revenues from the gambling on horse-racing that happens there. I’ve heard somewhere, and I’m sorry I don’t have a source, that the amount of money that flows through the racetrack in Hong Kong in the 9 months that they race is more than all the Las Vegas casinos sees in a year. Either way, it’s several billion dollars US a race season and that’s the above the board gambling. The off-books betting is probably more, so yeah, an ED in Hong Kong can easily afford to treat someone well for $13.

    And Hong Kong poor? Really? Clearly, you’ve never been there. Oh, there are some very poor people there, but given the choice (and less humid weather), I wouldn’t mind living in Hong Kong at all (despite crazy real estate prices and the fact it belongs to China again). Stupendous public transport system, absolutely amazing food for dirt cheap, excellent recreation opportunities, and a gateway to a whole mess of other cool places.

  22. #22 rob
    September 22, 2009

    i wish there was a vaccination for chicken pox when i got them in elementary school. i was horribly sick.

    i was out of school for 3 weeks. the pox covered my whole body. (in ears, in throat on bottom of feet). i had a high fever and hallucinations. i spent a lot of time soaking in a baking soda bath cause they itched so much. when everything healed up, i had scars ALL OVER my body. (my adult size palm can cover up over twenty scars anywhere on my body). the pox left little indentations in my skin and did not tan as well as the unexposed skin, so as a kid in the summer i had spots everywhere. kinda weird looking.

    now the scars are stretched out cause i grew, and they tan like the rest of my skin, so they aren’t at all obvious anymore unless you know what to look for.

    on my side above my waist and lower back they are still pretty obvious though. i tell people that they are scars from a shotgun hunting accident. they believe me. but then are really surprised when i tell them it is from chicken pox.

  23. #23 Janet Camp
    September 22, 2009

    I am NOT Janet Camp #6–Yikes! It was horrifying to see my name at the bottom of that one! I’m glad Orac has a theory about it because I would have had no clue. This is the second time I’ve been caught up in some kind of filtering thing–oh no; it’s the “curse of He.pp.eh” cast upon me for not believing!

  24. #24 LovleAnjel
    September 22, 2009

    I don’t see a problem with a religious/cultural figure helping someone understand & accept modern medicine (as with the Hmong). The only way my Polish grandma was convinced to eat well (she was very old, with Parkinson’s and Alzheimer’s, often had a hard time chewing) was when the priest at her Church told her that God would not be offended by broth on Fridays (she truly deeply followed Catholic rules). I can see where the slippery slope might be, but honestly I don’t care why people go to a real doctor for help, just that they go.

  25. #25 Tsu Dho Nimh
    September 22, 2009

    @5 Janet, Arizona and New Mexico hospitals have allowed shamans (medicine men, whatever you want to call them) to do ceremonies for Indian patients for decades. Despite that, the medicine men have shown no inclination to try to expand their scope to other ethnic groups.

    The Hmong shamans are tending to the emotional well-being of their patients, lowering the stress levels, and apparently learning quite a bit about medicine and hospitals. This means the Hmong will be less likely to avoid hospitals and clinics.

  26. #26 antipodean
    September 22, 2009

    I was definately getting the feeling that the fake Janet Camp posting (#6 and 7) would have made much more sense if you’d read it out in the voice of elmo.

    Sounded like Happ*h to me. Except for the lack of a batshit insane reference to the dreaded ‘theory’…

  27. #27 dt
    September 22, 2009

    So 85% of the time a medical practitioners initial diagnosis is correct?
    Sounds pretty good to me, especially as most of the time the remaining 15% came to no harm by the delay in diagnosis.
    I bet most CAM practitioners would kill in an attempt to get such good success rates. OOps! Some do, like chiros manipulating cervical spines….

  28. #28 davidp
    September 22, 2009

    It would be nice to have a breakdown of the second table “Table 5″ into Chickenpox and the other diseases – chickenpox often being considered a routine, minor disease (despite Rob’s experience, and the other complications)

    I also take from this study the obvious results that:
    - Vaccination works (higher vaccination rates, give lower disease rates)
    - Naturopaths cannot prevent infectious disease – their claims about disease causes and the benefits of their treatments are false, as is shown from the higher disease rates for those children who see naturopaths.

  29. #29 Donna B.
    September 22, 2009

    What worries me the most is that the State of Washington has given legitimacy to quacks. Well, actually what worries me MOST is that I fear the federal government is about to do the same in passing health care reform legislation that they do not understand.

    And what I do not understand is why we, as a country, seem so immune to logic and critical thinking.

  30. #30 John G. Leggett
    September 22, 2009

    Orac, the problem no one is talking about with all the current proposed health insurance reform plans. Is they all have an inherent conflict of interest. As several of the messages on this post imply. There are problems with the current system where there is institutional bias to protect the institution instead of correct any problems.

    If the government, insurance company, medical or nursing society or any other body both run the system and evaluate and arbitrate any problems. It is not going to make things better. Whoever runs a program wants to controls costs and services, fit them into a budget make a profit whatever. I do not think any doctor or nurse wants to work nights. I know I never did in all the years I worked shift work. So why would you unless there was some reason to do so.

    I do not think anyone be they doctor, nurse, administrator or bureaucrat wants to air their dirty linen to the world. When the government is the organization that controls the budget services and control’s the exposure of problems how will this work. Who will you go too, the same person who caused or ignored the problem in the first place.

    Going on to the other problems with all the proposals.. We are fed a lot of woo about how it is going to better. I want the science that shows it is going to be better. I want to know in what national health program they are shorter waits or better outcomes than in the US. Not Canada, England or France?

    I also have a personal problem with people who think I should pay for health care for those who are illegal, do not want to pay for their own health care. Not people that they did not go to school so they can not get a job, have a criminal record, drug addicts or alcoholics. The woman in California who somehow got the public health system to pay over a million dollars so she could have fertility drugs and become a single mother of octuplets. I am not talking about people who through some unfortunate circumstance can not get health insurance through the current system. Not people who like my son who was so severely handicapped from birth that he could never have paid his own way. Most of these are now covered by medicaid to the tune of ocwe 320 billion dollars a year.

    The first think I would like the federal government to do is show that it is spending the money for medicaid, medicare, VA, Indian health service efficiently and providing high quality health care for everyone now covered by these programs within budget with expanded services. Then we can talk about expanding these programs

  31. #31 Jay Gordon, MD, FAAP
    September 22, 2009

    Chicken pox. They got chicken pox thereby possibly conferring better immunity than if they had received just one Varivax™ shot.

    Implying that these children also were at high risk of contracting diphtheria or tetanus is disingenuous.

    The attempt to eradicate chicken pox from America is leading to decreased adult exposure to varicella and an increase in shingles. As you know, most countries in Europe are not using this vaccine for this exact and very scientific reason. They have calculated that the increase in shingles fatalities outweighs any possible benefit of making this a universal vaccine except in high risk individuals for whom the benefits of the shot outweigh the risk.

    I most definitely agree that high risk children and adults should receive a vaccine against chicken pox.

    And, while you’ve mentioned the huge flaws in the study’s methodology, you seem willing to overlook holes large enough to accommodate a Peterbilt™ in favor of citing weak conclusions with which you agree.

    Prior to approval of the vaccine, the “big boys” like Phil Brunell and Walt Orenstein had choice words for the unequivocal excitement of the manufacturer. I’ve posted a few below. (These are old quotes and the authors of the quotes have flipped over the ensuing 15 years or so.) I know Drs. Brunell and Orenstein personally. I trained with both of them. They are good men, honest scientists and have the best interests of children in their hearts. Nonetheless, they are paid speakers and consultants for the pharmaceutical industry. I believe the epithet you use is Pharma Shills. They flipped.

