Respectful Insolence

Vaccine injury and compensation

The comment thread for my post last week about how philosophical vaccine exemptions in California are endangering herd immunity is rapidly approaching 500 comments as I write this and may well surpass that number by the time this post “goes live” in the morning. I mention this because buried in the comment thread are a number of comments by our old “friend,” that anti-vaccine-sympathetic pediatrician to the stars, Dr. Jay Gordon doing what Dr. Jay does best and basically making a fool of himself on matters of vaccine science through his preference for anecdote over sound epidemiology and clinical trials, his utter insistence that his 30 years of clinical experience trump the aforementioned sound epidemiology and clinical trials (hint to Dr. Jay: they don’t), and going about his usual job of insisting that vaccines cause autism and that, despite his extreme distrust of vaccines, his advocacy of not vaccinating for some common childhood diseases because he imagines the vaccines to be more dangerous than th disease, and his consorting with leaders of the anti-vaccine movement like Jenny McCarthy, he really and truly is “not anti-vaccine.”

His denials fool no one, least of all me.

The reason I bring up Dr. Jay is because, round about comment #389 in the seemingly endless thread, Dr. Jay wrote:

Just tweeted: AND today’s brand new judicial decision must not be exaggerated to the detriment of calm discussion either: http://bit.ly/9kZFhm

Correlation does not prove causation even if I agree with this individual MMR decision. I just think that side-effect-denialists need to calm down, too.

I’ll give Dr. Jay credit for “talking the talk” when it comes to giving lip service to the mantra of “correlation does not necessarily equal causation,” but unfortunately he never seems to be able to “walk the walk” and stop asserting baldly that “vaccines cause autism” or likening vaccine manufacturers to tobacco companies. Leaving aside for the moment my intense desire, barely held in check, to mock Dr. Jay for his transparent and laughably inappropriate attempt to hijack the term “denialist” for the side of pseudoscience, an attempt so hilariously inapt that I really did laugh when I read it, it turns out that over the last couple of days Dr. Jay is not alone in seemingly wanting to rub my nose in this particular decision, which was reported in the U.K.’s The Daily Mail over the weekend. Basically, it is the story of a young man named Robert Fletcher in the U.K. who is severely disabled and has been awarded £90,000 in compensation by the governement’s Vaccine Damage Payment Unit for having been injured by the MMR vaccine back in the early 1990s.

Before I discuss the case in more detail, I’m going to say something that may surprise some who read here. I don’t have much a problem with this ruling. Not really. In fact, the main problem I have with this ruling is not that it was made, but rather that it took so damned long to make it and the payout was paltry. You see, Dr. Jay is laying down what I like to refer to as a steamy, drippy turd of an argument when he claims that there is a such thing as a “vaccine injury denialist.” None of us who make it our business to refute the pseudoscience claiming that vaccines cause autism deny that vaccines can on occasion cause actual injury. Rather, what we argue, based on good science and strong clinical trials data, is that such injuries are rare and that they do not include among them autism, asthma, and the veritable panoply of various conditions that anti-vaccine zealots claim to be due to “vaccine injury.”

Not that science has any persuasive effect on anti-vaccine zealots and their fellow travellers (like Dr. Jay), who would have you believe that being vaccinated is extremely dangerous and that it causes all sorts of problems, the worst of which is autism. As I’ve discussed on this blog hundreds of times over the last five years, sometimes in utterly nauseating (to some) detail, neither vaccines nor their various components, have been linked to autism. They just haven’t, and it’s not as though a link hasn’t been sought by real scientists and physicians in multiple large epidemiological studies over the last dozen years. Researchers have looked for such a link and haven’t found it. More than a decade later, there is still no credible scientific or clinical evidence (and Wakefield’s or Hewitson’s execrable “science” doesn’t count) that vaccines cause or are correlated with autism and a lot of credible evidence that they are not, Dr. Jay’s confident pontifications notwithstanding.

However, there can be (and are) vaccine reactions. No one is denying that. And because vaccination is in essence a social pact, in which by vaccinating we all take an infinitesimally small risk for a very large benefit, when a child suffers an adverse reaction there should be compensation. Indeed, that’s just what we have here in the U.S. with the Vaccine Court, which I’ve written about many times before. As I’ve pointed out (for example, here), because of rising litigation that jeopardized the vaccine program and threatened to drive pharmaceutical companies out of the vaccine business, Congress passed the National Childhood Vaccine Injury Act of 1986 (Public Law 99-660), which created the National Vaccine Injury Compensation Program (VICP). The idea was to create an alternative to the tort system through which people injured by vaccines could be quickly compensated through what is in essence a no-fault system. True, litigants claiming vaccine injury, if denied compensation by the Vaccine Court, can still sue in conventional courts, but all claims for compensation for vaccine injury in the U.S. must first go through the VICP and the Vaccine Court. In addition, the standards of evidence in the Vaccine Court of the VICP are arguably lower than what would be required to obtain compensation through conventional federal courts. For example, in the Vaccine Court the Daubert rules for the admission of scientific testimony from expert witnesses do not apply. Virtually all scientific testimony is allowed, which is, by the way, how such awful testimony was allowed in the Autism Omnibus test cases on behalf of the complainants.

Further streamlining of the system occurred in 2005, when the United States Court of Appeals for the Federal Circuit ruled that an award should be granted if a petitioner either establishes that a “Table Injury” of injuries that are generally accepted as potentially being caused by vaccines) occurred or proves “causation in fact” by proving the following three prongs:

  • a medical hypothesis causally connecting the vaccination and the injury;
  • a logical sequence of cause and effect showing that the vaccination was the reason for the injury; and
  • a showing of a proximate temporal relationship between vaccination and injury.

Compensation is virtually automatic for so-called “table injuries” (i.e., known injuries that science attributed to vaccines listed on the Vaccine Injury Table) within the correct time frame. Also, compensation can be awarded if plaintiffs can meet a standard of evidence showing a 51% or greater chance that the plaintiff was injured by the vaccine in question. Indeed, as one lawyer who represents cases in front of the vaccine court put it:

“There is a difference between scientific proof and legal proof,” Conway said. “One is 95 percent certainty, and the other is . . . 50 percent and a feather.”

In other words, the award of compensation does not mean that a scientific link was found, only that a court of law thinks it more likely than not that a specific set of health problems is due to vaccine injury, no more, no less. A legal finding of causation does not necessarily imply a scientific finding of causation, no matter how much anti-vaccine activists trumpet rulings compensating children for vaccine injury as vindication of their pseudoscientific views that vaccines cause autism. Indeed, this ruling doesn’t even “prove” that MMR can cause brain damage, a contentious scientific question whose answer is not at all clear.

Finally, the VICP will reimburse plaintiffs for legal fees and court costs even if they lose in Vaccine Court. Indeed, certain unscrupulous lawyers (cough, cough, Clifford Shoemaker) have taken advantage of this feature of the Vaccine Court and racked up some very impressive billings representing complainants in front of the Vaccine Court. In other words, here in the U.S. at least, as little as the anti-vaccine movement believes it and would prefer to believe a conspiracy theorist view in which they are the downtrodden speakers of truth to power beaten down by The Man, the entire system bends over backwards to give complainants the benefit of the doubt. That the complainants for the test cases for the Autism Omnibus could not prevail, even in the relatively friendly venue of the Vaccine Court, should be evidence enough of just how weak their cases were, particularly given that the test cases were presumably the strongest cases the Omnibus lawyers could come up with. That point was driven home recently when the appeal for the first test case, that of a child named Michelle Cedillo, to the Federal Circuit Court, was denied, a ruling that was not unexpected and in which I take no pleasure but that was completely appropriate.

Now back to Robert Fletcher’s unfortunate case. As his mother told The Daily Mail:

Robert is nearly 19 but mentally he is like a 14-month-old toddler. He can’t stand unaided and he is doubly incontinent.

‘He can’t speak except to say “Hi, Mum” or “Hi, Daddy”.

‘We chop up his food and have to anticipate all his needs. He is prone to various illnesses and last week suffered around 40 severe epileptic seizures.

‘In April this year, we thought we’d lost him. He contracted a chest infection and had to go to hospital for several days.

‘He is such a lovely boy. When he’s not ill, he’s so cheerful and seems to take everything on the chin. In between seizures he says “Hi, Mum” and tries to kiss me.

My heart goes out to the Fletchers; it must be incredibly trying to have to deal with such a set of disabilities day in and day out. Moreover, I have no problem with the government finding legal causation. It’s almost irrelevant if on a strictly scientific basis the MMR vaccine caused Robert’s condition. There’s enough of an appearance that it did that, on a legal grounds and a societal basis, he should be given the benefit of the doubt and compensated. In fact, I agree with Mike Stanton that compensation took far too long and that the amount awarded was far too little. Mike makes a rather fascinating comparison between the U.K.’s vaccine compensation system and that of the U.S. The results are not favorable to the U.K.:

Again, the contrast with the USA could not be greater. Statistics about vaccine claims, verdicts and compensation paid are readily available on government websites. The UK government admitted to paying £3.5 million in compensation over the previous 8 years in 2005. The USA has paid out nearly $2 billion to 2,472 claimants over the past 21 years. They meet the legal costs of all claims whether upheld or not. The American Way seems to be to admit that vaccine injuries are a rare but unfortunate occurrence and to make the no fault compensation programme as transparent and user friendly as possible. By contrast the UK government is secretive, mean spirited and places obstacles in the path of potential claimants in a misguided attempt to bolster the vaccination programme. But insisting that vaccines are safe rather than being honest about the risks and benefits has not led to greater vaccine take up. On the contrary, whenever the government dismisses people’s fears instead of taking them seriously its “we know best” attitude merely reinforces people’s doubts.

Of course, the cost of the American system is widespread abuse by certain lawyers, who know they’ll be paid, win or lose. To me that is an acceptable price to pay to make the compensation system fair and relatively fast. True, some lawyers are not satistified because they can’t ever expect the truly large “lottery jackpot”-sort of pay-off from a Vaccine Court ruling. That’s the reason why some of them are arguing that the pre-emption of regular courts in vaccine cases by the Vaccine Court is unconstitutional.

Mike also makes a rather provocative observation that, had Jackie Fletcher been compensated in a timely fashion back in the 1990s, perhaps Andrew Wakefield would not have found such fertile ground for his anti-vaccine pseudoscience. Remember, Jackie Fletcher is the woman who formed JABS, which is in essence the British version of the NVIC or Generation Rescue. Whether this is true or not is, of course, impossible to say. Alternate history scenarios are fun to argue but impossible to prove one way or the other. It does, however, appear undeniable to me that the British system is neither fair nor transparent, and that can’t help but decrease confidence in the vaccination system, regardless of how safe vaccines are. After all, only 100% safety, which is unachievable for any intervention, would guarantee that there will not be the occasional child who suffers an injury due to vaccination. Like both Mike Stanton and Kev Leitch, I believe that such children deserve prompt, fair compensation.

Predictably, the anti-vaccine movement is crowing over this ruling, citing it as vindication. The anti-vaccine crank propaganda blog Age of Autism, for instance, has two stories up already, one entitled UK Vaccine Injury Win: MMR Caused Brain Damage and Vaccine Injury: The Fletchers and Cedillos – a Tale of Two Families. In one of these posts, Teresa Conrick struggles mightily to try to argue that, really and truly, the Fletcher decision means that vaccines cause autism after all:

Jacki and John Fletcher are warrior parents who have persevered in their care and legal case for Robert, now 18 years old. Jackie, in a recent email to Anne Dachel, here at Age of Autism, revealed that Robert suffers from a severe seizure disorder, with an inflamed oesophagus, brain damage and has some minor autistic traits. The award stressed epilepsy as the result of his injury. That is great news but for the thousands still waiting with children and teens also injured by the MMR, the lack of the word, “autism”, is baffling. Welcome UK parents, to our world, too. Here in the states, we also have heard those words, “but not autism.”

Whether it is severe autism or minor autism, isn’t “autism” a set of behaviors?

Uh, no. Nice try, though.

Of course, Autism is more than just a “set of behaviors,” but even if autism were nothing more than a set of behaviors I would retort that, for example, ADHD is a “set of behaviors” too, but that does not mean ADHD is the same thing as autism. Ditto any number of neurodevelopmental disorders. Claiming that the rare neurologic injuries that can be caused by vaccines are “the same thing” as autism based on such an argument is specious reasoning at best, disingenuous at worst. Still, such posts are revealing. Age of Autism claims that it is all about “autism advocacy,” but in the end its merry band of propagandists are all about the vaccines, and so are its readers. They are anti-vaccine to the core. To them, autism is “vaccine injury,” and that’s it. No amount of science will convince them otherwise.

Injuries and complications that can be scientifically shown to be due to vaccines deserve compensation that is prompt, fair, and not onerous to obtain, even at the cost of letting sleazy lawyers take advantage of the system. Meanwhile, scientists should (and, the pharma conspiracy mongering of the anti-vaccine movement notwithstanding, do) work to make vaccines as safe as possible, so that such injuries are as rare as possible. Unfortunately, there will likely never be such a thing as a vaccine that is 100% absolutely safe; all that can be reasonably requested are vaccines whose benefits and safety far exceed a tiny risk of complications and a system that compensates those injuries. Although the ethical issue of how much risk is acceptable and what frequency of vaccine injuries are tolerable in the vaccination program is complex and difficult, we should not lose site of the fact that vaccines do far more than good.

Comments

  1. #1 MI Dawn
    September 1, 2010

    I find it very telling that the UK Vaccine Court stressed that Robert has epilepsy and moderate mental retardation but his mother and AOA just HAVE to say he is autistic. After all, unless they can link the MMR to autism, where would they be?

    I’m glad the Fletchers were compensated for what appears to be a possible vaccine injury from the information I have read. It shows the systems for compensation do work.

    On the other hand, I also feel sorry for the Cedillos. They can’t face the truth, that vaccines did not cause Michelle’s problems even to the extent that the UK court recognized the possible connection between Robert’s MMR and start of seizures.

  2. #2 Todd W.
    September 1, 2010

    First off, I have to second your condolences to the Fletchers and say that it’s about time they received compensation.

    Your explanation on how the compensation program works was very well-written and hopefully will clear up some of the misunderstanding that people have about it.

    Leaving aside the moment my intense desire, barely held in check, to mock Dr. Jay for his transparent and laughably inappropriate attempt to appropriate the term “denialist” for the side of pseudoscience

    Indeed. I’m still trying to get Dr. Jay’s definition of a “vaccine side effect denialist” and some concrete examples of such behavior, since he claimed that it occurs here at RI. Since he probably won’t bother to comment in the other thread, instead focusing his attention here, I’ll copy my questions for him, including a couple regarding his claim that he only vaccinates for HiB individuals that are at “highest risk”.

    So, Dr. Jay:

    * What is your definition of a “vaccine side effect denialist” (VSED)?
    * You say that VSEDs exist here at RI. Please provide a concrete example of VSED behavior.
    * What is your definition of “those at highest risk”?
    * Am I correct that your recommendation is that except for people who meet that definition, everyone else should not bother with the vaccine?

  3. #3 Marianne
    September 1, 2010

    Brilliant post.

    It is a sad fact that anti-vax is simply a faith position, supported by parents and some doctors alike, and the evidence will never change that.

    The target of blame has constantly shifted during its course of existence, from the vaccine itself to the ingredients in the vehicles, to the schedule and ‘overload’, I don’t know what the next ’cause’ will be. But there will be a new one, as the others are ticked off as officially not statistically harmful.

    A few people come up with the ‘theories’, they spread to receptive minds and are regurgitated and propagated.

    It’s just another meme that won’t end and is sadly causing a lot of real damage to innocent people. I cannot believe the amount of ‘measles is harmless’ talk I’ve observed lately, it’s truly shocking.

  4. #4 Todd W.
    September 1, 2010

    One thing that I just cannot comprehend is why people like Barbara Loe Fisher (who helped establish the compensation program in the U.S.) want to get rid of the compensation program and vaccine court. They actually want to make it more difficult for families to win claims and receive compensation, thanks to the higher standards of evidence required in the tort system!

    Ah. A thought just occurred to me. It’s not that they want to make it harder; that’s just an unfortunate side effect. They want to be able to go directly after the vaccine manufacturers. The stupid thing is that families can still do this! Yes, they need to go through the VICP first, but they can choose to reject the ruling and try their luck in the tort system.

    So I’m still at a loss as to what the hell BLF and those like her hope to accomplish by dismantling the VICP.

  5. #5 MikeMa
    September 1, 2010

    @Todd

    I’m still at a loss as to what the hell BLF and those like her hope to accomplish

    Notoriety? The idea that they are doing something? If the likes of BLF and AoA were to accept the status quo, their funding would dry up pretty quick.

  6. #6 a-non
    September 1, 2010

    I wonder if the thinking is that the potential payout for bringing down a vaccine manufacturer is far greater than what you can reasonably expect to get from the VICP. And the publicity of a jury trial (even one where you lose) is catnip to the AoA and NVIC folks and would keep them flush with donations for years to come.

    But for the parents of kids who could reasonably be compensated via the government program, they are far, far better served to stay in the VICP.

  7. #7 René Najera
    September 1, 2010

    So I’m still at a loss as to what the hell BLF and those like her hope to accomplish by dismantling the VICP.

    I’m picturing Batman interrogating the Joker (played by Barb Loe Fischer), asking, “What do you want, Joker?”
    Yes, what does BLF want? Has she said exactly what she wants, beside the anti-vaccine talking points?

  8. #8 Pablo
    September 1, 2010

    I’m still trying to get Dr. Jay’s definition of a “vaccine side effect denialist”

    Mike (and Orac)

    Don’t play this game. We all know damn well what Elmer Jay Fudd (“I own a mansion and a yacht”} means when he says “vaccine side effect denialist.” He’s not talking about the extensive list of vaccine side effects that are known for vaccines, that are provided by the manufacturer and given to parents or whoever when vaccines are given, along with how often they are found to occur and what to do about them when they occur.

    No, he is talking about autism, and his insistence that, despite all the scientific evidence to the contrary, one of the side effects of vaccines is autism, which he knows, because, damn it, he’s seen it. And anyone who disagrees with him must be in denial, because he knows, and who is anyone to doubt his wonderful analytical skills?

    We all know that’s what he means, so stop playing with him. Apparently, he spends so much time around kids that he is acting like them. Next week he’ll be calling Orac “Fatty Fatty Two-by-Four” and Todd will be “4-Eyed Brainiac,” although he will probably dismiss this comment with “I know you are but what am I?”

  9. #9 Pablo
    September 1, 2010

    (and yes, I recognize the irony of me calling him Elmer Jay Fudd)

  10. #10 Scott
    September 1, 2010

    his utter insistence that his 30 years of clinical experience trump the aforementioned sound epidemiology and clinical trials (hint to Dr. Jay: they don’t)

    That’s not even the half of it. He also insists that HIS clinical experience trumps the collective clinical experience of all the other pediatricians in the US.

    Truly, he seems to consider himself perfect and utterly infallible.

  11. #11 Mu
    September 1, 2010

    One caveat to the “paltry pay-out”, the UK has free health care, so the large chunk of “future medical expenses” that are awarded in the US does not apply.

  12. #12 Todd W.
    September 1, 2010

    @Pablo

    I realize that he probably means denying autism as a side effect, but I want him to provide his definition so that we have something for posterity.

    Oh, and those interested in BLF’s take on the VICP, here’s her statement to the Advisory Commission on Childhood Vaccines from 2008.

  13. #13 Science Mom
    September 1, 2010

    So by the anti-vax groups metric, all awards for vaccine injury PROVE that vaccines cause autism and denials of claims are vast government conspiracies. Got it.

    So I’m still at a loss as to what the hell BLF and those like her hope to accomplish by dismantling the VICP.

    @ Todd, let’s think about why the NVICP was instituted to begin with, with the insistence of BLF, no less. BLF wanted easier compensation for those injured or, at least, presumed to be injured by vaccines (fair enough) and the government could not afford to let Pharma get sued out of the vaccine business.

    I get the distinct impression that claimants, particularly those involved with the OAP, expected to walk in, offer some testimony and collect their checks. That didn’t happen and now BLF is calling for the NVICP’s head on a chopping block. If that were to happen, manufacturers would be faced with mountains of lawsuits and driven away from the vaccine biz; just what BLF and her band of merry fools would like to see. Even if it would come at the expense of vaccine-injured people. I doubt it is anything more than vindictiveness and certainly myopic on the part of the anti-vaxxers.

  14. #14 Scott
    September 1, 2010

    So I’m still at a loss as to what the hell BLF and those like her hope to accomplish by dismantling the VICP.

    My suspicion is that they want to put all vaccine manufacturers out of business permanently. They can’t get damages big enough to do that via the VICP.

  15. #15 Militant Agnostic
    September 1, 2010

    his utter insistence that his 30 years of clinical experience trump the aforementioned sound epidemiology and clinical trials (hint to Dr. Jay: they don’t)

    Jay’s assumption that he is so much smarter than the Scientific Consensus is exactly like the climate change denialists. He is of course oblivious to the irony of calling us denialists.

  16. #16 D. C. Sessions
    September 1, 2010

    What is your definition of “those at highest risk”?

    His patients.

  17. #17 augustine
    September 1, 2010

    [Science Momma: I get the distinct impression that claimants, particularly those involved with the OAP, expected to walk in, offer some testimony and collect their checks.That didn't happen and now BLF is calling for the NVICP's head on a chopping block.]

    Respectful insolence is a place where you get to check your critical thinking skills at the door and use whatever emotional logic you wish. While at the same time selectively championing critical thinking and science. It’s hypocritical of the self proclaimed defenders of logic and science. But I understand how easy it is to rationalize why you do it.

    It’s tough to stick to just logic, evidence, and science isn’t it, momma?

  18. #18 Kristen
    September 1, 2010

    I find it very sad that they are taking this young man and using him as a tool. Even most of us with autistic children cannot even begin to imagine how difficult life must be for his parents. We deal with plenty, but my heart goes out to this family and their struggles.

    That having been said: These people (anti-vaxers) are bottom-feeding slugs of the worst kind! They will minimize the real problems this family deals with to further their agenda. He doesn’t have autism, he has very real problems which likely have been caused by vaccines and his parents have been compensated (not nearly enough IMHO (and dear lord, why did it have to take so long?)). This proves that vaccines can cause serious injury; it doesn’t prove that vaccines cause every problem the anti-vaxers imagine they do.

    This case has proved that: 1.) vaccines have risks of serious adverse effects (no surprise to anyone here) and 2.) that parents who’s child has been so injured should be compensated quickly and with as little mental anguish as possible.

    Robert’s parents obviously love him very much and I wish them well as they continue to care for his many needs.

  19. #19 Science Mom
    September 1, 2010

    Poor Augie, trying to school me on critical thinking skills, particularly when you run screaming like a little girl from information you’re too dim to even attempt to refute. From BLF’s statement that Todd linked to:

    We were assured that, unlike a lawsuit in civil court, the federal compensation system would be based on the presumption that a vaccine or combination of vaccines caused the child’s injury or death if no other demonstrated cause could be found. The emphasis was on presumption and there was recognition that this presumption, in the absence of scientific data and certainty, would be in the plaintiff’s favor even if that presumption would result in some children being compensated who were not, in fact, vaccine injured.

    The emphasis on presumption was integral to the integrity of a no-fault, expedited vaccine injury compensation system. There continues to be a lack of scientific understanding of the specific biological mechanisms involved in most vaccine-associated injuries and deaths and an absence of pathological profiles to conclusively prove which health problems following vaccination are, in fact, vaccine-induced and which are not. These gaps in scientific knowledge and uncertainty means that a no-fault vaccine injury compensation system must err on the side of presumption of causation rather than proof of causation to offer a viable administrative alternative to a lawsuit.

    And both Justice and U.S. Court of Claims officials can refrain from trying to discredit and destroy the reputations of plaintiff’s expert witnesses in what is perceived by parents as an attempt to frighten and discourage doctors from testifying on behalf of vaccine injured children.

    And from AoA’s post:

    Her lawyers advanced scientific and legal arguments that the combination of her mercury-containing and live virus vaccines substantially contributed to her life-threatening medical conditions. In EBCALA’s view, Cedillo met the required standard of “more likely than not.”

    EBCALA has grave concerns regarding a legal process that permitted the admission of critical evidence by the government at the last minute, not only foreclosing Cedillo’s opportunity to challenge it, but unfairly precluding any inquiry into how the Department of Justice obtained the critical piece of evidence in the first place. The court’s failure to inquire into this area raises serious questions regarding the due process and fair play of the VICP. Adding to EBCALA’s concern was the Special Master’s insufficient analysis of Cedillo’s scientific biopsy results. A recent study by leading United States researchers – that the Court of Federal Claims elected not to admit – found no basis to question the reliability of the laboratory results, contrary to the government’s position and the OAP’s finding.

    And this is utter bullshit as evidenced by their amicus brief and subsequent decision by the Federal Circuit court. So what part of “I get the distinct impression”, do you have difficulty with little augie? Are you aware that ‘distinct impressions’ can be qualified with what I posted above or do you believe that they are to be qualified with double-blind RCTs?

    We can also add misogynistic arsehole to your battery of bigotry fuckwit.

  20. #20 symball
    September 1, 2010

    just a note on the judgement here- although I don’t begrudge jackie fletcher her money, this was not a cut and dried case. there were three members of the panel that voted on this, one barrister, and two physicians, one retired for several years. the physician who is still working voted against the award. all three agreed that this certainly was not autism.

    It is also worth reminding ourselves that even if the vaccine had caused a spike in body temperature that caused a febrile convulsion that triggered the epilepsy and neurological damage, the risk of febrile convulsion is far greater with measles than with a vaccine side effect. It is still more dangerous to not vaccinate, even if you might be predisposed to this type of fit.

  21. #21 augustine
    September 1, 2010

    [Science Momma: We can also add misogynistic arsehole to your battery of bigotry fuckwit.]

    In your personal opinion, how many kids died from measles before the vaccine?

  22. #22 moderation
    September 1, 2010

    I am not sure why you all spend so much time engaging Dr. Jay Gordon. His opinions are so far afield … as to be considered embarassing by his peers, the AAP and even residents who train at his hospital.

    In my opinion his practice is a money grab at those parents who fear vaccination and are looking for someone with the titles of authority to tell them “It’s OK. Your fears are well founded”. I am well aware that making a lot of money does not invalidate someone’s point of view, but I do wonder how much Dr. Jay is raking in. This seems a valid point, since the anti-vaccine community makes such a BIG point of Dr. Paul Offit’s profiting off the rotovirus vaccine.

  23. #23 HereWeGoAJen
    September 1, 2010

    I’ve been writing about vaccines lately on my blog because I am astounded at some of the misinformation that is out there.

  24. #24 Paul Browne
    September 1, 2010

    Symball “this was not a cut and dried case. there were three members of the panel that voted on this, one barrister, and two physicians, one retired for several years. the physician who is still working voted against the award. all three agreed that this certainly was not autism.”

    It’s even less cut and dried than that, one of the 3 members of the panel, pediatrician Professor Sundara Lingam, disagreed with the conclusion reached by the other two and is quoted by the Daily Fail as saying that he believed Robert was ‘genetically predisposed to epilepsy and that the vaccination triggered it rather than caused it.’ and that ‘Robert would have developed epilepsy in any event, even if he had not had the vaccination’.

    http://www.dailymail.co.uk/news/article-1307095/Family-win-18-year-fight-MMR-damage-son–90-000-payout-concerns-vaccine-surfaced.html

    So it’s clear that the evidence for causality was very weak, though it probably would have been enough to qualify for compensation under the 50% and a feather requirements of the US vaccine court.

    Orac is right that this should have been settled years ago, now it will just be used as propaganda by the anti-vaxers wo know that a lot of people have only a vague grasp of the science involved.

    A bad day for public health!

  25. #25 Pablo
    September 1, 2010

    I am not sure why you all spend so much time engaging Dr. Jay Gordon.

    I would qualify that: I’m not sure why they all spend so much time engaging Jay Gordon _seriously_.

    I engage him with all the seriousness that he deserves, meaning like a piece of rat turd that shouldn’t be taken seriously at all.

    I like to engage the Blue Jay with snide cracks and childish insults, because, ultimately, despite the grandstanding language he uses, that is the same level of discourse that he uses. He has nothing useful to contribute.

    Some people still treat him like he is well-meaning and acting in good faith. I abandoned any such pretense long ago. I consider the guy to be comedic relief more than anything else. Relevant? Not in terms of any serious discussion, no.