    Best,

    Jay

    The American Medical Association Family Medical Guide (Cover page, Publication information)

    Chickenpox is a mild, though irritating, disease. You can expect a complete recovery and consequent life-long immunity.

    Weighing Chickenpox Vaccine for All – page 1, page 2 – New York Times, 7/7/93

    But from a medical perspective, chicken pox is more a monumental nuisance than a danger.

    “Do you want to give a vaccine – with unknown side effects – to prevent a very mild disease?” asked Dr. Phillip Brunnell, head of pediatric infectious disease at Cedars Sinai Hospital in Los Angeles. “I think it’s a difficult question and I’m glad I don’t have to make the decision.” He and others emphasize that to justify vaccinating everyone against a disease that for most is more inconvenient that harmful, the shot itself must be unquestionably safe. “Some things can’t be answered in a trial,” Dr. Brunnell said. “You’re just going to have to license the vaccine and see what happens. All the information you’re ever going to have you have in hand.” Some experts, like Dr. Brunnell, have suggested that there is an easier way than vaccinating to reduce the cost of chicken pox to society: by simply reducing the number of days children are kept home when they have the disease. Many schools do not allow children to return until the last of their lesions has crusted over, in the mistaken belief that the child is contagious up to that point. But the disease is most contagious before the rash appears. Most children feel well enough to return to class far earlier, Dr. Brunnell said. “If the parent’s lost work is the problem, then maybe we should send children back to school sooner,” he said.

    “From what I know right now, if it were my kid, I think I’d rather he get the vaccine than chickenpox,” Dr. Orenstein said. “My 10-year-old had a very mild case, and I thought, what’s the big deal? But when my 5-year-old got it, the child was very uncomfortable, and we were up for several nights. It’s that kind of problem that the vaccine would eliminate rather than serious disease.”

    Chickenpox or Vaccine: A Choice?

    First, a few words about chickenpox in children. Here’s the best description I’ve seen: “Chickenpox is most commonly an annoying illness lasting three to seven days, and happily never seen again.” Usually the worst part about it is that a parent has to lose a few days of work caring for the child. The best part–and it is a very good part–is that having chickenpox gives you lifelong immunity. Once you have had chickenpox, you will never get it again.

    Chickenpox – New York State Department of Health Communicable Disease Fact Sheet

    Is there a treatment for chickenpox?

    In 1992, acyclovir was approved by the U. S. Food and Drug Administration for treatment of chickenpox in healthy children. However, because chickenpox tends to be mild in healthy children, most physicians do not feel that it is necessary to prescribe acyclovir.

    “Opponents of universal immunization are concerned about the long-term safety and effectiveness. Proponents insist that chicken pox is not always a minor illness, accounting for 56 deaths in otherwise healthy children and more than 9,900 hospitalizations annually. But a physician at the Centers for Disease Control and Prevention who preferred to remain anonymous said in a telephone interview that the varicella-related deaths and complications were not the main consideration for development of the new vaccine. It was driven by economic considerations that took into account the number of workdays lost by parents who must stay home with a sick child.”

    P.S. David, how do I turn key words into hyperlinks? And what is the code for “block bold” or “block italics.”

    Thanks!

    J

  32. #32 Jay Gordon, MD, FAAP
    September 22, 2009

    Chicken pox. They got chicken pox thereby possibly conferring better immunity than if they had received just one Varivax™ shot.

    Implying that these children also were at high risk of contracting diphtheria or tetanus is disingenuous.

    The attempt to eradicate chicken pox from America is leading to decreased adult exposure to varicella and an increase in shingles. As you know, most countries in Europe are not using this vaccine for this exact and very scientific reason. They have calculated that the increase in shingles fatalities outweighs any possible benefit of making this a universal vaccine except in high risk individuals for whom the benefits of the shot outweigh the risk.

    I most definitely agree that high risk children and adults should receive a vaccine against chicken pox.

    And, while you’ve mentioned the huge flaws in the study’s methodology, you seem willing to overlook holes large enough to accommodate a Peterbilt™ in favor of citing weak conclusions with which you agree.

    Prior to approval of the vaccine, the “big boys” like Phil Brunell and Walt Orenstein had choice words for the unequivocal excitement of the manufacturer. I’ve posted a few below. (These are old quotes and the authors of the quotes have flipped over the ensuing 15 years or so.) I know Drs. Brunell and Orenstein personally. I trained with both of them. They are good men, honest scientists and have the best interests of children in their hearts. Nonetheless, they are paid speakers and consultants for the pharmaceutical industry. I believe the epithet you use is Pharma Shills. They flipped.

    Best,

    Jay

    THESE ARE ALL QUOTES FROM A VARIETY OF AUTHORITIES WAAAAY BACK AT THE END OF THE TWENTIETH CENTURY.

    The American Medical Association Family Medical Guide (Cover page, Publication information)

    Chickenpox is a mild, though irritating, disease. You can expect a complete recovery and consequent life-long immunity.

    Weighing Chickenpox Vaccine for All – page 1, page 2 – New York Times, 7/7/93

    But from a medical perspective, chicken pox is more a monumental nuisance than a danger.

    “Do you want to give a vaccine – with unknown side effects – to prevent a very mild disease?” asked Dr. Phillip Brunnell, head of pediatric infectious disease at Cedars Sinai Hospital in Los Angeles. “I think it’s a difficult question and I’m glad I don’t have to make the decision.” He and others emphasize that to justify vaccinating everyone against a disease that for most is more inconvenient that harmful, the shot itself must be unquestionably safe. “Some things can’t be answered in a trial,” Dr. Brunnell said. “You’re just going to have to license the vaccine and see what happens. All the information you’re ever going to have you have in hand.” Some experts, like Dr. Brunnell, have suggested that there is an easier way than vaccinating to reduce the cost of chicken pox to society: by simply reducing the number of days children are kept home when they have the disease. Many schools do not allow children to return until the last of their lesions has crusted over, in the mistaken belief that the child is contagious up to that point. But the disease is most contagious before the rash appears. Most children feel well enough to return to class far earlier, Dr. Brunnell said. “If the parent’s lost work is the problem, then maybe we should send children back to school sooner,” he said.

    “From what I know right now, if it were my kid, I think I’d rather he get the vaccine than chickenpox,” Dr. Orenstein said. “My 10-year-old had a very mild case, and I thought, what’s the big deal? But when my 5-year-old got it, the child was very uncomfortable, and we were up for several nights. It’s that kind of problem that the vaccine would eliminate rather than serious disease.”

    Chickenpox or Vaccine: A Choice?

    First, a few words about chickenpox in children. Here’s the best description I’ve seen: “Chickenpox is most commonly an annoying illness lasting three to seven days, and happily never seen again.” Usually the worst part about it is that a parent has to lose a few days of work caring for the child. The best part–and it is a very good part–is that having chickenpox gives you lifelong immunity. Once you have had chickenpox, you will never get it again.

    Chickenpox – New York State Department of Health Communicable Disease Fact Sheet

    Is there a treatment for chickenpox?

    In 1992, acyclovir was approved by the U. S. Food and Drug Administration for treatment of chickenpox in healthy children. However, because chickenpox tends to be mild in healthy children, most physicians do not feel that it is necessary to prescribe acyclovir.

    “Opponents of universal immunization are concerned about the long-term safety and effectiveness. Proponents insist that chicken pox is not always a minor illness, accounting for 56 deaths in otherwise healthy children and more than 9,900 hospitalizations annually. But a physician at the Centers for Disease Control and Prevention who preferred to remain anonymous said in a telephone interview that the varicella-related deaths and complications were not the main consideration for development of the new vaccine. It was driven by economic considerations that took into account the number of workdays lost by parents who must stay home with a sick child.”

    P.S. David, how do I turn key words into hyperlinks? And what is the code for “block bold” or “block italics?”

    Thanks!

    J

  33. #33 Jay Gordon, MD, FAAP
    September 22, 2009

    Chicken pox. They got chicken pox thereby possibly conferring better immunity than if they had received just one Varivax™ shot.

    Implying that these children also were at high risk of contracting diphtheria or tetanus is disingenuous.

    The attempt to eradicate chicken pox from America is leading to decreased adult exposure to varicella and an increase in shingles. As you know, most countries in Europe are not using this vaccine for this exact and very scientific reason. They have calculated that the increase in shingles fatalities outweighs any possible benefit of making this a universal vaccine except in high risk individuals for whom the benefits of the shot outweigh the risk.

    I most definitely agree that high risk children and adults should receive a vaccine against chicken pox.

    And, while you’ve mentioned the huge flaws in the study’s methodology, you seem willing to overlook holes large enough to accommodate a Peterbilt™ in favor of citing weak conclusions with which you agree.

    Prior to approval of the vaccine, the “big boys” like Phil Brunell and Walt Orenstein had choice words for the unequivocal excitement of the manufacturer. I’ve posted a few below. (These are old quotes and the authors of the quotes have flipped over the ensuing 15 years or so.) I know Drs. Brunell and Orenstein personally. I trained with both of them. They are good men, honest scientists and have the best interests of children in their hearts. Nonetheless, they are paid speakers and consultants for the pharmaceutical industry. I believe the epithet you use is Pharma Shills. They flipped.

    Best,

    Jay

    THESE ARE ALL QUOTES FROM A VARIETY OF AUTHORITIES WAAAAY BACK AT THE END OF THE TWENTIETH CENTURY.

    The American Medical Association Family Medical Guide (Cover page, Publication information)

    Chickenpox is a mild, though irritating, disease. You can expect a complete recovery and consequent life-long immunity.

    Weighing Chickenpox Vaccine for All – page 1, page 2 – New York Times, 7/7/93

    But from a medical perspective, chicken pox is more a monumental nuisance than a danger.

    “Do you want to give a vaccine – with unknown side effects – to prevent a very mild disease?” asked Dr. Phillip Brunnell, head of pediatric infectious disease at Cedars Sinai Hospital in Los Angeles. “I think it’s a difficult question and I’m glad I don’t have to make the decision.” He and others emphasize that to justify vaccinating everyone against a disease that for most is more inconvenient that harmful, the shot itself must be unquestionably safe. “Some things can’t be answered in a trial,” Dr. Brunnell said. “You’re just going to have to license the vaccine and see what happens. All the information you’re ever going to have you have in hand.” Some experts, like Dr. Brunnell, have suggested that there is an easier way than vaccinating to reduce the cost of chicken pox to society: by simply reducing the number of days children are kept home when they have the disease. Many schools do not allow children to return until the last of their lesions has crusted over, in the mistaken belief that the child is contagious up to that point. But the disease is most contagious before the rash appears. Most children feel well enough to return to class far earlier, Dr. Brunnell said. “If the parent’s lost work is the problem, then maybe we should send children back to school sooner,” he said.

    “From what I know right now, if it were my kid, I think I’d rather he get the vaccine than chickenpox,” Dr. Orenstein said. “My 10-year-old had a very mild case, and I thought, what’s the big deal? But when my 5-year-old got it, the child was very uncomfortable, and we were up for several nights. It’s that kind of problem that the vaccine would eliminate rather than serious disease.”

    Chickenpox or Vaccine: A Choice?

    First, a few words about chickenpox in children. Here’s the best description I’ve seen: “Chickenpox is most commonly an annoying illness lasting three to seven days, and happily never seen again.” Usually the worst part about it is that a parent has to lose a few days of work caring for the child. The best part–and it is a very good part–is that having chickenpox gives you lifelong immunity. Once you have had chickenpox, you will never get it again.

    Chickenpox – New York State Department of Health Communicable Disease Fact Sheet

    Is there a treatment for chickenpox?

    In 1992, acyclovir was approved by the U. S. Food and Drug Administration for treatment of chickenpox in healthy children. However, because chickenpox tends to be mild in healthy children, most physicians do not feel that it is necessary to prescribe acyclovir.

    “Opponents of universal immunization are concerned about the long-term safety and effectiveness. Proponents insist that chicken pox is not always a minor illness, accounting for 56 deaths in otherwise healthy children and more than 9,900 hospitalizations annually. But a physician at the Centers for Disease Control and Prevention who preferred to remain anonymous said in a telephone interview that the varicella-related deaths and complications were not the main consideration for development of the new vaccine. It was driven by economic considerations that took into account the number of workdays lost by parents who must stay home with a sick child.”

    P.S. David, how do I turn key words into hyperlinks? And what is the code for “block bold” or “block italics?”

    Thanks!

    J

  34. #34 Jay Gordon, MD, FAAP
    September 22, 2009

    Sorry. Something went wrong above. ORAC, please delete my duplicate posts.

    Thanks.

    Jay

  35. #35 Jay Gordon, MD, FAAP
    September 23, 2009

    Brunell’s Brush-off
    Pediatrics 1977;59;954

    As is usually the case, Dr. Plotkin and I are generally in
    agreement. Our major difference is with respect to timing. In
    the last sentence of my commentary, I clearly qualified my
    own feelings that no additional clinical vaccine trials appear
    to be indicated with the phrase “at this time.” If at some
    time in the future it is shown that (1) varicella produces more
    morbidity than is now generally appreciated or (2) we might
    achieve greater success in immunizing or reimmunizing
    adults or (3) additional basic or clinical research provides
    new information, I would certainly encourage reexamination
    of the problem. I also have had the opportunity of reviewing
    the most recent work of the Japanese group to which Dr.
    Plotkin refers. This may, indeed, require a reassessment of
    the situation. I do not think, however, that it is appropriate
    to discuss this work until it appears in print.
    The emphasis on a varicella-zoster vaccine that would
    produce less severe zoster than the natural disease is a
    desirable goal. There is abundant evidence that zoster
    produces more morbidity than varicella. A varicella-zoster
    vaccine, therefore, might better be designed to decrease the
    morbidity from zoster.
    In assessing the “morbidity” due to varicella, it might be
    worthwhile to examine the problem of school absences.
    Sometime ago it was suggested that children with varicella
    be allowed to attend school! There is little to suggest that the
    current policy of exclusion prevents infection. One might
    argue that even if it did it might be undesirable to prevent
    varicella in children and delay infection until adulthood. The
    fact that such a suggestion was advanced, moreover, speaks
    to the mildness of the illness in most normal children. I do
    not advocate that the regulation excluding children from
    school be changed at this time. It is a proposal that might be
    worth examining as we define morbidity from varicella in
    normal children.
    We have moved from an era of philosophy to one of
    careful and thoughtful examination of scientific proposals. I
    do not think we could or would want to claim some of the
    privileges we once had in the use of human subjects for
    research. Even without imposed restraints, however, otmr past
    experiences should have tatmght tis the need for caution. I
    wholeheartedly support research that would increase our
    understanding of virus latency. Hopefully, these findings will
    enable us to intelligently pursue the prevention and therapy
    of latent virus infections caused by varicella-zoster virus,
    herpes simplex virus, cytomegalovirtis, and Epstein-Barr
    virus.

    7703 Floyd Curl Drive
    San Antonio, Texas 78284
    PHILIP A. BRUNELL, M.D.
    Department of Pediatrics,
    The University of Texas Health
    Science Center

  36. #36 RebeccaF
    September 23, 2009

    John G. Leggett: “I want to know in what national health program they are shorter waits or better outcomes than in the US. Not Canada, England or France?”

    Depends on what you mean with better outcomes. Higher life expectancy?

    Depends on what you mean with shorter waits. For emergency treatment or non-emergency treatment?

    Germany is probably a good answer to your question in any case. I have yet to have to wait for more than a week to get treated for a non-emergency and more than a few hours for an emergency.