  26. #26 Dangerous Bacon
    September 1, 2010

    I agree that a decision regarding compensation in the Fletcher case should have been handed down far, far more quickly.

    It’s not clear from Orac’s presentation or the Daily Mail article on just what basis it was decided that the MMR shot triggered the seizure disorder. The Daily Mail story states that the child’s first seizure occurred ten days after the vaccination and that this was considered a solid temporal link. Was there a marked febrile response to the shot? Was there still significant fever at the time the first seizure occurred?

    On the larger issue of the link between fever and febrile seizures in children (and the small risk that the occurrence of “complex” febrile seizure will predispose the child to a chronic seizure disorder), are antivaxers convinced that a potential fever spike due to a vaccine is a horrible risk that should not be tolerated, but “natural” fever spikes due to disease are benevolent?

  27. #27 jay.sweet
    September 1, 2010

    Well that was just depressing. One of the worst parts about being a parent is that now these types of stories, instead of just being vaguely sad but easy to shrug off as a fact of life, now they scare the shit out of me. heh….

    One of the most pro-vaccine people I know has it written on her medical records in big red ink that she is never to be given a pertussis vaccine, because she had a pretty severe reaction to the DTAP (or whatever combo vaccine they gave in the early 80s) as a child. Bad fever, I can’t recall what all else. Obviously she recovered, but it was severe enough to result in the explicit warning in her records.

    These things happen. And for those who truly understand the risks and benefits in play, the fact that these things happen ought to make people even angrier towards those who forgo vaccination for ideological or fear-based reasons — my friend is now dependent on everybody else to get the pertussis vaccine, since she cannot safely get immunized against it!

  28. #28 jay.sweet
    September 1, 2010

    Re: Paul Browne and Dangerous Bacon’s comments… yeah, to be honest I was hoping to see a bit more discussion of the science involved in the case. For one thing, it’s just interesting on its own. For another, engaging the abstract reasoning part of my brain distracts from how freaking depressing the reality of the Fletcher’s situation is.

    So it sounds like he probably would have manifested the epileptic symptoms whenever he eventually got a reasonably high fever? Is that what we are looking at?

  29. #29 ebohlman
    September 1, 2010

    jay.sweet: If she got a pertussis vaccine in the early 80s, it would have been the DTP with whole-cell pertussis. That vaccine is no longer used, and the DTaP (acellular pertussis) has a much better safety record (IIRC, about half the total payouts the NVICP has issued were for injuries associated with the whole-cell pertussis vaccine).

  30. #30 Paul Browne
    September 1, 2010

    jay.sweet”So it sounds like he probably would have manifested the epileptic symptoms whenever he eventually got a reasonably high fever? Is that what we are looking at?”

    That’s the most likely explanation, there have been cases like this before, for example the Hannah Poling case a couple of years ago that Orac discussed at length http://scienceblogs.com/insolence/2008/03/the_hannah_poling_case_and_the_rebrandin.php

    It’s worth noting that since the Hannah Poling case the vaccine court found in the three Autism Omnibus test cases that vaccines did not cause autism.

    http://www.theness.com/neurologicablog/?p=478
    http://scienceblogs.com/insolence/2009/02/will_2009_be_a_very_bad_year_for_antivac.php

  31. #31 dt
    September 1, 2010

    Re the science behind the Fletcher case – there is no formal report published about the tribunal’s findings. The 2 doctors disagreed about the issue of causality. The one who thought vaccine caused the damage seems to be a retired Peadiatric urology surgeon. Hardly confidence-inspiring.

    @Dangerousbacon #25:
    The critical time post MMR vaccination for vaccine-induced convulsions is actually around the 10 day mark, so this would fit with the boy’s case.
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC320893/

    The point that measles would lead to (in a susceptible child) a far likelier outcome of febrile seizures and possible neurological damage that with just vaccine alone is very apposite.

  32. #32 augustine
    September 1, 2010

    [science momma:So what part of "I get the distinct impression", do you have difficulty with little augie? Are you aware that 'distinct impressions' can be qualified with what I posted above or do you believe that they are to be qualified with double-blind RCTs?]

    “I get the distinct impression” is your disclaimer for “here comes conclusions based in logical error and bias.

  33. #33 Dangerous Bacon
    September 1, 2010

    Thanks, dt. That’s useful information. And to quote from the linked commentary:

    “The serious effects of the illness against which these vaccines protect are well documented and measurable. Encephalitis and resulting encephalopathies from many of the diseases themselves are prevented in as many children (perhaps more) as incur febrile seizures (a relatively benign outcome in the long run) following vaccination. Immunization for pertussis was terminated in Sweden in 1979. Over a 2-year period, over 2000 children were hospitalized with pertussis. Four percent suffered neurologic complications, and three died 4. A serious acute encephalitis caused by measles can occur in approximately 1 out of 1000 cases, and subacute sclerosing panencephalitis, a typically fatal complication of measles, occurs in approximately 1 in 1,000,000 cases. Such occurrences appear to be prevented through vaccination. “

  34. #34 Jake Crosby
    September 1, 2010

    “No amount of science will convince them otherwise.”

    Because no actual science says otherwise.

  35. #35 Orange Lantern
    September 1, 2010

    Thank you, Jake, for exemplifying Orac’s point.

  36. #36 Orac
    September 1, 2010

    It is rather amazing how rapidly and well Jake demonstrates my points for me. I almost wonder if I should thank him.

    In any case, with school starting up again, for his sake I sincerely hope that he doesn’t use the same sorts of research skills to write his term papers as he does to write his AoA screeds.

  37. #37 dcotler
    September 1, 2010

    Fans of Dr Jay might want to ask him why he has declined to meet the Maintenance of Certificate requirements of the American Board or Pediatrics. The ABP recommends that Pediatricians certified before 1988, although granted lifetime certification, periodically demonstrate their competence. Dr Jay has not seen fit to do this. He relies on his original certification from 1981. His expertise, if any, is thirty years out of date.

    https://www.abp.org/MOCVerification/jsp/Search.faces

  38. #38 Sid Offit
    September 1, 2010

    I’m glad the Fletchers were compensated for what appears to be a possible vaccine injury from the information I have read. It shows the systems for compensation do work.
    —————————–
    90K pounds – 135K USA dollars is hardly compensation

  39. #39 Composer99
    September 1, 2010

    Several months ago, I would have said ‘I get the distinct impression that augustine is an idiot’.

    After several months of reading his tripe, I can safely conclude based on the available evidence that he is a **Anglo-Saxon epithet** idiot.

  40. #40 Mephistopheles O'Brien
    September 1, 2010

    Sid – I would tend to agree, but perhaps standards and conditions are different in the UK than in the USA.

  41. #41 MikeMa
    September 1, 2010

    Mephistopheles & Sid,
    There is also the universal healthcare available in the UK. As was mentioned earlier, this provides a much higher base onto which the 90k is applied.

  42. #42 Mephistopheles O'Brien
    September 1, 2010

    MikeMa – that, indeed, was one of those conditions I was thinking of. Thanks.

  43. #43 Enkidu
    September 1, 2010

    “are antivaxers convinced that a potential fever spike due to a vaccine is a horrible risk that should not be tolerated, but “natural” fever spikes due to disease are benevolent?”

    A lot of anti-vaxers don’t believe that they will ever contract the disease. And even if by some “luck” they do happen to catch it, they believe that their immune systems are superior and will fight it off no problem.

    Of course, I once had an anti-vaxer tell me that the fevers associated with vaccines are caused by “chemicals processing through the brain.” (I’m assuming she meant chemicals added to vaccines… you know, the dreaded toxins? I never got clarification on that) So I guess in her eyes, fevers from vaccines are way different and more evil/damaging than fevers from disease.

  44. #44 Science Mom
    September 1, 2010

    “I get the distinct impression” is your disclaimer for “here comes conclusions based in logical error and bias.

    Impression =/= conclusion. Gah you’re an idiot augie. And that is a foregone, well-qualified conclusion, courtesy of your own tripe.

    @ Composer, well said.

  45. #45 Todd W.
    September 1, 2010

    @Science Mom

    Y’know, I keep trying to think how best to parody augie, but it parodies itself so well, I don’t think I could top it.

  46. #46 augustine
    September 1, 2010

    [enkidu: A lot of anti-vaxers don't believe that they will ever contract the disease. And even if by some "luck" they do happen to catch it, they believe that their immune systems are superior and will fight it off no problem.]

    I’m not an anti-vaxxer but when you say “superior” what do you mean? Superior to what?

    [So I guess in her eyes, fevers from vaccines are way different and more evil/damaging than fevers from disease.]

    child gets vaccinated. child goes into convulsions. Pro forced vaccine propagandist masquerading as science defender: “Good thing you got that seizure. Could you imagine what real chicken pox would have done to you? That vaccine just saved your life. The seizure is still not as bad as the risk (not actually getting but the “risk”) of getting real chickenpox. Therefore the benefit still outweighs the risks! Viva la vaccine! Viva la vaccine! Viva la vaccine!

  47. #47 Matthew Cline
    September 1, 2010

    We were assured that, unlike a lawsuit in civil court, the federal compensation system would be based on the presumption that a vaccine or combination of vaccines caused the child’s injury or death if no other demonstrated cause could be found.

    They thought that Vaccine Court would be “guilty until proven innocent”? I wonder what gave them that impression.

    @Scott:

    That’s not even the half of it. He also insists that HIS clinical experience trumps the collective clinical experience of all the other pediatricians in the US.

    Actually, I get the impression that he thinks that all the other pediatrician agree with him.

  48. #48 Thomas Joseph
    September 1, 2010

    However, there can be (and are) vaccine reactions.

    For some people, eating peanuts can kill them. Therefore, everyone should avoid peanuts.

  49. #49 Ian
    September 1, 2010

    The amount is still pretty paltry, considering the high level of disability this person has, and the amount of resources required to care for a person with that level of impairment. The UK might be very different from Canada, but our health care system does a piss-poor job of caring for those with any kind of special need – physical, psychological, or developmental. If the $135k is a recognition of culpability it is a small one. I’d prefer to see the court order that the bill be picked up for a long-term home care nurse or something of the sort.

    Out of curiosity, who pays? Is it the government or the manufacturer?

  50. #50 augustine
    September 1, 2010

    {For some people, eating peanuts can kill them. Therefore, everyone should avoid peanuts.}

    No. The government should mandate that EVERYONE should have to eat peanuts. And they should use propaganda to encourage compliance. All peanut side effects should be trivialized and suppressed to keep peanut compliance high. Peanut anaphylaxis activists should be ridiculed by health authorities and social pressure should be applied to marginalize them. Terms like peanut benefit denialist should be encouraged to indentify dissenters from the plan.

    -this statement is endorsed by the peanut farmers of america. All research will be conducted and verified by Planters.

    Thomas joseph. Analogy fail.

  51. #51 Matthew Cline
    September 1, 2010

    @augustine:

    I’m not an anti-vaxxer but

    According to you, vaccines are “prophetic medicine”. So how in the world can you not be anti-vaccine? If you’re not an anti-vaxxer, then, in your own words, how does an individual go about making a rational decision on whether or not to get a particular vaccine?

  52. #52 Pablo
    September 1, 2010

    For some people, eating peanuts can kill them. Therefore, everyone should avoid peanuts.

    Yeah, I don’t get this. The most common place I hear this these days is in conjunction with shampoos. The objection is something like, “Some people have allergic reactions to sulfates.” I’m like, and? What does that have to do with me? I’ve been using sulfate-based shampoos for, like, 40 years and haven’t had an allergic reaction. Why should I stop using it because some people are allergic to it?

    I mean, if you have an allergic reaction to sulfate shampoo, by all means, don’t use it. But why should that be an issue for me?

  53. #53 Catherina
    September 1, 2010

    Thanks Paul (@24)

    I was wondering about that. As far as I know this story, young Master Fletcher did not get encephalitis, “just” the first of many epileptic fits. I wonder whether he has been tested for channel mutations that are common, for example in Dravet Syndrome.

  54. #54 Composer99
    September 1, 2010

    ugh troll, the evidence, consisting of your very own comments on this blog, indicate that you are, in fact, anti-vaccine. The second half of your comment #46 on this post is evidence of your anti-vaccination sentiment (otherwise, you wouldn’t distort the conventional position on vaccination so).

    So you are (as has also been demonstrated in the past) a liar as well as an anti-vaccine troll (and, of course, an idiot).

    Postscript: I understand that you have taken to twisting my user name into ‘compost’ (hence, the reciprocal effort on my part to refer to you as ‘ugh’ – which is my reaction whenever you and your BS appears on this blog). I do not view this as being as insulting as you no doubt wish. After all, unlike you, compost serves a useful function.

  55. #55 Kristen
    September 1, 2010

    I’m not an anti-vaxxer but when you say “superior” what do you mean? Superior to what?

    Augustine, you should really warn everyone when you are going to say something so ridiculous. I am tired of cleaning my laptop, and spitting water all over my computer is not becoming of a lady.

    The amount is still pretty paltry, considering the high level of disability this person has, and the amount of resources required to care for a person with that level of impairment.

    This is what I was thinking as well. I know from experience that (in the U.S.) insurers whether they be government or private tend to fight to not pay what they don’t deem necessary. There may be various expenses that are not covered.

    I am sure the parents are thinking about the future as well (there will be a time they will be unable to care for him) and where he will go. This can be very expensive, especially if they want to be sure he is getting good care. Even if the universal health care system has homes they pay for, these are probably not nearly as good as private (if it is anything like the Medicaid system in the U.S. they are as cheap as possible).*

    Not to mention; do they ever get to be alone? Do they ever get to go on a short vacation to regroup and relax? Caring for a disabled person 24/7 gets mentally and physically exhausting.

    No, I think this is a drop in a very big, expensive bucket.

    *All of this comes from an American who knows almost nothing about the U.K.’s health care.

  56. #56 Desdemona
    September 1, 2010

    Ok, honest question from someone who just doesn’t know. I read a past vaccine post of yours and I think this would be a good place to ask.

    So, I do Vaccinate, but on a spaced out schedule so that if my son has a allergic reaction I will know which one caused it and hopefully less foreign bodies will mean less of a reaction (since he’s almost 2 and has never had a reaction this second probably matters less since he isn’t allergic to any of the generic ingredients).