  37. #37 Todd W.
    September 23, 2009

    @Jay Gordon

    The attempt to eradicate chicken pox from America is leading to decreased adult exposure to varicella and an increase in shingles.

    Umm…what exactly are you suggesting, here? That being vaccinated for chicken pox increases the risk for shingles? It was my understanding that the only way you could get shingles was if you had been infected with chicken pox before.

  38. #38 ANB
    September 23, 2009

    Dr. Brunell is currently on the pediatrics staff at the Uniformed Services University of the Health Sciences in Bethesda, MD.

    http://www.usuhs.mil/pediatrics/index.html

  39. #39 tonyl
    September 23, 2009

    @jay Gordon: Chicken pox. They got chicken pox thereby possibly conferring better immunity than if they had received just one Varivax™ shot.

    At what cost? The complications due to Chicken pox are more severe and have a higher likelyhood than complications due to the vaccine. Then, of course, that “better” imunity comes with the added bonus of Shingles later in life. Oh joy! Thanks Jay for encouraging your patients to subject their kids a likely episode of Shingles in their future!

    The attempt to eradicate chicken pox from America is leading to decreased adult exposure to varicella and an increase in shingles.

    Utter BS. I challenge you to provide actual scientific evidence backing this claim.

  40. #40 Pablo
    September 23, 2009

    Utter BS. I challenge you to provide actual scientific evidence backing this claim.

    Remember, Jay Gordon doesn’t care about science. His experience in his office trumps any scientific study.

  41. #41 Todd W.
    September 23, 2009

    @John G. Legget

    I also have a personal problem with people who think I should pay for health care for those who are illegal, do not want to pay for their own health care.

    As I understand it, the health care reform bill does not have any provisions in it that would extend coverage to illegal immigrants.

    That aside, you are already paying for their health care, as well as for those who choose not to or are unable to get insurance. Whenever these individuals go into a hospital ER, for example, and are not able to pay, you end up paying indirectly through higher premiums, increased costs from the hospital and so on.

    Though I agree that Federal health care should not be extended by law to those who are here illegally, whether you end up paying for it indirectly through your insurance premiums or through your taxes doesn’t really change the issue.

  42. #42 James Sweet
    September 23, 2009

    Re: This idea that “natural immunity is better”… sure, the data suggests that natural immunity makes you less likely to get the disease in the future than does a vaccine, but that’s misleading because the odds of having ever had the disease in your life are 100% if you have a natural immunity. Duh.

    To recycle analogy I’ve used before: This is like if I was worried about getting in a car accident, so I observed that if my car was totaled I would not be able to drive any more, and thus would be at zero risk of being in a car accident. Therefore, clearly the best choice is to drive as recklessly as possible, in the hopes of totaling my car and avoiding a future accident.

    FAIL.

  43. #43 James Sweet
    September 23, 2009

    Also, those saying that chicken pox is usually “no big deal” are missing the point. Yes, it is true that the vast majority of children who contract chicken pox will suffer no long-term negative effects. As it turns out, that is also true for the vast majority of children who get vaccinated. It’s also true for the vast majority of children who never wear a seat belt.

    This is one reason why we have science: so that we can evaluate the costs and benefits of alternatives where the potential negative consequences are too rare to be adequately comprehended by our Stone Age brains. The human brain is completely inadequate at intuitively evaluating low level risks.

  44. #44 Caravelle
    September 23, 2009

    I’ve been reading the comments on PalMD’s post, but I haven’t found where he gives the right answer to his challenge ! As a non-MD it’s frustrating. Did he ever give it ? Did I miss it in the comments (likely, the thread is very long) or was there a follow-up post ?

  45. #45 red rabbit
    September 23, 2009

    @ Jay Gordon: go back to medical school. Scientifically, one must be infected with the chicken pox virus primarily to get reactivation, or herpes zoster (shingles). They may or may not have manifested disease recognised as chicken pox, but they can be shown to have been infected in the more distant past.

    And anecdotally, as that seems to appeal to you more: I got shingles in medical school. During my neurology rotation, much to everyone’s entertainment. I had primary chickenpox in 1981, and have had titers showing immunity two or three times since then, prior to my shingles outbreak, meaning this cannot possibly have been a new infection.

    @David #17: I thought that was true, until a physiotherapist in the ICU suggested acupuncture for one of our INTENSIVE CARE patients. Apparently they also do a lot of “low intensity laser” (aka a blinky light) and therapeutic ultrasound. I nearly gagged when I realised he was serious. I have seriously lost a lot of the respect I had for PT.

  46. #46 titmouse
    September 24, 2009

    The attempt to eradicate chicken pox from America is leading to decreased adult exposure to varicella and an increase in shingles.

    Holy shit, Dr. Gordon! I cannot believe a pediatrician would repeat this common misunderstanding concerning primary varicella infection and a reactivation of the dormant virus residing in a sensory ganglion aka “shingles.”

    Before you can get shingles you have to have chickenpox, which is the primary varicella infection. Once the acute infection resolves, in some people there will remain inactive viral particles within a sensory ganglion. Years later for a variety of reasons these dormant virons can start replicating again. They then travel down nerve axons toward the skin. That’s what shingles is.

    Your infectious disease department needs to have a talk with you.

  47. #47 titmouse
    September 24, 2009

    Dr. Gordon,

    I note that you often append “FAAP” to your name. Allow me to quote the infectious disease experts at the American Academy of Pediatrics:

    Available data indicate that the risk of herpes zoster after immunization seems to be lower than the risk of zoster after wild-type varicella infection.

    This makes sense, given that the 1-shot vaccination didn’t convey sufficient immunity to prevent outbreaks. Some vaccinated people got chickenpox, and so developed a risk for shingles. AAP now recommend a booster shot. We should see fewer cases of shingles in the future.

    http://aappolicy.aappublications.org/cgi/reprint/pediatrics;120/1/221.pdf

  48. #48 titmouse
    September 24, 2009

    Jay Gordon:

    .) I know Drs. Brunell and Orenstein personally. I trained with both of them. They are good men, honest scientists and have the best interests of children in their hearts. Nonetheless, they are paid speakers and consultants for the pharmaceutical industry. I believe the epithet you use is Pharma Shills. They flipped.

    So let me get this straight: Philip Brunell MD is a good man, an honest scientist who cares about kids AND he’s pimping a vaccine that’s bad for kids ‘cuz he’s on the take?

    How does your brain do that?

  49. #49 titmouse
    September 24, 2009

    Jay Gordon:

    The attempt to eradicate chicken pox from America is leading to decreased adult exposure to varicella and an increase in shingles.

    I can’t get over this shingles gaff. It’s not a typo. It’s not an “oops I said teh opposites of wat I meens.”

    Perhaps I’d forgive an MD for saying something so stupid if the MD were speaking tentatively about a topic outside his specialty –e.g., “I’m a little rusty here, but I seem to recall…”

    The WTF just won’t stop. My head asplodes.

    Time to turn off the ‘puter and take the sailboat out for a ride across the pond, I think.

  50. #50 titmouse
    September 24, 2009

    Ok one more thing.

    Dr. Gordon posted Dr. Brunell’s earlier statements about the varicella vaccine to convey the impression that others think as he does. I’m sure he finds it inconvenient that Dr. Brunell has since changed his mind.

    If I were in Dr. Gordon’s shoes, I’d prefer to quote a respected ID specialist who currently opposes the varicella vaccine. Wonder why he didn’t do that…

  51. #51 Jay Gordon, MD, FAAP
    September 24, 2009

    @titmouse
    I note that you often append “FAAP” to your name. Allow me to quote the infectious disease experts at the American Academy of Pediatrics”

    If you do a simple Google search of virtually every name on that list of experts, you will find that they are paid speakers and consultants to the companies whose vaccines they recommend. ORAC and company love to dismiss the “pharma shill gambit.” They are wrong in dismissing it.