    Anyways, my only bent with Vaccines is that the studies do seem limited. Mind you I am not a medical profession so it could just be my knowledge that is limited.

    What do they do for long term studies? I did hear that one country has a database of all of their citizens (or at least a large number of them) and that they used this against the autism claim and the thermesol (sorry for bad spelling) claim to show that there are no direct correlations. Do they routinely monitor individuals who have received specific vaccines for long term affects? Without some high tech programing this would probably not be easy.

    It seems that the studies are all short term. They gave x number of people the vaccine and it didn’t kill them or cause immediate side effects so they send it out. It’s kind of a tough situation since of course if your making a vaccine to protect against something you want to protect against it now and not 10 years from now. But, even if you send out the vaccine to the public it doesn’t mean you can just wipe your hands clean of it and start on the next.

    So, long term studies? At least with all of the anti-vac’ers they do have a comparison group. Is anyone taking advantage of this?

  57. #57 jay.sweet
    September 1, 2010

    ebohlman: Interesting. In any case, given the severity of the reaction, it’s probably a good idea for her not to get the vaccine at this point, just out of an abundance of caution — at least, as long as herd immunity remains strong, that is!

  58. #58 Todd W.
    September 1, 2010

    @Desdemona

    There are a couple different ways that vaccines are studied long-term. Manufacturers conduct post-marketing surveillance studies, as well as collect reports of adverse events. They are required by law to report these events to the FDA within a specific timeframe depending on seriousness of the event.

    Other non-manufacturer researchers (e.g., physicians, universities, etc.) are conducting research as well.

    Then there’s the Vaccine Safety Datalink at the CDC.

    You can probably find more by searching for clinical trials at clinicaltrials.gov or for published research at places like PubMed.

    One challenge with longitudinal studies like this, though, is controlling for confounding variables. The longer it goes on, the greater the chance that some other event/thing not accounted for will cause some reaction. Sussing out whether it was the vaccine 15, 20, 30 years before or something else entirely is a rather challenging task.

  59. #59 Florida US. Doctor
    September 1, 2010

    It should be noted that this reform on health care is still much to improve and that there are millions of people still expect proper care, hopefully helping people who suffer pain really are millions at the country level, to obtain the benefits they need .

  60. #60 Shay
    September 1, 2010

    Thank you, Jay. I don’t suppose you care to comment on the fact that California is on the verge of breaking a fifty-year record for pertussis cases?

  61. #61 Science Mom
    September 1, 2010

    @ Desdemona, there is also this longitudinal study in the works: http://www.nap.edu/catalog.php?record_id=12211 in addition to what Todd W. already posted.

  62. #62 Desdemona
    September 1, 2010

    @Todd

    Thanks for the comment. I would think that with vaccines, and probably many other biology related topics, the number of variables can be astounding. But it is good to know that they are at least making an attempt. I do vaccinate though since I am more worried about the “long term” effects of some of these diseases!

    As a person who has read posts by a lot of anti-vacers (I follow a whole foods diet and am on a food list) the “superior immune system” that some trust in is from giving themselves and their kids really controlled diet. The immune system of their organic/wholesome feed diet kid is, in theory, better than the Vac’d kid next door who eats chicken nuggets and pizza for dinner.

    I try to have the best of both worlds :)

  63. #63 Pablo
    September 1, 2010

    The immune system of their organic/wholesome feed diet kid is, in theory, better than the Vac’d kid next door who eats chicken nuggets and pizza for dinner.

    Even if this were true (I don’t know and I don’t care), so what? It’s a false dichotomy.

    Vaccinated kids who eat good diets have better immune systems than non-vaccinated kids that eat good diets.

    No one is saying, “If you have vaccinated, you don’t have to worry about taking care of your health.” That’s a complete strawman, not even close to anything real.

    Anyone who is trying to tell you something like that, or even implies it, is deceiving you.

  64. #64 augustine
    September 1, 2010

    [matthew cline: So how in the world can you not be anti-vaccine?]

    I have no problem with you taking vaccines. I actually think they should be sold OTC at the grocery store. Out of the hands of the sales person, the doctor. They’re safer than tylenol or aspirin.

  65. #65 Crommunist
    September 1, 2010

    Most doctors offices lose money on vaccines, incidentally. In case you were labouring under the impression that family docs and pediatricians are rolling in sweet vax cash.

  66. #66 Chris
    September 1, 2010

    Desdemona:

    The immune system of their organic/wholesome feed diet kid is, in theory, better than the Vac’d kid next door who eats chicken nuggets and pizza for dinner.

    Are you often peaking into your neighbors’ windows at supper time? Also, how is my home made pizza with fresh basil, tomatoes, spinach, mushrooms, fresh cheese and fresh dough so unhealthy?

    If you want to know how I feel about your judgment of other children’s diets, I would like you familiarize you with a quote I found quite disgusting:

    “How come what we offered was not enough to keep her here when children with far less — impatient distracted parents, a small apartment on a busy street, extended day care, Oscar Mayer Lunchables — will happily stay?”

  67. #67 augustine
    September 1, 2010

    {pablo: Vaccinated kids who eat good diets have better immune systems than non-vaccinated kids that eat good diets.]

    So do you think vaccinated kids who eat poor diets have better immune systems than unvaccinated kids who have good diets?

    Poor diet kids health outcomes are often compared when trying to scare people into vaccinating. Are you saying a strawman argument is used in favor of getting kids vaccinated when using this tactic?

  68. #68 Desdemona
    September 1, 2010

    Chris

    I was giving the mind set of others I talk too… not saying that YOU are a horrible parent and feed your kid crap food. It was the random fast food example that came to my head. I was not downing your pizza specifically, that is for sure.

    There are plenty of studies, however, that show negative long term effects of a truly fast food diet, which is the diet I was comparing too. I don’t need to peak into anyone’s house when there are studies which compare various feeding habits.

    There is also a lot more to raising kids than just food! (in response to your quote). That and kids have different personalities.

  69. #69 augustine
    September 1, 2010

    [Most doctors offices lose money on vaccines, incidentally. In case you were labouring under the impression that family docs and pediatricians are rolling in sweet vax cash.]

    Since you were wondering, that was not the impression. I’m sure peds are on the low end of the economic ladder. But vaccine visits do bring income that is billable. It also establishes rapport for future visits. But, no I was not “labouring” under that impression.

    Vaccine doctors sell vaccines. They promote their use for everyone with skin. But you could classify them as agents of the state. Carrying out the will of state policy makers.

  70. #70 Matthew Cline
    September 1, 2010

    @augustine:

    I have no problem with you taking vaccines. I actually think they should be sold OTC at the grocery store.

    So your definition of “anti-vaccine” is “someone who wants to prevent vaccines from being manufactured”? That’s an extremely narrow definition.

    And another question to you: in your opinion, has any decision by any individual to take any vaccine ever been a rational decision?

  71. #71 dcotler
    September 1, 2010

    @64
    Thanks for that. I liken my responsibility to vaccinate my patients to having the equivalent of a BMW in my refrigerator. I paid for it, I maintain it, I fix it even if somebody else damages it (e.g. accidentally throwing thousands of dollars worth in the garbage), I pay increased insurance on its account, I keep extensive records on it, but I don’t get to drive it. If I am lucky and my staff functions perfectly, I may get enough reimbursement to break even on it. AND I spend my day trying to explain what is in their children’s interest to people who see me as either part of a conspiracy to hurt their children for profit, or, at best, a dupe of that conspiracy.

  72. #72 Alan Kellogg
    September 1, 2010

    @63

    So you’re not anti-vax, you’re anti-doctor.

  73. #73 Composer99
    September 1, 2010

    @ Chris:

    I would read Desdemona’s comment (cited below) as meaning she is pointing out the mindset of anti-vaccine activists who populate her food mailing list rather than stating her opinion (as she pointed out in #66).

    Desdemona is free to correct me if I am wrong.

    As a person who has read posts by a lot of anti-vacers (I follow a whole foods diet and am on a food list) the “superior immune system” that some trust in is from giving themselves and their kids really controlled diet. The immune system of their organic/wholesome feed diet kid is, in theory, better than the Vac’d kid next door who eats chicken nuggets and pizza for dinner.

    Bold section is emphasis mine.

    Also, would you describe your home-made pizza as being representative of pizzas consumed by the majority of pizza-eating American children? I would, perhaps, take that into account before taking too much umbrage at Desdemona’s comment.

  74. #74 augustine
    September 1, 2010

    [Alan kellog: So you're not anti-vax, you're anti-doctor.]

    No, I’m not anti-doctor.

  75. #75 Crommunist
    September 1, 2010

    @68

    It always boggles my mind that people think doctors are in it only for the money. Don’t get it twisted – being a doctor is a good gig, eventually. Doctors make a very decent amount of money, eventually. But I don’t know a single one of my med-school buds who went into it because of the lure of an easy buck. My law school and business school friends, that’s another story.

    Medical practice is the worst get-rich-quick scheme ever. It’s more like a get-well-off-over-a-number-of-decades scheme.

  76. #76 augustine
    September 1, 2010

    [And another question to you: in your opinion, has any decision by any individual to take any vaccine ever been a rational decision?]

    And I’ve asked you the same before. Has any decision by any individual(not their doctor) to not take any vaccine been a rational decision? Whatever your answer is my answer to you.

  77. #77 DrYak
    September 1, 2010

    Slightly off topic, but what do the anti-vax crowd in general think of adult vaccinations? This came up for me because I’ve just got a shed-load of vaccinations (Rabies, Japanese Encephalitis, tetanus, etc, etc…) in preparation for going to work in Indonesia. Plus if there were vaccines for Malaria and Dengue I’d take them in an instant.

    Just looking at the effects of the diseases – rabies almost invariable fatal without a nasty treatment regime, JE – 33% chance of death, 33% chance of brain damage, no treatment, makes it a no-brainer, despite the cost and miniscule risk of side-effects.

    So, what do the billions of people in the third world where polio, measles, rabies, JE, pertussis, etc are still endemic do if the anti-vaxers succeed in shuting down the vaccine manufacturers do? Are they willing to have the blood of countless people on their hands?

  78. #78 Enkidu
    September 1, 2010

    augie @46: “when you say “superior” what do you mean? Superior to what?”

    They think that their immune systems are superior in the fight against microbes. Like Desdemona said, they feed them healthy foods and give them plenty of outdoor time (for the Vit D and excercise) so in their world, their kids’ immune systems will never “lose” to a virus or bacteria. They wish that there were more cases of measles around so that they could take their kids to a measles party (seriously). And they get giddy at the thought of getting their kids’ titers checked, so they can say, “See! Look at the diseases my kids have been exposed to and I didn’t even know it because they are SUPER healthy!”

    As for the second part of your post, I have no idea what in the heck you are talking about in regards to what I posted. I guess you are implying that vaccine side effects are in fact worse than disease side effects?

  79. #79 Enkidu
    September 1, 2010

    Dr Yak asked, “Are they willing to have the blood of countless people on their hands?”

    Yes, because they aren’t their kids.

    I think for the most part, anti-vaxers are anti-adult vaccines too. They hate the flu shot, that’s for sure. And they tend to downplay the severity of most diseases; I know many anti-vaxers that don’t believe polio is even CAPABLE of causing paralysis, or that pertussis is anything more than a pesky cough. However, I think most would be open to a rabies vaccine if their child or themselves were bitten.

  80. #80 Aaron M Hatch
    September 1, 2010

    Good post. I take issue with one part, though:

    “Claiming that the rare neurologic injuries that can be caused by vaccines are “the same thing” as autism based on such an argument is specious reasoning at best, disingenuous at worst.”

    Maybe it read it wrong, but I don’t think they were claiming the set of behaviors depicting autism are the same as any other disorder. They were merely saying that autism is the name for a spectrum detailing the severity of certain behaviors.

  81. #81 Interrobang
    September 1, 2010

    or that pertussis is anything more than a pesky cough

    I had pertussis when I was nine, right around the time the single shot you used to get back when I was that age wears off. Far as I know, I had a fairly mild case — I was only awake pretty much constantly for a few days because I couldn’t stop coughing long enough to sleep, and I only coughed so hard I vomited ten or twelve discrete times. But I was still off school for about three weeks and I coughed pretty hard practically every time I took a deep breath for the next couple months. Sure, it eventually went away by itself, and I didn’t so far as I know have any long-term complications from it.

    Same with chicken pox. As far as I know, I didn’t have a very severe case, but I’ve still got a chicken pox scar above my one eyebrow (and it’s been 30 years since I had it), and from what I remember, I felt wretched during the whole time — I had a bad headache and was blowing my nose constantly, as well as being driven out of my juvenile mind by the itch. Again, it went away by itself in ten days or so, and no long-term consequenses aside from a few minor scars.

    Same with the H1N1 flu — I had that last October, and it was miserable. For the first 30 hours or so, I was feverish and achy to the point where even my soft mattress felt like it was stuffed with rocks. For the second 30 hours or so, I threw up and/or defecated what I think was every meal I’d eaten since early childhood (probably since that case of the chicken pox). The third 30 hours had me in the hospital with bronchitis and on an asthma inhaler for a couple of months.

    Again, no real serious injuries or complications from not-particularly-bad cases of these things, but anybody who’d be in favour of subjecting their kid to anything like that out of some kind of idiot availability-heuristic-influenced cognitive bias towards thinking serious vaccine complications happen far more frequently than they do*, is objectively pro-misery and probably needs their head read to boot. Grrrr…

    __________
    * Quick: What’s actually more dangerous — flying, or riding in a car? (Hint: It isn’t the thing people fear more. I don’t know too many “white-knuckled car riders.”)

  82. #82 Chris
    September 1, 2010

    Sorry, Desdemona, I apologize.

    Recently I have had issues with the “I’m a better mommy” groups. I have a disabled child and have actually had my parenting questioned due to his seizures and genetic heart condition. (for the record I did breastfeed, I can cook and actually never bought baby food because I made it, and I have just spent two hours making choucroute garnie, custard for trifle, and cutting up strawberries and plums, along with picking raspberries for the trifle… oh, per a previous comment from a “super smothering mom” I never have had an epidural, something she assumed caused my son’s neonatal seizures… which is right up there with the goof-ball who suggested the cause was me drinking milk, he previously said it was because I gave the infant milk but he backtracked when told the milk was from me!).

    I get angry that there is a bar that gets arbitrarily set that if you don’t do xyz, then your kid deserves abc!

    It is also the naive assumption that “boosting you immune system” is automatically good. An immune system is a complicated system, and can get out of whack for various odd reasons. My immune system has decided to make me miserable when the alder trees bloom, when there is ragweed and grass pollen in the air and when I touch anything with coated with the metal nickel. For an amusing read see Boost Your Immune System?.

    So I am sorry if I mis-read what you wrote. You may wish to share the above article with the food forum, and also remind them that microbial diseases really don’t care what your kid eats.

  83. #83 Donna B.
    September 1, 2010

    Ever once in a while I think it’s good for an old fart like me to enter the fray and tell what it was like in the good ole days before vaccines were routinely available.

    How many posting here — especially those questioning the good of vaccines — remember iron lungs for polio victims? Or the classmate with the leg brace? How many of you have a scar from the smallpox vaccine?

    How many women posting here lived with a tincture of fear throughout their pregnancies that they might contract rubella?

    I never got to know my grandfather because he died of the flu when my father was 10 years old. The flu! We think that’s not so serious these days don’t we?

    My children all had chickenpox and except for one it was mild — no worse than cold with a mild rash. For that one, it was a week of high fever and excruciating pain from pustules covering her entire body. There are scars. Though she might never have been close to death, she was very, very sick. That there is a vaccine that can prevent that happening to her children is something I am very grateful for.

  84. #84 Jay Gordon
    September 1, 2010

    David, I have a variation on the “pharma-shill gambit,” if you don’t mind.

    I know that you and no one else here is paid by the pharmaceutical industry. But you are, in fact, compensated by “Science Blogs,” right? If I’m wrong, I apologize but I seem to remember your talking about this some time ago.

    If so, are you compensated more if there is more traffic on this site or is there just a flat payment for writing?

    Also, you can stop wasting words by calling me “our old “friend,” that anti-vaccine-sympathetic pediatrician to the stars, Dr. Jay Gordon” and resume just calling me “anti-vaccine.” I’m not anti-vaccination, but I know what you mean and all the regulars here do, too.

    You’re not exactly “splitting hairs,” but you’re not saying much earthshaking when you say that scientific proof and judicial proof are very different. I’m not sure who doesn’t understand that. Otherwise, this is another fine post.

    Please answer my question within seconds of it’s appearing here. If not, I’ll assume you’re dodging the question because of some scurrilous reason or three.

    Best,

    Jay

  85. #85 augustine
    September 1, 2010

    [I never got to know my grandfather because he died of the flu when my father was 10 years old. The flu! We think that's not so serious these days don't we?]

    My grandfather died at 42 from an aneurysm. What’s your point? Oh you think he wouldn’t have died today because of some technological ideology? You think a flu shot would have saved your grandfather? That is faith, not science. Have you seen the CDC numbers on flu deaths? Have you seen the data on the flu vaccine’s effectiveness? Only ideologists push the flu vaccine. I can understand some of the other vaccines but the flu shot is the biggest psychological scam of our time. Either you’re a practitioner of scientism or you’ve been duped if you “believe” in the flu shot.

    But I thank you flu shot and your staunch worshippers. If it weren’t for you and your psychological madness I’d have never doubted vaccines. I also thank you for your close cousins Hep B vaccine and Gardasil. They make the argument easier for the truth.

  86. #86 adelady
    September 1, 2010

    Yes, Donna, I’m old enough.

    My kids got chickenpox, as did I when I was a child. But my poor husband had never had it as a child so he caught it from the kids. It was terrible in a mid-40s man. Delirious with fever, every visible skin area and all mucous membranes were piled high with vile pustules. He suffered horribly.

    And we both remember schools being closed down during the polio epidemics. Our parents were relieved and *grateful* when the public health people lined us all up at school and injected the vaccine.

    These evil or misguided or ignorant people agitating against vaccination seriously have no idea how well off they are that the rest of us are sensible.

  87. #87 Jay Gordon
    September 1, 2010

    @Donna B

    If in fact you are an “old fart” I’ll peg you at about sixty years old give or take a decade. Your polio and small pox scar comments put you about there. Right?

    If so, your grandfather died somewhere in the late 1920s or 1930s. Medical changes not only include vaccination but antibiotics, ventilators and many other interventions which would have save your grandfather. Your error is common around here.

    Orac! Why do refuse to answer my questions??!! It’s been over ten minutes. Could it be that you really have no answer????

    :-)

    Jay

    P.S.

    Below is the beginning of my web site’s revision. Dangerous Bacon has made it clear that he’ll work for no less than $3.00/hour helping me edit and add to this. Because I sell few vaccines and lose money on the ones I do sell, I can’t possibly afford his rates until the next diphtheria outbreak here in So Cal. I will appreciate others’ comments, though.

    Thanks.

    J

    Welcome to our website. Here, I hope to be a very strong voice for breastfeeding, the Family Bed, Attachment Parenting, changing school lunches and childhood nutrition in general, stopping TV ads for junk foods. AND for changing the way we give vaccines.

    I support parents’ rights to vaccinate their children on a schedule which they feel is best for their individual child.

    I also support their right to give no vaccines at all.

    Public health and herd immunity are a part of any vaccination discussion I have with the parents of my patients.

    The proper studies to prove a connection between vaccines and serious injury may never be done and we may have to rely on the evidence we have gathered and continue to gather.

    I don’t believe that all autism is caused by vaccines nor that every person receiving vaccines is endangered. I do, however, reject the idea that vaccination is an unequivocally beneficial medical procedure. At the very least, there is a small “sub-group” of individuals genetically predisposed to injury from vaccines. When we vaccinate every single child in the same way, ignoring family history, past medical history and behavioral differences this does not constitute the best practice of medicine.

    Again, herd immunity could be adversely affected if large scale changes were made in current vaccine schedule. I am not suggesting this. I am suggesting that vaccines could be manufactured more safely, administered more safely by beginning later in a baby’s life and that herd immunity could be retained and public health strengthened by more judicious use of vaccines combined with educating parents about measures which will keep their children healthier. These measures include breastfeeding, excellent nutrition and much more we hope this site will offer.

    My point of view is held by only a very, very small minority of physicians and medical experts and parents certainly should not ignore the information given them by their own pediatricians.

  88. #88 adelady
    September 1, 2010

    Oh and I forgot. My husband never knew one grandfather because he died – from the flu – when his mother was just a baby.

  89. #89 augustine
    September 1, 2010

    [adelady: Oh and I forgot. My husband never knew one grandfather because he died – from the flu – when his mother was just a baby.}

    So you’re speculating?

  90. #90 adelady
    September 1, 2010

    Dr JG, Antibiotics, ventilators, other interventions?

    During the 1918-19 flu epidemic, healthy young people dropped dead in the streets!! Antibiotics might have saved some who died from pneumonia and other complications, but most died from the flu itself.

    (And yes, I’m another old fart.)

  91. #91 Drivebyposter
    September 1, 2010

    “So, Dr. Jay:

    * What is your definition of a “vaccine side effect denialist” (VSED)?
    * You say that VSEDs exist here at RI. Please provide a concrete example of VSED behavior.
    * What is your definition of “those at highest risk”?
    * Am I correct that your recommendation is that except for people who meet that definition, everyone else should not bother with the vaccine?” -Todd W.

    That’s been asked of you for days. Not the “seconds” that you seem to imply that everyone is demanding from you. We all understand that you are a practicing pediatrician and thus do not have all the time in the world to spend on RI. However, the fact remains that you clearly read posts (because you respond to many of them), but it seems you rarely answer questions and tend to focus on the things you consider insulting.

    I propose that the other posters here repeat as many of the
    big questions Dr. Jay avoids until he stops avoiding them.

    And to answer Jay’s question, Scienceblogers do get money for blogging (If I remember that correctly), but more than that is a mystery to me.

  92. #92 Mu
    September 1, 2010

    Jay, you support the right of parents to not vaccinate their children. Do you also support the right of society to exclude those children from public schools, colleges, pools, sport teams etc.?

  93. #93 dcotler
    September 1, 2010

    Jay, Why have you failed to fulfill the requirements for Maintenance of Certification?

    ” Prior to 1988, certification by the American Board of Pediatrics was granted for life. These certified pediatricians are not required to recertify or to meet the requirements of Maintenance of Certification in this area, but are strongly encouraged to do so in the area of their general or subspecialty practice(s).”

    Thirty years as a Pediatrician turns some docs I know into clueless old farts. They fear recertification exams, and decline to demonstrate their competence or lack of same, even though the ABP “strongly encourages” them to do so.

    https://www.abp.org/MOCVerification/jsp/Search.faces

  94. #94 augustine
    September 1, 2010

    Dear Too Old,
    Sorry but you asked for it.

    [Dr JG, Antibiotics, ventilators, other interventions?

    During the 1918-19 flu epidemic, healthy young people dropped dead in the streets!! Antibiotics might have saved some who died from pneumonia and other complications, but most died from the flu itself.

    (And yes, I'm another old fart.)]
    —————————————
    “Bacteria were the real killers in 1918 flu pandemic ”

    http://www.newscientist.com/article/dn14458-bacteria-were-the-real-killers-in-1918-flu-pandemic.html

  95. #95 Chris
    September 1, 2010

    So, Jay, did you vaccinate with the MMR before 1998?

    An article you might want to look at: Neonatal Deaths After Hepatitis B Vaccine, The Vaccine Adverse Event Reporting System, 1991-1998. It seems to be an interesting look at co-sleeping in cases “7/14/24/SIDS”, “12/17/18/Accidental suffication”, “13/13/22/SIDS”, “15/1/16/SIDS”, “16/1/19/SIDS”, and some otherwise unknown congenital problems.

    So you say:

    The proper studies to prove a connection between vaccines and serious injury may never be done and we may have to rely on the evidence we have gathered and continue to gather.

    Could you just add this to your website so your readers can make up their own minds (most come from here):

    Pediatr Infect Dis J. 2010 May;29(5):397-400.
    Lack of association between measles-mumps-rubella vaccination and autism in children: a case-control study.
    Mrozek-Budzyn D, Kieltyka A, Majewska R.

    Lack of Association between Measles Virus Vaccine and Autism with Enteropathy: A Case-Control Study.
    Hornig M et al.
    PLoS ONE 2008; 3(9): e3140 doi:10.1371/journal.pone.0003140
    *Subjects: 25 children with autism and GI disturbances and 13 children with GI disturbances alone (controls)

    Measles Vaccination and Antibody Response in Autism Spectrum Disorders.
    Baird G et al.
    Arch Dis Child 2008; 93(10):832-7.
    Subjects: 98 vaccinated children aged 10-12 years in the UK with autism spectrum disorder (ASD); two control groups of similar age: 52 children with special educational needs but no ASD and 90 children in the typically developing group

    Geographic clustering of nonmedical exemptions to school immunization requirements and associations with geographic clustering of pertussis.
    Omer SB, Enger KS, Moulton LH, Halsey NA, Stokley S, Salmon DA.
    Am J Epidemiol. 2008 Dec 15;168(12):1389-96. Epub 2008 Oct 15

    MMR-Vaccine and Regression in Autism Spectrum Disorders: Negative Results Presented from Japan.
    Uchiyama T et al.
    J Autism Dev Disord 2007; 37(2):210-7
    *Subjects: 904 children with autism spectrum disorder
    (Note: MMR was used in Japan only between 1989 and 1993.)

    No Evidence of Persisting Measles Virus in Peripheral Blood Mononuclear Cells from Children with Autism Spectrum Disorder.
    D’Souza Y et al.
    Pediatrics 2006; 118(4):1664-75
    *Subjects: 54 children with autism spectrum disorder and 34 developmentally normal children

    Immunizations and Autism: A Review of the Literature.
    Doja A, Roberts W.
    Can J Neurol Sci. 2006; 33(4):341-6
    *Literature review

    Pervasive Developmental Disorders in Montreal, Quebec, Canada: Prevalence and Links with Immunizations.
    Fombonne E et al.
    Pediatrics. 2006;118(1):e139-50
    *Subjects: 27,749 children born from 1987 to 1998 attending 55 schools

    Relationship between MMR Vaccine and Autism.
    Klein KC, Diehl EB.
    Ann Pharmacother. 2004; 38(7-8):1297-300
    *Literature review of 10 studies

    Immunization Safety Review: Vaccines and Autism. Institute of Medicine.
    The National Academies Press: 2004
    (w w w . nap.edu/books/030909237X/html) *Literature review

    MMR Vaccination and Pervasive Developmental Disorders: A Case-Control Study.
    Smeeth L et al.
    Lancet 2004; 364(9438):963-9
    *Subjects: 1294 cases and 4469 controls

    Age at First Measles-Mumps-Rubella Vaccination in Children with Autism and School-Matched Control Subjects: A Population-Based Study in Metropolitan Atlanta.
    DeStefano F et al. Pediatrics 2004; 113(2): 259-66
    *Subjects: 624 children with autism and 1,824 controls

    Prevalence of Autism and Parentally Reported Triggers in a North East London Population.
    Lingam R et al.
    Arch Dis Child 2003; 88(8):666-70
    *Subjects: 567 children with autistic spectrum disorder

    Neurologic Disorders after Measles-Mumps-Rubella Vaccination.
    Makela A et al.
    Pediatrics 2002; 110:957-63
    *Subjects: 535,544 children vaccinated between November 1982 and June 1986 in Finland

    A Population-Based Study of Measles, Mumps, and Rubella Vaccination and Autism.
    Madsen KM et al.
    N Engl J Med 2002; 347(19):1477-82
    *Subjects: All 537,303 children born 1/91–12/98 in Denmark

    Relation of Childhood Gastrointestinal Disorders to Autism: Nested Case Control Study Using Data from the UK General Practice Research Database.
    Black C et al.
    BMJ 2002; 325:419-21
    *Subjects: 96 children diagnosed with autism and 449 controls

    Measles, Mumps, and Rubella Vaccination and Bowel Problems or Developmental Regression in Children with Autism: Population Study.
    Taylor B et al.
    BMJ 2002; 324(7334):393-6
    *Subjects: 278 children with core autism and 195 with atypical autism

    No Evidence for a New Variant of Measles-Mumps-Rubella-Induced Autism.
    Fombonne E et al.
    Pediatrics 2001;108(4):E58
    *Subjects: 262 autistic children (pre- and post-MMR samples)