    Cases of shingles do occur in people vaccinated for chickenpox and decreasing repeated exposure to chickenpox has led to an increase in shingles in adults. Look it up.

    Best,

    Jay

  52. #52 Jen
    September 24, 2009

    IIRC, I remember reading years ago about a researcher (Gary Goldman?) that was finding an increase in shingles in adults since implementation of widespread varicella vaccination because they weren’t being exposed to wild varicella anymore. Apparently, those exposures were acting as a “booster” and since vaccination was reducing the numbers of children with varicella infections, those “boosters” were no longer occurring, hence the increase in shingles in adults. I believe this is what Dr. Gordon was referring to. I’ll have to dig up that info later when I have more time.

  53. #53 titmouse
    September 24, 2009

    Available data indicate that the risk of herpes zoster after immunization seems to be lower than the risk of zoster after wild-type varicella infection.

    So this is a lie, Dr. Gordon?

  54. #54 Todd W.
    September 24, 2009

    @Jay Gordon

    Cases of shingles do occur in people vaccinated for chickenpox and decreasing repeated exposure to chickenpox has led to an increase in shingles in adults. Look it up.

    You made the claim. You back it up with a citation. Thank you.

  55. #55 tl
    September 24, 2009

    Well Jay, since you are not willing to do your own homework, I spent one minute searching on Zoster incidence and found this paper.

    Yawn BP, et al., “A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction.” Mayo Clin Proc. 2007 Nov;82(11):1341-9.

    When discussing the observed increase in shingles, they discuss the hypothosis that this is due to increased chicken pox vaccine uptake and note: “The few published North American studies that explore this hypothesis have reported conflicting results, possibly because varicella vaccine has been in widespread use for only 10 years in the United States.44,45 Continued surveillance of HZ incidence will be needed to better assess the impact of widespread varicella vaccination. “

    In other words, there might be a causal relationship, but the data does not yet support it. Which is a far cry from your claim of a definite observed effect.

    So, basically, you’re willing to inflict a definite and dramatically increased chance of both chicken pox and shingles on children to avoid a potential, but unconfirmed small increased risk to adults? Especially when there is a vaccine to shown to protect those in the 65 an older category and currently being tested for younger groups?

  56. #56 titmouse
    September 24, 2009

    All I could find in a brief surf was a speculative hypothesis originating with a computer scientist and former employee of the CDC, Gary S Goldman PhD. I couldn’t find any paper testing that hypothesis. I did find a few papers citing Dr. Goldman’s idea as if it were an established finding rather than speculation.

    For a number of reasons we might expect the incidence of H Zoster to increase (e.g., aging, cancer and HIV patients living longer). So a shingles increase by itself is not surprising and can’t be assumed to be due to the varicella vaccination of children.

    I found some anecdotes about parents of young children and pediatricians having fewer episodes of shingles. Well, dur. I’ll bet failure to thrive and dementia rates are also lower among those two groups.

    You must have a prior infection with varicella before you can get shingles. If rates of varicella infection go down, rates of shingles outbreaks should go down as more people are effectively vaccinated.

    The notion that exposure to the wild type virus can boost cell mediated immunity isn’t unreasonable. But favoring this over vaccination is weird. With booster shots we can drive shingles rates into the ground. Why settle for the good ol’ days when lots of people got shingles?

  57. #57 titmouse
    September 24, 2009

    Dr. Gordon, I want to apologize on one point. I initially read you as claiming that adults were not being exposed to varicella and so were getting a primary infection later in life manifesting as shingles. I’ve encountered this misunderstanding among several vaccine wary people –e.g., “It’s better to get chickenpox as a kid because you’ll be immune your whole life. The shot won’t make you immune when you’re older, and so you’ll be more likely to get shingles.”

    Now I see that you meant that adults with latent varicella infections are not being re-exposed to varicella as often, thanks to increasing herd immunity. That’s not as batshit insane as I’d first thought.

  58. #58 Jen
    September 26, 2009

    “The notion that exposure to the wild type virus can boost cell mediated immunity isn’t unreasonable. But favoring this over vaccination is weird. With booster shots we can drive shingles rates into the ground.”

    I was hoping that this would generate an interesting discussion. If Dr. Goldman’s predictions are correct, (and I find this thought horrifying) will the benefits of mass vaccination against varicella still outweigh the risks? I’m thinking no. The pain from shingles can be excruciating and last for several weeks. Not to mention the potential for blindness, scarring and infection. (shudder)

    Yes, we have a shingles vaccine now, but honestly, how many adults really follow CDC guidelines and get all the recommended immunizations? Furthermore, the vaccine is not terribly effective, and what about all those adults on immunosuppressive drugs that cannot be vaccinated?

  59. #59 passionlessDrone
    September 26, 2009

    Hi Jen -

    Furthermore, the vaccine is not terribly effective, and what about all those adults on immunosuppressive drugs that cannot be vaccinated?

    In an ironic twist, it is just these people, the immunosuppressed, who are the most likely to get shingles.

    http://www.ninds.nih.gov/disorders/shingles/detail_shingles.htm

    About 25 percent of all adults, mostly otherwise healthy, will get shingles during their lifetimes, usually after age 40. The incidence increases with age so that shingles is 10 times more likely to occur in adults over 60 than in children under 10. People with compromised immune systems – from use of immunosuppressive medications such as prednisone, from serious illnesses such as cancer, or from infection with HIV – are at special risk of developing shingles. These individuals also can have re-eruptions and some may have shingles that never heals. Most people who get shingles re-boost their immunity to VZV and will not get the disease for another few decades.

    We might eventually be able to get to a place where we eliminate shinges; but to do so we’ll put this population in a hell of a crutch for a while. They can’t be vaccinated, and lower wild exposure means they are more likely to relapse.

    - pD

  60. #60 titmouse
    September 27, 2009

    passionlessDrone, you sound convinced that immunocompromised people will get shingles more often if the varicella vaccine is widely used.

    Do we have any evidence for this? All I could find was one computer scientist involved in analyzing data for one part of California. He noted more shingles and speculated that the varicella vaccine might be why. It’s a reasonable speculation. However, most reasonable speculations don’t pan out when studied.

    Your reference says, “Some scientists believe that immunizing children against chickenpox increases the risk of shingles in adults who were not themselves immunized during childhood.” “Some scientists believe” isn’t evidence.

    Immunocompromised people already avoid exposing themselves to infections. They stay away from sick kids. So it’s possible that wide use of the varicella vaccine won’t significantly change their rate of exposure to wild type varicella.

  61. #61 passionlessDrone
    September 27, 2009

    Hi Titmouse –

    I most definitely your concerns over the dangers of reasonable speculations.

    There are several reviews that show mixed results when analyzing for this type of thing. The best that I know of that does show an increase of shingles in an older population set is this one:

    Herpes zoster-related hospitalizations and expenditures before and after introduction of the varicella vaccine in the United States

    Which shows a steady rise in shingles hospital admissions in older American’s after the introduction of chicken pox vaccine.

    In so far as the immunosuppressed avoiding people with chicken pox; if I understand the potential problem correctly, this is exactly what triggers an episode of shingles, no latent exposure to chicken pox. It is this lack of immunological toggling that allows the residual virus to make a re-emergence.

    - pD

  62. #62 skeptiquette
    September 27, 2009

    Titmouse,

    I was able to find a review article that addressed this exact question, but it was written in french.

    [Impact of routine pediatric varicella vaccination on the epidemiology of herpes zoster.]
    Alain S, Paccalin M, Larnaudie S, Perreaux F, Launay O.
    Med Mal Infect. 2009 Jun 30. [Epub ahead of print] French

    I may just request it through interlibrary loan service just to look at the references.