    Measles-Mumps-Rubella and Other Measles-Containing Vaccines Do Not Increase the Risk for Inflammatory Bowel Disease: A Case-Control Study from the Vaccine Safety Datalink Project.
    Davis RL et al.
    Arch Pediatr Adolesc Med 2001;155(3):354-9
    *Subjects: 155 persons with IBD with up to 5 controls each

    Time Trends in Autism and in MMR Immunization Coverage in California.
    Dales L et al.
    JAMA 2001; 285(9):1183-5
    *Subjects: Children born in 1980-94 who were enrolled in California kindergartens (survey samples of 600–1,900 children each year)

    Mumps, Measles, and Rubella Vaccine and the Incidence of Autism Recorded by General Practitioners: A Time Trend Analysis.
    Kaye JA et al.
    BMJ 2001; 322:460-63
    *Subjects: 305 children with autism

    Further Evidence of the Absence of Measles Virus Genome Sequence in Full Thickness Intestinal Specimens from Patients with Crohn’s Disease.
    Afzal MA, et al.
    J Med Virol 2000; 62(3):377-82
    *Subjects: Specimens from patients with Crohn’s disease

    Autism and Measles, Mumps, and Rubella Vaccine: No Epidemiological Evidence for a Causal Association.
    Taylor B et al.
    Lancet 1999;353 (9169):2026-9
    *Subjects: 498 children with autism

    Absence of Detectable Measles Virus Genome Sequence in Inflammatory Bowel Disease Tissues and Peripheral Blood Lymphocytes.
    Afzal MA et al.
    J Med Virol 1998; 55(3):243-9
    *Subjects: 93 colonoscopic biopsies and 31 peripheral blood lymphocyte preparations

    No Evidence for Measles, Mumps, and Rubella Vaccine-Associated Inflammatory Bowel Disease or Autism in a 14-year Prospective Study.
    Peltola H et al.
    Lancet 1998; 351:1327-8
    *Subjects: 3,000,000 doses of MMR vaccine

    Exposure to Measles in Utero and Crohn’s Disease: Danish Register Study.
    Nielsen LL et al.
    BMJ 1998; 316(7126):196-7
    *Subjects: 472 women with measles

    Immunocytochemical Evidence of Listeria, Escherichia coli, and Streptococcus Antigens in Crohn’s Disease.
    Liu Y et al.
    Gastroenterology 1995; 108(5):1396-1404
    *Subjects: Intestines and mesenteric lymph node specimens from 21 persons from families with a high frequency of Crohn’s disease

    Neuropsychological Performance 10 years after Immunization in Infancy with Thimerosal-Containing Vaccines
    Tozzi AE, Bisiacchi P, Tarantino V, De Mei B, D’Elia L, Chiarotti F, Salmaso S.
    Pediatrics, February 2009, Vol. 123(2):475-82

    Mercury Levels in Newborns and Infants after Receipt of Thimerosal-Containing Vaccines
    Pichichero ME, Gentile A, Giglio N, et al
    Pediatrics, February 2008; 121(2) e208-214

    Mercury, Vaccines, And Autism: One Controversy, Three Histories
    Baker JP
    American Journal of Public Health, February 2008;98(2): 244-253

    Continuing Increases in Autism Reported to California’s Developmental Services System: Mercury in Retrograde
    Schechter R, Grether JK
    Arch Gen Psychiatry, January 2008; 65(1):19-24

    Early Thimerosal Exposure and Neuropsychological Outcomes at 7 to 10 Years
    Thompson WW, Price C, Goodson B, et al; Vaccine Safety Datalink Team
    N Engl J Med, Sep 27, 2007; 357(13):1281-1292

    Pervasive Developmental Disorders in Montreal, Quebec, Canada: Prevalence and Links with Immunizations
    Fombonne E, Zakarian R, Bennett A, Meng L, McLean-Heywood D
    Pediatrics, July 2006, Vol. 118(1):e139-e150

    Vaccine Adverse Event Reporting System Reporting Source: A Possible Source of Bias in Longitudinal Studies
    Goodman MJ, Nordin J
    Pediatrics, February 2006, Vol. 117(2):387-390

    No effect of MMR withdrawal on the incidence of autism: a total population study.
    Honda H, Shimizu Y, Rutter M.
    J Child Psychol Psychiatry. 2005 Jun;46(6):572-9.

    Comparison of Blood and Brain Mercury Levels in Infant Monkeys Exposed to Methylmercury or Vaccines Containing Thimerosal
    Burbacher TM, Shen DD, Liberato N, Grant KS, Cernichiari E, Clarkson T
    National Institute of Environmental Health Sciences, April 21, 2005

    Thimerosal Exposure in Infants and Developmental Disorders: A Prospective Cohort Study in the United Kingdom Does Not Support a Causal Association
    Heron J, Golding J, ALSPAC Study Team
    Pediatrics, September 2004, Vol. 114(3):577-583

    Thimerosal Exposure in Infants and Developmental Disorders: A Retrospective Cohort Study in the United Kingdom Does Not Support a Causal Association
    Andrews N, Miller E, Grant A, Stowe J, Osborne V, Taylor B
    Pediatrics, September 2004, Vol. 114(3):584-591

    Thimerosal-Containing Vaccines and Autistic Spectrum Disorder: A Critical Review of Published Original Data
    Parker SK, Schwartz B, Todd J, Pickering LK
    Pediatrics, September 2004, Vol. 114(3):793-804

    The Evidence for the Safety of Thimerosal in Newborn and Infant Vaccines
    Clements CJ
    Vaccine, May 7, 2004, Vol. 22(15-16):1854-1861

    Safety of Thimerosal-Containing Vaccines: A Two-Phased Study of Computerized Health Maintenance Organization Databases
    Verstraeten T, Davis RL, DeStefano F, et al
    Pediatrics, November 2003, Vol. 112(5):1039-1048

    The Toxicology of Mercury–Current Exposures and Clinical Manifestations
    Clarkson TW, Magos L, Myers GJ
    New England Journal of Medicine, October 30, 2003, Vol. 349(18):1731-7

    Association Between Thimerosal-Containing Vaccine and Autism
    Hviid A, Stellfeld M, Wohlfahrt J, Melbye M
    Journal of the American Medical Association, October 1, 2003, Vol. 290(13):1763-6

    Thimerosal and the Occurrence of Autism: Negative Ecological Evidence from Danish Population-Based Data
    Madsen KM, Lauritsen MB, Pedersen CB, et al
    Pediatrics, Sept. 2003, Vol. 112(3 Pt 1):604-606

    Autism and Thimerosal-Containing Vaccines. Lack of Consistent Evidence for an Association
    Stehr-Green P, Tull P, Stellfeld M, Mortenson PB, Simpson D
    American Journal of Preventive Medicine, August 2003, Vol. 25(2):101-6

    Impact of the Thimerosal Controversy on Hepatitis B Vaccine Coverage of Infants Born to Women of Unknown Hepatitis B Surface Antigen Status in Michigan
    Biroscak BJ, Fiore AE, Fasano N, Fineis P, Collins MP, Stoltman G
    Pediatrics, June 2003, Vol. 111(6):e645-9

    Vaccine Safety Policy Analysis in Three European Countries: The Case of Thimerosal
    Freed GL, Andreae MC, Cowan AE, et al
    Health Policy, December 2002, Vol. 62(3):291-307

    Mercury Concentrations and Metabolism in Infants Receiving Vaccines Containing Thimerosal: A Descriptive Study
    Pichichero ME, Cernichiari E, Lopreiato J, Treanor J
    The Lancet, November 30, 2002, Vol. 360:1737-1741

    An Assessment of Thimerosal Use in Childhood Vaccines
    Ball LK, Ball R, Pratt RD
    Pediatrics, May 2001, Vol. 107(5):1147-1154

    Pediatric hospital admissions for measles. Lessons from the 1990 epidemic.
    Chavez GF, Ellis AA.
    West J Med. 1996 Jul-Aug;165(1-2):20-5.

    Impact of universal Haemophilus influenzae type b vaccination starting at 2 months of age in the United States: an economic analysis.
    Zhou F, Bisgard KM, Yusuf HR, Deuson RR, Bath SK, Murphy TV.
    Pediatrics. 2002 Oct;110(4):653-61.

    Impact of specific medical interventions on reducing the prevalence of mental retardation.
    Brosco JP, Mattingly M, Sanders LM.
    Arch Pediatr Adolesc Med. 2006 Mar;160(3):302-9. Review.

    Encephalopathy after whole-cell pertussis or measles vaccination: lack of evidence for a causal association in a retrospective case-control study.
    Ray P, Hayward J, Michelson D, Lewis E, Schwalbe J, Black S, Shinefield H, Marcy M, Huff K, Ward J, Mullooly J, Chen R, Davis R; Vaccine Safety Datalink Group.
    Pediatr Infect Dis J. 2006 Sep;25(9):768-73.

    Childhood vaccinations, vaccination timing, and risk of type 1 diabetes mellitus.
    DeStefano F, Mullooly JP, Okoro CA, Chen RT, Marcy SM, Ward JI, Vadheim CM, Black SB, Shinefield HR, Davis RL, Bohlke K; Vaccine Safety Datalink Team.
    Pediatrics. 2001 Dec;108(6):E112.

    Pediatrics. 2010 Jun;125(6):1134-41. Epub 2010 May 24.
    On-time vaccine receipt in the first year does not adversely affect neuropsychological outcomes.
    Smith MJ, Woods CR.

  96. #96 augustine
    September 1, 2010

    [Mu: Jay, you support the right of parents to not vaccinate their children. Do you also support the right of society to exclude those children from public schools, colleges, pools, sport teams etc.?]

    Mu, do you support the right of society to not pay for those public services if they are denied public school based on the rejection of invasive medical mandates by the state?

    Do you support the right of society to impose religious services at public school because the majority agree that it’s good for society?

  97. #97 Orac
    September 1, 2010

    You’re not exactly “splitting hairs,” but you’re not saying much earthshaking when you say that scientific proof and judicial proof are very different. I’m not sure who doesn’t understand that.

    Tell that to Age of Autism. They appear not to understand the difference. Either that, or they know the difference and intentionally deceive. Take your pick: ignorant or dishonest.

  98. #98 dcotler
    September 1, 2010

    I knew there was a reason why Dr Jay’s “point of view is held by only a very, very small minority of physicians and medical experts.” They are foolish enough to rely on evidence, and lack Dr Jay’s “experience.”

  99. #99 augustine
    September 1, 2010

    Chris dude,

    Is it perfectly logical for a person to believe they are actually trapped in the wrong body? Are they REALLY trapped in the wrong body and necessitate vaginoplasty or peniplasty to remedy this actual mix up.

    In what world is that logical? Your world? Does anything go in your world except for parents who pass on vaccination?

    Penile inversion to remedy body mix up: totally logical.
    parent refusing hep.B vaccine for disease that they will NEVER get: insane

    Only in scientism world where the bloggers blog.

  100. #100 Jay Gordon
    September 1, 2010

    @Mu
    Excellent question, difficult issue. Under certain circumstances quarantines have probably been helpful but, no, I don’t support blanket exclusion of unvaccinated children any more than I support exclusion of HIV positive children from schools. As we walk out our front doors we accept a world filled with risks and unvaccinated children do not pose a reasonable nor statistical risk in schools, pools or on the pitch.

    @drivebyposter
    I have answered all those questions in one way or another but I’ll try again.

    Many of the overzealous comments about vaccines over the past few years at RI have implied or stated that vaccines are without, or virtually without, side effects. Otherwise sensible scientists have made statements to that effect including Dr. Paul Offit’s famous–and misquoted–“10,000 vaccines” statement. If you’ve spent years here, like many of us, you have seen the denial I’m talking about. If you spend the next few weeks looking through the archives you’ll find these people. Trust me, they’re in there.

    “Highest risk” depends on too many variables for a simple answer to suffice. Are children with bad asthma had higher risk from pertussis? Yes. Are surgeons and other HCPs at higher risk of exposure to hepatitis B? Yes. Do children on high dose steroids for asthma or getting treated for malignancies need chicken pox vaccination? Yes. I could go on here, but you get the idea. I give vaccines to many children in my practice but I give far fewer than most pediatricians do in large measure because I don’t view vaccination as an unequivocally beneficial nor completely safe medical intervention. For those reasons, if for no others, I think that vaccine scheduling must be individualized.

    Lastly, my recommendation for most other families is contained in my web site statement above.

    I get no money for posting here and my website costs me quite a bit of money each month and I receive no compensation from other sources nor increased business or sales because of the site. Someday I hope to, by the way.

    Best,

    Jay

  101. #101 Jay Gordon
    September 1, 2010

    @Mu
    Excellent question, difficult issue. Under certain circumstances quarantines have probably been helpful but, no, I don’t support blanket exclusion of unvaccinated children any more than I support exclusion of HIV positive children from schools. As we walk out our front doors we accept a world filled with risks and unvaccinated children do not pose a reasonable nor statistical risk in schools, pools or on the pitch.

    @drivebyposter
    I have answered all those questions in one way or another but I’ll try again.

    Many of the overzealous comments about vaccines over the past few years at RI have implied or stated that vaccines are without, or virtually without, side effects. Otherwise sensible scientists have made statements to that effect including Dr. Paul Offit’s famous–and misquoted–“10,000 vaccines” statement. If you’ve spent years here, like many of us, you have seen the denial I’m talking about. If you spend the next few weeks looking through the archives you’ll find these people. Trust me, they’re in there.

    “Highest risk” depends on too many variables for a simple answer to suffice. Are children with bad asthma had higher risk from pertussis? Yes. Are surgeons and other HCPs at higher risk of exposure to hepatitis B? Yes. Do children on high dose steroids for asthma or getting treated for malignancies need chicken pox vaccination? Yes. I could go on here, but you get the idea. I give vaccines to many children in my practice but I give far fewer than most pediatricians do in large measure because I don’t view vaccination as an unequivocally beneficial nor completely safe medical intervention. For those reasons, if for no others, I think that vaccine scheduling must be individualized.

    Lastly, my recommendation for most other families is contained in my web site statement above.

    I get no money for posting here and my website costs me quite a bit of money each month and I receive no compensation from other sources nor increased business or sales because of the site. Someday I hope to, by the way.

    Best,

    Jay

  102. #102 Orac
    September 2, 2010

    Many of the overzealous comments about vaccines over the past few years at RI have implied or stated that vaccines are without, or virtually without, side effects.

    Bullshit, Dr. Jay.

    The statements on this blog are based on science and designed to counter the sorts of nonsense from people like you, who try to imply that vaccines are dangerous, that they cause autism, that they’re full of toxins (yes, Dr. Jay, I still haven’t forgotten when you tried a bit of fear mongering about formaldehyde in vaccines and I slapped you down), that vaccine companies are as bad as tobacco companies, and all sorts of other misinformation that you–yes, you–spew. In marked contrast to me, you rely on your own anecdotal experience and a misplaced faith that your anecdotal experience over 30 years of clinical practice catering to vaccine-averse pampered Southern Californians somehow counts for more than epidemiology, science, and clinical trials, your arrogance leading you to believe that you couldn’t possibly be misled like the rest of us humans.

    The result?

    Utterly and completely ignorant nonsense like this:

    The proper studies to prove a connection between vaccines and serious injury may never be done and we may have to rely on the evidence we have gathered and continue to gather.

    No, Dr. Jay, the main people here exaggerating are anti-vaccine apologists and fellow travelers. Like you.

  103. #103 Chris
    September 2, 2010

    Jay, did you give the MMR before 1998?

    Little Augie shows again that s/he/it is a sexist fool with sexual identity issues. Your assumption to why I have never had an epidural is obviously quite wrong. Plus s/he/it continues to refuse to read any of the links.

    So, Little Augie, did you suffocate your new pet recently as you tried to make it sleep with you?

    Personally, I am thankful that my children have more sense than you. My oldest is still quite disabled, but will be attending community college with disability services later this month. My next child continues to pay for his own apartment by working as a lifeguard as a sophomore majoring in engineering. The youngest actually hugged me last night, even though she is sixteen years old, after I processed almost twenty pounds of peaches and talked about the first time I dealt with that many at a custom cannery in Toppinish, WA. She is still in high school, but will be replacing some of her classes with Running Start.

    Little Augie, what have you ever accomplished?

  104. #104 titmouse
    September 2, 2010

    MOC? Meh, no biggie either way.

    Dr. Gordon, have you noticed there is no Dr. Oz here? No Chopra? No Weil, etc?

    Other celebrity MDs seem content with their piles of money and the chance to rub elbows with the beautiful people. But you crave something more: the respect of your peers.

    You might be happier if you said to yourself, “Hey 2 out of 3 ain’t bad.” Or you might write off the critics here as merely envious of your money/fame thing.

    But you don’t do that. You keep trying to assert that you are *reasonable* to those who value reason.

    Why bother, when all is vanity? The respected and the ridiculous both meet the same end.

  105. #105 Jay Gordon
    September 2, 2010

    Whoa! Orac, you posted but didn’t answer my question about your compensation for website traffic!

    I’ll answer for you: None of my business!! It is not my concern to know how another person earns his living. The only little twist here is, if you are paid for the amount of traffic on the site, it would account for your posts getting just plain outrageous and provocative to add more people and generate more responses. And maybe increase click throughs to the advertisements here.

    @dcotler!!! I looked at that site. You haven’t recertified either. Then I looked at lots of other local pediatricians and a fair number of others I know around the country who are not required to recertify. Guess what? Neither you nor a single one of them have taken and passed the exam. I even found one rather prominent mainstream pediatrician who never certified at all. Thanks for the tip, Donald Nelson Cotler of Maplewood, New Jersey.

    Orac!! Answer my question, please. (I changed my mind about the NOMB thing.)

    Best,

    Jay

  106. #106 Matthew Cline
    September 2, 2010

    @Dr Gordon:

    When we vaccinate every single child in the same way, ignoring family history, past medical history and behavioral differences this does not constitute the best practice of medicine.

    What behavioral differences indicate that a child might be in a subgroup which is more vulnerable to vaccine damage? And, besides adverse vaccine reactions and allergies to vaccine ingredients, which past medical history and family history indicate a child might be in that subgroup?

  107. #107 Jay Gordon
    September 2, 2010

    My apologies to Donald Nelson Cotler. It’s hard to discern whether or not he’s taken the exam. I’ll assume he has and apologize for posting otherwise. The others I looked at have not.

    I believe I erred.

    Jay

  108. #108 dcotler
    September 2, 2010

    In fairness to Dr Jay, clinical experience can sometimes constitute significant evidence. For example, I have given over 300,000 immunizations in my career, without a single serious reaction. I think that is statistically significant.

    As long as I am still here, I would like to call bullshit on something else Dr Jay just wrote:

    “I get no money for posting here and my website costs me quite a bit of money each month and I receive no compensation from other sources nor increased business or sales because of the site. Someday I hope to, by the way.”

    Bullshit. Any Pediatrician with a reputation for being antivax will get more business than (s)he can handle. I found that out after a local “holistic birthing” center mistakenly started recommending me as one of those clowns. They got that idea because I do not kick antivax parents out of my practice for fear that they will end up with the likes of Dr Jay.

  109. #109 Jay Gordon
    September 2, 2010

    Orac, you seem to have posted again without addressing the Science Blog’s compensation policy. My goodness, I’ve posted useful information, answered questions asked of me, apologized for a possible error in my last post and knitted a sweater and you haven’t had time to do anything but spew curses and non sequiturs about what I said before I learned more and thought harder.

    It seems as if listening, learning and improving count against you here. OK, teh shots cause autism becuz of teh formaldehyde. Happier now, David?

    Do you really mean to tell me that you’ve learned nothing at all about medicine in the past three or four years? Well, I have.

    Jay

  110. #110 dcotler
    September 2, 2010

    You did indeed err, Dr Jay. It is easy to find out who meets the requirements.
    https://www.abp.org/MOCVerification/jsp/Search.faces
    I do, you don’t.

  111. #111 Jay Gordon
    September 2, 2010

    @dcotler If you are Donald, thank you for accepting my apology.

    My practice is quite busy and remains so because I work hard. Not because of my POV about vaccines.

    If you’re successful, it’s because you work hard not because of your maverick stance about not kicking “antivax parents” out of your office.

    My experience has been that, among mainstream doctors, the small minority of pediatricians with a reputation for tolerating non-vaccinating parents get more business than they can handle. I’m assuming you tolerate this group because you want to influence them in the direction you believe best for their children and not because you lose less money by not giving them shots. Sauce for the goose?

    And, seeing as we’re calling out errors, your post above about the BMW in your refrigerator is clever but not accurate.

    Jay

  112. #112 augustine
    September 2, 2010

    [Chris: Personally, I am thankful that my children have more sense than you. My oldest is still quite disabled, but will be attending community college with disability services later this month. My next child continues to pay for his own apartment by working as a lifeguard as a sophomore majoring in engineering. The youngest actually hugged me last night, even though she is sixteen years old, after I processed almost twenty pounds of peaches and talked about the first time I dealt with that many at a custom cannery in Toppinish, WA. She is still in high school, but will be replacing some of her classes with Running Start.]

    And the purpose of this entire paragraph is? That you can can peaches?

  113. #113 augustine
    September 2, 2010

    [For example, I have given over 300,000 immunizations in my career, without a single serious reaction. I think that is statistically significant.]

    And you pay what in malpractice and why? It’s all your colleagues fault?

  114. #114 Sid Offit
    September 2, 2010

    @Chris
    It is also the naive assumption that “boosting you immune system” is automatically good. An immune system is a complicated system, and can get out of whack for various odd reasons.
    ——————
    I know what you mean, like with vaccines and rising autoimmune diseases and such

  115. #115 Jay Gordon
    September 2, 2010

    Dr. Cotler, you are being deceptive in implying that I have a deficiency. Neither you nor I are required to take a recertification exam. Most pediatricians not required to have not. You know that. (“Prior to 1988, certification by the American Board of Pediatrics was granted for life. These certified pediatricians are not required to recertify or to meet the requirements of Maintenance of Certification in this area, but are strongly encouraged to do so in the area of their general or subspecialty practice(s).) I’ll look into it the idea of taking the exam.

    I have no idea how many vaccines I’ve given in thirty-one years versus the number you’ve given in your twenty-five years, but I appreciate your recognizing that our experience vaccinating children is extremely valuable. And statistically significant.

    I doubt you’ll catch much flack for what would have been anathema in a post from me . . . but maybe some will call you an a-hole or worse as they have repeatedly screeched when I imply exactly what you’ve said “out loud.”

    In fairness to Dr Jay, clinical experience can sometimes constitute significant evidence. For example, I have given over 300,000 immunizations in my career, without a single serious reaction. I think that is statistically significant.

    We may be classifying “serious reactions” differently. You seem to indicate that you would not consider a temporal relationship between vaccines and a seizure or the development of autism a “serious reaction.” I mean that with no malice because that certainly is the opinion of the majority of Academy members. I disagree and would classify autism following vaccination as a possible “serious reaction” to the vaccine. We might actually have some common ground if this occurred within minutes while the child were still in our office–I’ve not seen that–but we would probably disagree about the appearance of the symptoms of autism three or four hours or four, five or ten days following a vaccine. This is something I believe I have seen.

    Have you never seen a child develop autism within the weeks following a vaccine? Not that this constitutes proof, but an accumulation of a reasonable number of these cases is evidence worth considering.

    Jay

  116. #116 augustine
    September 2, 2010

    Chris,

    Are you their dad or are you their mom? I don’t understand why you’re so emotional about such a rational question about being trapped in the wrong body.

    Actually I do. I just like to see you squirm. You made an error in logic. It is your belief system. Just admit it. Political correctness be damned. You’ve been swooped into it all. If you need to you can call Orac for counseling on this one.

    Is it logical for one to ACTUALLY be trapped in the wrong body? Is it logical to forgo the measles vaccine?

  117. #117 The Gregarious Misanthrope
    September 2, 2010

    Seriously folks, stop feeding the troll. The thing talks like Jenny McCarthy’s parrot: spouting random anti-vax non-sequiturs with the occasional transgender rant it must have picked up from an old Jim Carrey routine.

  118. #118 Jay Gordon
    September 2, 2010

    That’s what I get for staying awake for just one more comment!

    Donald, thanks for the MOC heads up. I didn’t really look into it much before but I’ve registered now. It looks like it will be a valued credential in the future. I wish I’d taken notice before.

    Good Night All!

    Jay

  119. #119 augustine
    September 2, 2010

    gregarious misantelope:

    maybe you can help out Chris with his faux paux.

    Do YOU think it is logical that a person is ACTUALLU trapped in the wrong body and vaginoplasty will fix the problem? Or do you plead politically correct? No wonder pro mass vaccine propagandists can’t keep their stories straight. They have situational logic. It’s confusing, you know.

    I’m really surprised how this stumps all of the “scientists. I know. most are really science groupies and wannabes like science momma and Chris but oh well.

    But, this should be a straight up answer that keeps getting avoiding by the pc over the science.

  120. #120 Julain Frost
    September 2, 2010

    Dr. Jay:

    Whoa! Orac, you posted but didn’t answer my question about your compensation for website traffic!

    And yet you post comments here thus driving up Orac’s traffic and insuring this thread stays in the Top Five Most Active for longer. Methinks thou dost protest too much.

  121. #121 NZ Sceptic
    September 2, 2010

    Good heavens! When I sent you this Daily Mail link a few days ago Orac (Here in NZ we are a few hours ahead of the UK and US) I made the following comment: “I bet AoA is already constructing a long and rambling, distorted and deceitful post about it….”
    And voila! I must be a psychic!

  122. #122 Robert S.
    September 2, 2010

    Chris @65. I’d never seen that quote that angered me quite so much. I want to get in a time machine and beat the crap out of that woman for blaming her daughter for dying from HIV that Maggiore herself transmitted.

    “How come what we offered was not enough to keep her here when children with far less — impatient distracted parents, a small apartment on a busy street, extended day care, Oscar Mayer Lunchables — will happily stay?”

    Eliza did not choose to slowly and painfully die from AIDS. She died from a total failure to provide treatment. As for Maggiore herself, I say good riddance, one less person who would let their child die for their own comfort.

  123. #123 dt
    September 2, 2010

    @sidoffit #110

    Don’t confuse the pseudosciencey, biologically imprecsie, touchy-feely, tree-huggy talk of “boosting one’s immune system” with the scientifically valid concept of stimulating certain parts of the immune system via vaccination.

    The latter process does not really “boost” the immune system, it merely primes it so it can kick into action immediately the real challenge comes along. Vaccines in general stimulate the immune system less than a natural infection will (there are particular exceptions to this rule, such as tetanus for example).

  124. #124 mario
    September 2, 2010

    Nevermind the bullshit. As an outside observer, knowing nothing about the subject, it is easy to see who I can trust
    Dr j says: “no studies” ….cris answers: here is a bunch would you mind showing these to your patients? …no answer.
    Dr dcotler says: if were are going for experience, then here are my conclusions….dr j answers : you’re right! (totally missing the sarcasm, I would say in a sly not a naive way) oh but I have 31 years and you only 25 plus you are biased by your definitions and I’m sure that you consider all bullet wounds just minor scratches…
    Mr orac, I am glad you did not answer about your income, not falling into smear tactics is hard to do.

  125. #125 Coryat
    September 2, 2010

    “Vaccine doctors sell vaccines. They promote their use for everyone with skin. But you could classify them as agents of the state. Carrying out the will of state policy makers.”

    Yes Augustine, doctors are the agents of the state. Only in the cretinous bizzaro-world that you inhabit does that make sense.

  126. #126 Jud
    September 2, 2010

    “There is a difference between scientific proof and legal proof,” Conway said. “One is 95 percent certainty, and the other is . . . 50 percent and a feather.”

    Seems that this has created a bit of confusion – very understandably, since the confusion makes proof of a vaccine claim seem easier than it actually would be for this attorney’s potential clients.

    So let me try to clear it up a bit, for the U.S. at least.

    In the regular court system, to prevail in a civil (i.e., not criminal) case, you must generally provide a “preponderance” of the evidence, which is Conway’s “50% and a feather.” But the *standard* for what constitutes scientific evidence is found in a line of cases originating from the Supreme Court’s Daubert ruling, which limits the type of evidence that can be accepted in court. So yes, it’s 50% and a feather, but your 50% and a feather will be comprised of studies where the conclusion was statistically significant at the 95% level.