    I also came across another couple of interesting articles

    Incidence of Herpes Zoster Among Children Vaccinated With Varicella Vaccine in a Prepaid Health Care Plan in the United States, 2002-2008.
    Tseng HF, Smith N, Marcy SM, Sy LS, Jacobsen SJ.
    Pediatr Infect Dis J. 2009 Sep 19. [Epub ahead of print]

    and

    An outbreak of varicella in elementary school children with two-dose varicella vaccine recipients–Arkansas, 2006
    Gould PL, Leung J, Scott C, Schmid DS, Deng H, Lopez A, Chaves SS, Reynolds M, Gladden L, Harpaz R, Snow S.
    Pediatr Infect Dis J. 2009 Aug;28(8):678-81

    haven’t read them yet, but they look interesting.

    Why would there be an outbreak amongst a school age population that has a 97 % vaccination coverage?

    I also thought it was interesting that certain subgroups (asthmatics, etc.) showed a higher incidence of zoster infection following VZV vaccination. It makes you think about the current protocol and whether the restrictions for vaccine administration are sensitive enough.

    skeptiquette

  63. #63 titmouse
    September 27, 2009

    Hi skeptiquette,

    I’m convinced that re-exposure to varicella partially blocks the activation of latent varicella residing in sensory ganglia. I don’t understand the mechanism for this. Perhaps some IgG gets into the nerve cells and gums up the virus’ ability to replicate.

    But the role of re-exposure to varicella in suppressing re-activation of latent virus is not a good argument against the varicella vaccine. It’s simply an argument for booster shots.

    passionlessDrone raised the one caveat: what about the immunocompromised who can’t receive a live virus vaccine?

    The immunocompromised are a special group. They have high rates of shingles AND their exposure to exogenous wild type varicella is likely very low. That’s not necessarily a causal connection. There’s a temporal correlation between going on prednisone or chemo and getting shingles, so I’d say the immune problem is the major causal factor.

    If you were facing a period of immune compromise, not having any varicella living in your sensory ganglia would be ideal. As passionlessDrone said, in the long run the varicella vaccine will reduce shingles outbreaks. But what of this present cohort of middle aged adults walking around with varicella buddies inside?

    That’s a question for the experts, which I am not. I’m guessing a varicella booster shot prior to organ transplant or chemo would be a good idea.

  64. #64 titmouse
    September 27, 2009

    More musing:

    Vaccine strategies depend on whether our goal is erradication of the infectious agent or not. Erradication means nearly everyone must be vaccinated to break the lifecycle of the infectious agent.

    Smallpox has been erradicated. Polio was nearly erradicated, and still could be erradicated. We’re never going to erradicate tetanus. The bacterium that produces the tetanus toxin, Clostridium tetani, is in the soil and isn’t going anywhere soon. Influenza has its animal hosts and also isn’t going anywhere.

    For some illnesses, partial erradication might set the stage for a later public health disaster. For example, in a few years when everyone vaccinated for smallpox have died, re-introduction of the smallpox virus into a population would kill about 90%, based on the experience of early native americans. The threat of weaponized smallpox means we’re always going to need a plan for rapid production and distribution of smallpox vaccine.

    Polio, measles, mumps, rubella –I say good riddance. Paralysis, deafness, birth defects all suck. We could erradicate these infections in a few years if everyone around the world were vaccinated. Anti-vaccine rhetoric is the primary barrier to erradication. Funny thing, too. Erradication is the quickest path toward a world with fewer routine vaccinations.

    What about varicella? Should erradication be our goal? Having survived a two-week course as an adolescent during which I wished I were dead, I’ve an emotional bias toward erradication. A friend’s course of ophthalmic shingles provides another reason for me to hate on that virus.

    As more humans enjoy living to ripe old ages, more will face periods of immune compromise and shingles. That I think is the strongest argument for erradication. However, we can’t wipe varicella out in a year like we might wipe out polio. It’s hiding in the sensory ganglia of billions of people. Even if all were vaccinated tomorrow, someone would get shingles, scratch their skin, then shake hands with someone with an inadequate immune response to the vaccine, leading to a small chickenpox outbreak.

    So I imagine a future with a varicella booster shot schedule similar to the tetanus schedule. How many years between boosters? I have no idea, but prospective studies over the coming decades should provide an answer.

  65. #65 Chris
    September 27, 2009

    In any study that looked into the increase of shingles being related to the varicella vaccines being introduced fourteen years ago — has the fact that baby boomers have reached the age that is most likely to get shingles?

    Just wondering.

    Also, since the vaccine has only been around for fourteen years, how can you tell what its real long term effect is?

  66. #66 titmouse
    September 28, 2009

    The link passionlessDrone gave above states:

    Population-adjusted rates of HZHDs did not change significantly from the prevaccination years (1993-1995) through the initial 5 years of the varicella vaccination period. Beginning in 2001, however, the rate of HZHDs overall began to increase, and by 2004 the overall rate was 2.5 HZHDs

    I’m trusting that “population-adjusted rates” means that the researchers controlled for obvious confounds, such as an aging population and comorbidities. Of course, my trust may be misplaced.

  67. #67 Jen
    September 28, 2009

    What disturbs me greatly about this whole situation is that, according to Dr. Goldman, the CDC was apparently trying to suppress his findings wrt an increase in shingles. He wrote a book about this; excerpts can be read here:
    http://books.google.com/books?id=GYzowYRYN_oC&printsec=frontcover&dq=The+Chickenpox+Vaccine:+A+New+Epidemic+of+Disease+and+Corruption#v=onepage&q=&f=false

  68. #68 Chris
    September 28, 2009

    Jen:

    What disturbs me greatly about this whole situation is that, according to Dr. Goldman, the CDC was apparently trying to suppress his findings wrt an increase in shingles.

    Oh, really?

    (Oh, love the title of the book, A New Epidemic of Disease and Corruption, no bias there! Though I did learn what Mr. Goldman’s credentials are, he has an undergraduate degree in engineering and his PhD is in Computer Science, he also publishes the journal Medical Veritas.)

    Int J Toxicol. 2006 Sep-Oct;25(5):313-7.
    The case against universal varicella vaccination.
    Goldman GS.

    Int J Toxicol. 2005 Jul-Aug;24(4):205-13.
    Universal varicella vaccination: efficacy trends and effect on herpes zoster.
    Goldman GS.

    Vaccine. 2005 May 9;23(25):3349-55.
    Cost-benefit analysis of universal varicella vaccination in the U.S. taking into account the closely related herpes-zoster epidemiology.
    Goldman GS.

    Vaccine. 2003 Oct 1;21(27-30):4243-9.
    Incidence of herpes zoster among children and adolescents in a community with moderate varicella vaccination coverage.
    Goldman GS.

    Vaccine. 2003 Oct 1;21(27-30):4238-42..
    Varicella susceptibility and incidence of herpes zoster among children and adolescents in a community under active surveillance.
    Goldman GS.

    Is this the form of suppression:
    J Infect Dis. 2008 Mar 1;197 Suppl 2:S224-7.
    The impact of the varicella vaccination program on herpes zoster epidemiology in the United States: a review.
    Reynolds MA, Chaves SS, Harpaz R, Lopez AS, Seward JF.

    Which says:

    Speculation that a universal varicella vaccination program might lead to an increase in herpes zoster (HZ) incidence has been supported by modeling studies that assume that exposure to varicella boosts immunity and protects against reactivation of varicella-zoster virus (VZV) as HZ. Such studies predict an increase in HZ incidence until the adult population becomes predominantly composed of individuals with vaccine-induced immunity who do not harbor wild-type VZV. In the United States, a varicella vaccination program was implemented in 1995. Since then, studies monitoring HZ incidence have shown inconsistent findings: 2 studies have shown no increase in overall incidence, whereas 1 study has shown an increase. Studies from Canada and the United Kingdom have shown increasing rates of HZ incidence in the absence of a varicella vaccination program. Data suggest that heretofore unidentified risk factors for HZ also are changing over time. Further studies are needed to identify these factors, to isolate possible additional effects from a varicella vaccination program. Untangling the contribution of these different factors on HZ epidemiology will be challenging.

  69. #69 Chris
    September 28, 2009

    Another thing makes me wonder about Mr. Goldman’s research: why did he not include the experience in Japan? The vaccine was developed there, and has been in use there for many more years than in the USA. I did a PubMed search on “Goldman GS Japan” and go no results. But when I do a search using “varicella vaccine shingles japan” there were 49 hits.

    I did find a Canadian study:
    Epidemiol Infect. 2007 Aug;135(6):908-13. Epub 2007 Feb 12.
    Secular trends in the epidemiology of shingles in Alberta.
    Russell ML, Schopflocher DP, Svenson L, Virani SN.

    Which says:

    Varicella vaccine was licensed in Canada in 1998, and a publicly funded vaccination programme introduced in the province of Alberta in 2001. ….. Shingles rates increased between 1986 and 2002. There was a sex effect and evidence of an age-sex interaction. Females had higher rates than males at every age; however, the difference between females and males was greatest for the 50-54 years age group and declined for older age groups. The increased rate of shingles in Alberta began before varicella vaccine was licensed or publicly funded in Alberta, and thus cannot be attributed to vaccination.

    I believe we can blame an increase on shingles on baby boomers.

  70. #70 Chris
    September 28, 2009

    Doing a bit more digging, I find that Mr. Goldman is an editor of a crank journal that is not indexed on PubMed (Medical Veritas, which includes editors and writers like Boyd Haley, Andrew Wakefield, Harold E. Buttram and Viera Scheibner, all of whom are anti-vax cranks).

    He also runs an online private school (Pearblossom Private School, which only has math going up to Algebra II, though I don’t know if that is typical for home school curriculum).

  71. #71 Dr Benway
    September 29, 2009

    Good work, Chris.

    If zoster is going up at the same rate in countries that aren’t using the varicella vaccine, the speculation that the vaccine might be causing the increase falls flat.

    Medical Veritas conveniently allows us to apply the titmouse law to Dr. Goldman. Suddenly there aren’t so many articles supporting a vaccine-zoster link.

    I take back my convinced feeling of a few posts ago. I feel like a cheap date.

  72. #72 Chris
    September 29, 2009

    You’re welcome.

    I am a baby boomer. I was born in the peak year, 1957. I spent my youth being blamed for overcrowded schools, being an market force and other issues with being a statistical population blip. I don’t know why an increase of a disease associated with turning a certain age would be overlooked. It just seemed like a more obvious explanation.

  73. #73 Jen
    September 29, 2009

    “If zoster is going up at the same rate in countries that aren’t using the varicella vaccine, the speculation that the vaccine might be causing the increase falls flat.”

    Uh, not so fast. You’ll note in this article that chicken pox incidence declined significantly in Alberta prior to vaccine licensure.

    http://www.ncbi.nlm.nih.gov/pubmed/15964104?ordinalpos=7&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

    “…The incidence of chickenpox varied by age group and year and there was evidence of age-group-year interaction. Among those aged 5-19 years, chickenpox incidence began to decline prior to vaccine licensure in Canada. Among those aged less than one year and those aged 1-4 years, the incidence increased until 1999 when a decline began.”

    “CONCLUSION: Chickenpox rates began to decline prior to the introduction of the publicly funded vaccination program; however the declines in rates among the youngest age-groups are consistent with a vaccination program effect.”

    And a study from the UK:

    http://www.ncbi.nlm.nih.gov/pubmed/15383443?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

    CONCLUSION: General practitioner consultation rates for chickenpox are declining in Wales except in pre-school children.

  74. #74 Chris
    September 29, 2009

    So what? Alberta is right next to the the USA, and there is travel back and forth all the time. So fewer kids in Calgary were getting infected by their American cousins (my kids are the American cousins to kids in both British Columbia and Alberta, plus a family of three kids in the Netherlands).

    And the UK one said “except in pre-school children.” Big whoop.

    Still, it does not make Goldman’s work any better. Which I believe is fueled by some anti-vax sentiment. Especially since he ignored all the other countries (like Japan), and it is much too early. The vaccine has only been available in this country for fourteen years. Come back an about 36 years and see if there is a real increase in shingles.

    In the mean time, get a shingles vaccine.

  75. #75 Jen
    September 29, 2009

    “Still, it does not make Goldman’s work any better. Which I believe is fueled by some anti-vax sentiment. Especially since he ignored all the other countries (like Japan), and it is much too early.”

    I’m not sure what Goldman’s associations Medical Veritas have to do with anything, since he founded that organization after he left the CDC, (quite angrily, and rightfully so, I might add) in 2004.

    It is my understanding (and Goldman does address this) that varicella vaccination was never mandatory in Japan, and only about 20% of Japanese children were ever vaccinated, so there was likely lots of wild-type virus around to boost immunity, so if the theory is correct, an increase in shingles wouldn’t have been seen. Do you have data that show very high rates of varicella vaccination in Japan?

    Much too early? Get a shingles vaccine in the mean time? Can you tell me how many of those shingles vaccines I’m going to need in my lifetime to protect me? I am 36, so give me an estimate. Also, will my insurance cover the cost, since I am not in the age group that it is recommended for? Just curious.

    You really want to wait 36 years to find out if there is a real increase in shingles? I don’t. (I’m sure Merck would like for us all to wait, though.) I’ve seen what shingles can do in my many years of nursing. It is not pretty.

  76. #76 Chris
    September 29, 2009

    Goldman is still under qualified and the only voice with that message. So the only reply to his hypothesis is:

    Insufficient data.

    (by the way, all of my kids have had chicken pox, they are too old to have had the vaccine before it went through the kindergarten and preschool they were in… so they have longer to wait than you)

  77. #77 Chris
    September 29, 2009

    Interesting bit of reasoning. You want chicken pox to continue to infect young children, so you can avoid shingles? Never mind the several children who become seriously ill! Checking the CDC Pink Book table of cases and deaths for the year my kids all the chicken pox I see there were 115 deaths from chicken pox.

    Wow, just wow.

    Get the shingles vaccine.

  78. #78 Jen
    September 29, 2009

    “Interesting bit of reasoning. You want chicken pox to continue to infect young children, so you can avoid shingles?”

    Chris, I don’t want to see children sick any more than you do, which is precisely why I do not work in pediatrics.

    However, I do not feel that the benefits of mass varicella vaccination outweigh the risks. (That’s not the same as what you’re trying to imply–that I’m some heartless ghoul who delights in the misery of children for my own selfish benefit.)

    Since chicken pox can have more serious consequences in adolescents and adults, it would have made more sense to vaccinate this age group if they had not had the opportunity for exposure to the wild virus, rather than requiring it for every child. I believe that wild pox protects the “herd” far more effectively than any vaccine.

  79. #79 Chris
    September 29, 2009

    You are still going on too little information. And if you are going with Goldman, biased information. Right now all you have to do is look at this table you can see the numbers of cases have been cut to a third and the deaths are down to 15% of what they were in just ten years. Given enough time the numbers of shingles cases will also go down as the chance of getting chicken pox gets smaller and smaller, and so does the chance of having varicella living in the background.

    Plus little kids do get very sick with chicken pox (anecdote alert: when it went through our area at least one preschooler ended up in the hospital with a very real possibility of loosing his leg due to a severe secondary bacterial infection).

    And this is the bonus: they are now eligible to get shingles later!

    Woo hoo!… you will have a fellow shingles sufferer to commiserate with when you are 70. (oh shucks, there goes your attempt to not be perceived as a ghoul)

    Just get the shingles vaccine.

  80. #80 Chris
    September 29, 2009

    Here is a story about why waiting until a child is older is not a good idea: A Tragic Tale.

    Then there are these stories that include:

    Six of the eight deaths occurred among children and adolescents aged under 20 years.

    So while chickenpox is worse for older people, younger groups do suffer.

    Just get the shingles vaccine.

  81. #81 Jen
    September 29, 2009

    “Plus little kids do get very sick with chicken pox (anecdote alert: when it went through our area at least one preschooler ended up in the hospital with a very real possibility of loosing his leg due to a severe secondary bacterial infection).”

    Chris, no one is denying that children can suffer complications from chicken pox, although I always wonder how those cases were managed in the hours and days leading up to them. I’m sure you’re aware that NSAID (ibuprofen) use has been associated with an increased risk of bacterial infections, although it’s not conclusive just yet. (PubMed search: necrotizing fasciitis NSAIDS varicella) And as you well know, my disdain for antipyretic use is not news to anyone who reads this blog regularly.

    “Just get the shingles vaccine.”

    How nice for Merck, eh? They’re creating an epidemic of shingles by attempting to wipe out varicella, as well as ensuring that a vulnerable population will be dependent on their “solution” to the problem for many decades. Never mind that thousands will be ineligible to receive the vaccine, since you know, not everyone plans on becoming immune compromised and getting adequately vaccinated beforehand.

    Pardon me while I throw up.

  82. #82 Chris
    September 29, 2009

    Okay, don’t get the shingles vaccine.

    What epidemic of shingles? Documentation please (and make sure it is not by Goldman).

  83. #83 Jen
    September 29, 2009

    One more thing…if you’ll note the two articles I posted earlier today, wrt to a decline in chicken pox in countries who don’t utilize varicella vaccine, you’ll see that chicken pox is shifting to younger age groups, likely due to earlier school attendance and babies in daycare, which I fear means that we’ll be seeing shingles in younger age groups than what was previously observed as well. I’ve already heard some anecdotal reports of shingles in children here in the states, which was previously almost unheard of.

  84. #84 Chris
    September 29, 2009

    Oh, good grief.

    Younger kids should not get shingles if they get the varicella vaccine. They need to have had chickenpox in order to get shingles. There is a small chance that someone could get shingles from the vaccine version of the virus, but from one study it is one third the chance of getting actual chickenpox (see paragraphs after the one quoted below).

    One thing is if there is enough herd immunity to chickenpox, it will go away. Then you won’t have to worry about shingles.

    Jen, one cause of the virus coming back as shingles is stress. To avoid shingles, you should stay away from the websites that led you to Goldman’s work. I looked up “shingles epidemic”, and what I got mostly websites like whale.to and friends.

    Knowing the quality of “research” you used, I did some poking around and came up with a real review of the vaccination program, and its risks:

    A major concern since the beginning of the varicella vaccination program has been the impact of varicella vaccination on the incidence of HZ. Some studies suggested that exposure of individuals with latent wild-type VZV infection (as a result of natural infection) to individuals with varicella reduces the risk for HZ, presumably by externally boosting VZV immunity.71–76 The relative importance of boosting VZV immunity by exposure to exogenous virus versus endogenous reactivation is unknown. Nonetheless, mathematical models71,76 predict that by decreasing varicella exposures, the varicella vaccination program might increase the risk for HZ in the short- and medium-term (during the first 30–50 years of the vaccination program). In the long-term, as vaccinated cohorts age into older adulthood, the incidence of HZ is expected to decline to levels lower than in the prevaccine era because of the reduced tendency of vaccine virus strain, compared with wild-type virus, to reactivate.77,78 One model estimated that individuals who were aged 10 to 44 years at the introduction of the program will be most affected by not experiencing boosting from exposure to children with varicella.71 Their lifetime risk for HZ was projected to increase to greater than 50% compared with 33% in the prevaccine era.

    Now go get a nice cup of tea, and calm down. Stay away from places that upset you, especially where you hear those scary anecdotes.

  85. #85 Jen
    September 29, 2009

    “Younger kids should not get shingles if they get the varicella vaccine.”

    Reading comprehension FAIL.

    “They need to have had chickenpox in order to get shingles.”

    That’s what I said, Chris. The studies from Canada and the UK are noting an increase in chicken pox infections in younger age groups. Now, if you introduce a varicella vaccine in these countries, and wipe out exogenous boosting through wild pox exposure, what will happen to shingles rates? I predict more shingles in children.

    Of course, we’ll have to wait 36 or so years to know for sure, since it seems to take about that long for enough evidence to accumulate to convince some of you.

  86. #86 passionlessdrone
    September 29, 2009

    Hello friends –

    I had shingles when I was an early teenager, say around 14. (Can’t remember). This was about twenty and a few years ago. I never remember getting chicken pox, so it is likely I had it as an infant.

    Anyways, my question being, why do we need to wait 36 years for good data?

    - pD

  87. #87 Chris
    September 30, 2009

    Jen:

    That’s what I said, Chris. The studies from Canada and the UK are noting an increase in chicken pox infections in younger age groups

    And this is new? It is news to me, as I said my kids were kindergarten and younger. My six-month old baby got chickenpox from her three year old brother. It started in the three-year-old’s preschool, and then spread through the older child’s kindergarten.

    pD just said he got as an infant. What is younger than that?

    From the paper I referenced:

    The first dose is recommended routinely at age 12 to 15 months and the second at 4 to 6 years.

    So make sure they are vaccinated when they are a year old. Make sure the preschool your kid goes to enforces the vaccination requirements. Get the booster before kindergarten. Is that so difficult?

    Also, the first paper with the search words “shingles children” in pubmed.gov (at least today) is Incidence of Herpes Zoster Among Children Vaccinated With Varicella Vaccine in a Prepaid Health Care Plan in the United States, 2002-2008, which says:

    Children vaccinated after age 5 years had a higher but not statistically significant different rate than children vaccinated between 12 and 18 months (34.3 vs. 28.5 per 100,000 person-years). Among children vaccinated between 12 and 18 months, incidence rates gradually increased each year in the first 4 years after vaccination

    (remember these are kids who were only vaccinated once)

    And it concludes:

    These data demonstrate that diagnosed HZ is rare among children following varicella vaccine. Despite the small numbers, the roles of delayed vaccination, severe asthma, and development disorders warrant further investigation. In the future, analyses of HZ isolates will be needed to identify the virus strains causing reactivation.

    Now, do yourself a favor and try to prevent a reactivation of the virus. Relax, and stay away from those scaremongering websites.

  88. #88 Jen
    September 30, 2009

    “Now, do yourself a favor and try to prevent a reactivation of the virus. Relax, and stay away from those scaremongering websites.”

    Why Chris, I’m truly touched by your concern for my well-being.

    That said, nothing you have presented convinces me that mass varicella vaccination’s benefits outweigh the risks. Sorry.

    Really, you ought to be thanking me for warning you in advance of what is about to happen, so you can make sure to get your shingles vaccine ASAP, since you’ll soon be part of the group who will suffer the most serious adverse effects of shingles. ;)

  89. #89 Chris
    September 30, 2009

    You are making mountains out of molehills. Again, stay away from places like Age of Autism, NVIC, SafeMinds, InsideVaccines, NaturalNews, and similar ilk. It is not good for your stress level (plus they are all silly places).

    I am not particularly concerned, though I will inquire about the shingles vaccine during my next annual appointment with my doctor. Last week I got a flu shot, along with my kids: and we are all still fine.

    And yes, you are too young. When you are old enough, your questions should be answered. I had a thought: if you are afraid of getting shingles and don’t want anything by Merck, you could always go to Japan and get it from the original company that developed it. Just a thought.

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