    A controlled study where there was one more individual showing the effect with substance X than showed the effect with a placebo wouldn’t meet the Daubert criteria and would never make it into court to become part of that “50% and a feather.” Clear so far, I hope?

    Now the Vaccine Court has loosened the Daubert standard. In particular, studies and reports need not be peer-reviewed in order to be accepted into evidence. But this does *not* mean such evidence must be accepted as true. With the exception of “table injuries,” claimants must logically prove harm from vaccines using the “three prongs” Orac mentioned above:

    – a medical hypothesis causally connecting the vaccination and the injury;
    – a logical sequence of cause and effect showing that the vaccination was the reason for the injury; and
    – a showing of a proximate temporal relationship between vaccination and injury.

    In the Autism Omnibus rulings I’ve read, claimants have not been able to come up with a logical medical hypothesis showing how the vaccine caused autism, so they failed the first two “prongs.”

    In the Vaccine Court (or in a regular civil action), preponderance of the evidence is not just the *quantity* of evidence, it is the *quality*. If the claimant has a mountain of reports, but not one of them shows a logical way to get from vaccine to autism, then that’s not 50% and a feather, that’s zero in terms of proof.

    Hope that helps folks understand the relationship between scientific proof and legal proof.

  127. #127 LW
    September 2, 2010

    I wonder just how much experience Dr. Gordon really has with vaccines. I know, I know, 31 years practicing, but I’ve been reading Respectful Insolence for years, and he’s always said that he vaccinates only rarely. In recent threads he’s said that he only gives the DTaP (or, as he calls it, the DPT). So, when he touts his “clinical experience”, is he touting his recollection of what he remembers that he thought he observed many years ago, his memory being colored by his beliefs and backed up by what his patients’ parents say they remember they observed, colored by their own belief, and filtered through his beliefs?

  128. #128 Donna B.
    September 2, 2010

    Just to clarify something from my earlier post way up there somewhere on this thread…

    The reason I mentioned my grandfather’s death from the flu and how we don’t think of the flu as so bad anymore is precisely because we have so many more ways to treat it.

    We have therefore come to think of it as ‘not too bad’. It’s the same for augustine’s relative who died of an aneurysm – treatments and diagnoses are better there too. Though beyond that it’s a lousy comparison to a viral/bacterial disease.

    So, it somehow seems to make sense to some people that since we have better medicines for viral/bacterial diseases, it’s not as important to prevent them as it once was.

    That’s simply foolish.

  129. #129 dt
    September 2, 2010

    Dr Jay Gordon’s susceptibility to irrational thinking worries me. He doesn’t think we should vaccinate kids against Hib because “there isn’t a problem with it now” (to paraphrase his thoughts).

    Yet he fully accepts that before universal vaccination against Hib, kids in their thousands got invasive haemophilus infections and hundreds died.

    So why does he want to turn the clock back?
    I am totally bewildered.

  130. #130 dt
    September 2, 2010

    DonnaB @126
    I guess people like Augie behave rather differently than you and me. We’d make sure our kids drove a car with airbags, ABS, seatbelts etc because we’d want as much protection as possible in the case of an accident.

    Augie wouldn’t bother with all this. Having an accident doesn’t worry him, because nowadays we have better brain surgeons, orthopedic surgeons, ERs and ITUs to deal with the consequences of a crash.

  131. #131 Dangerous Bacon
    September 2, 2010

    I see Jay Gordon is upset over Orac getting significant website traffic and some income from ScienceBlogs as a result.

    Jay: “I get no money for posting here and my website costs me quite a bit of money each month and I receive no compensation from other sources nor increased business or sales because of the site. Someday I hope to, by the way.”

    Jay seems to be jealous that despite posting provocatively idiotic articles on his own website he doesn’t get a lot of traffic (or compensation), while Orac’s detailed, well thought-out (and often provocative) articles do get attention. A number of obvious remedies suggest themselves.

    LW said: “I wonder just how much experience Dr. Gordon really has with vaccines. I know, I know, 31 years practicing, but I’ve been reading Respectful Insolence for years, and he’s always said that he vaccinates only rarely. In recent threads he’s said that he only gives the DTaP (or, as he calls it, the DPT).”

    To be precise, Jay said that for kids under ten his “vaccine schedule” is either zero or a single DTP shot (which is woefully inadequate, as the American Academy of Pediatrics calls for five doses of this vaccine).

    I’m still waiting to hear why Jay is angry at Penn & Teller’s show for airing his (allegedly truncated) comment that “Children should not be vaccinated” when he’s admitted here that he essentially follows just that practice.

  132. #132 dcotler
    September 2, 2010

    Jay, I have actually never seen anything resembling the “onset” of autism in any reasonable temporal relation to an immunization. Mario got it right @122. I will ignore my biased experience if you will ignore yours.

    Regarding MOC, I think it is prudent for Pediatricians with lifetime certification to reassure our patients and VARIOUS THIRD PARTIES (as well as ourselves) that we haven’t missed anything important since our original certification. Judging from the perspicacity you demonstrate in this arena, I predict that you will pass the test easily. The part that doesn’t fit, for me, is how you can believe some of the things you advocate in the face of overwhelming evidence to the contrary.

  133. #133 Pablo
    September 2, 2010

    I’m still waiting to hear why Jay is angry at Penn & Teller’s show for airing his (allegedly truncated) comment that “Children should not be vaccinated” when he’s admitted here that he essentially follows just that practice.

    I think I know the problem.

    See, in the original agreement, the producers promised not to cut ANY of the comments, and to play them in full. But see, in Dr. Jay’s comment, they cut out the part where he said, “In my opinion…” Hence, they LIED to him!!!!!!!!!

    It’s not that they misrepresented his views or the meaning of his statement, they just failed to air the complete quote as they promised. Hence, they are liars and he can blow off in false anger to try to distract the attention from the fact that he does advocate against vaccination.

    It works, at least for the simpletons who are anti-vaccine. They get to dismiss everything in P&T’s show because, supposedly, they unfairly edit people’s quotes to make them look bad.

    It’s like dismissing a full body of work because you find a grammatical or spelling error. It’s stupid (and basically false) pedantric outrage.

  134. #134 K0ilar
    September 2, 2010

    Now, why exactly does augustine bring that “beeing trapped in a wrong body”-theme up here? Does anyone have a clue? If you, augie, want to induce a discussion about what is “rational” and what is not, you might want to follow this argumentation: It is not of anyone’s business what people do to their bodies (I believe you are with me on this one, as you claim the state should not be able to enforce invasive procedures, but here comes the kicker:) AS LONG as they do not harm others! Now it might or might not be rational to have one’s sex changed, but why care as anyone who does so, does not hurt anyone else. On the other hand it IS rational, according to scientific data (that many here fortunately not get tired of gathering) to vaccinate a child. And this not only for the sake of the group, but also for the sake of the child, although adverse reactions may seldomly occur. (I am not gonna have Dr Jay claiming me – ridiculously – to be a “side-effect-dinialist”.)
    By the way, I don’t know if you read my thread #493 on the other post, but how do you feel in your position as beeing the evil twin of one of the few geologists who claim the earth is 6000 years old, Dr Jay?

  135. #135 Chris
    September 2, 2010

    It seems he does not understand that not all engineers are men. He cannot fathom why a person with a neuter name can be both a mother and an engineer. Plus he is a sexist git, which you can figure from how he addresses Science Mom (who has a brilliant website with Catherina).

  136. #136 Todd W.
    September 2, 2010

    @Dr. Jay

    To sum up your responses:

    * What is your definition of a “vaccine side effect denialist” (VSED)?

    Your answer: Someone who says [I'm assuming habitually and even when presented with any and all evidence to the contrary] there are no or virtually no side effects from vaccines. Thank you for providing your definition (which you had not clearly stated before).

    * You say that VSEDs exist here at RI. Please provide a concrete example of VSED behavior.

    Your answer: “If you spend the next few weeks looking through the archives you’ll find these people. Trust me, they’re in there.” Or, to paraphrase, “I’m not going to back up my claim. You go do my homework.” So, no real answer there. Sorry, Jay, but you know better than that.

    * What is your definition of “those at highest risk”?

    If you recall from when I originally asked this question in the other thread, the context was the HiB vaccine. This question was asked after you stated that you only give the vaccine to those “at highest risk”, with no qualifiers or definitions.

    Your answer:

    “Highest risk” depends on too many variables for a simple answer to suffice. Are children with bad asthma had higher risk from pertussis? Yes. Are surgeons and other HCPs at higher risk of exposure to hepatitis B? Yes. Do children on high dose steroids for asthma or getting treated for malignancies need chicken pox vaccination? Yes. I could go on here, but you get the idea. I give vaccines to many children in my practice but I give far fewer than most pediatricians do in large measure because I don’t view vaccination as an unequivocally beneficial nor completely safe medical intervention. For those reasons, if for no others, I think that vaccine scheduling must be individualized.

    In other words, you have a variety of criteria and will not commit to specific definitions here. I’m still curious about your definition for “highest risk” in relation to HiB, from the context of the original question.

    * Am I correct that your recommendation is that except for people who meet that definition, everyone else should not bother with the vaccine?

    Again, this was asked specifically about the HiB vaccine, which you said you only give to those “at highest risk”.

    Your answer: “Lastly, my recommendation for most other families is contained in my web site statement above.”

    Rather than make a concrete statement here, you direct people to your web site. Well, I did actually go there. I looked over the information found in the A-Z Index under Vaccines. I found information about HiB. I found your opinions about the HiB vaccine. If I were unaware of anything else, your post would certainly scare me into not getting the vaccine for my child. In that sense, it was not exactly based on the best available scientific evidence. You know what I did not find, though? A recommendation about whether or not to get the HiB vaccine.

    I even used the Search feature. Nada.

    With these results (1 clear answer out of 4 questions asked), I will ask again those question which you did not answer:

    * You say that VSEDs exist here at RI. Please provide a concrete example of VSED behavior.
    * What is your definition of “those at highest risk” (in the original context of the question – HiB)?
    * Am I correct that your recommendation is that except for people who meet that definition, everyone else should not bother with the [HiB] vaccine?

  137. #137 Orac
    September 2, 2010

    Your answer: “If you spend the next few weeks looking through the archives you’ll find these people. Trust me, they’re in there.” Or, to paraphrase, “I’m not going to back up my claim. You go do my homework.” So, no real answer there.

    Indeed. That’s why Dr. Jay blew out another one of my irony meters when he demanded I tell him whether Seed pays me to blog and demanded again when I ignored him.

    Tell ya what, Dr. Jay. Give us a straight answer to questions you were asked first (such as our request that you provide concrete examples of “vaccine injury denialism” from this blog), and then maybe I’ll answer your question. Until then, my answer will be the same as yours: Search my archives. It’s in there.

  138. #138 Orac
    September 2, 2010

    hoa! Orac, you posted but didn’t answer my question about your compensation for website traffic!

    Why? You planning on trying to get me fired from my job, as Age of Autism’s readers did a couple of months ago?

  139. #139 Chris
    September 2, 2010

    I am still wondering if Jay gave the MMR vaccine prior to 1998. Is he really more persuaded by Wakefield’s press conference that misrepresented his now retracted Lancet paper than all of the research done on the vaccine since before its approval in 1971? Seriously?

  140. #140 Dangerous Bacon
    September 2, 2010

    Regarding alleged “vaccine side effect denialists”, Jay Gordon said: “Many of the overzealous comments about vaccines over the past few years at RI have implied or stated that vaccines are without, or virtually without, side effects. Otherwise sensible scientists have made statements to that effect including Dr. Paul Offit’s famous–and misquoted–“10,000 vaccines” statement.”

    Talk about exploding irony meters. Jay, where did you get the idea that Dr. Offit has ever suggested that vaccines have no or virtually no side effects? His oft-misquoted/misinterpreted statement had to do with immune system capacity, and was made in response to claims that vaccines “overload” a young child’s immune system.

    So, will you now stop misrepresenting what Dr. Offit said?

  141. #141 Scott
    September 2, 2010

    So, it somehow seems to make sense to some people that since we have better medicines for viral/bacterial diseases, it’s not as important to prevent them as it once was.

    That’s simply foolish.

    Actually, that’s accurate – not foolish. It is true that better treatments have reduced the value of prevention (since the problems associated with getting the disease are less), and hence the risk/benefit ratio of vaccination as well.

    Where the antivax brigade falls off the logic train is when they conclude that the difference is enough to be relevant. In reality, the situation has simply gone from being utterly overwhelmingly in favor of vaccination/prevention, to being simply overwhelmingly in favor.

    So less, but not to a degree that makes a practical difference to the decision-making process.

  142. #142 augustine
    September 2, 2010

    [I guess people like Augie behave rather differently than you and me. We'd make sure our kids drove a car with airbags, ABS, seatbelts etc because we'd want as much protection as possible in the case of an accident.]

    Can’t have a forced mass vaccine ideology post without the seatbelt analogy gambit.

  143. #143 augustine
    September 2, 2010

    [Danger bAcon: So, will you now stop misrepresenting what Dr. Offit said?]

    If you tell the health department and doctor’s who sell vaccines.

    http://www.chatham-kent.ca/NR/rdonlyres/4C480F5C-A485-4B25-AF77-4C3C35C34701/8985/CDC_IC_Tool.pdf

    “DID YOU KNOW? Scientists have estimated that babies can
    respond to 10,000 shots at one time! Today, at your baby’s
    two month visit, your baby will receive four shots.”

    I call this here Propaganda. You call it education or literature.

  144. #144 Science Mom
    September 2, 2010

    It seems he does not understand that not all engineers are men. He cannot fathom why a person with a neuter name can be both a mother and an engineer. Plus he is a sexist git, which you can figure from how he addresses Science Mom (who has a brilliant website with Catherina).

    Thank you for your kind words Chris. Stick a fork in augie, he’s done. He has disdain for those that are more educated than he, which is to say, nearly everyone here. But even more so for women. He rectally-sources all of his assertions and doesn’t have a grasp of the most rudimentary principles of any scientific discipline. He is nothing more than a pathetic, attention-seeking, inferiority-complexed twerp.

  145. #145 augustine
    September 2, 2010

    [Plus he is a sexist git, which you can figure from how he addresses Science Mom (who has a brilliant website with Catherina).]

    Ok away from the transgender example because you seem to be hung up and sensitive about it. Can a person be a kitty cat trapped in human body. Can he be a wolf trapped in human body?

    If they put on whiskers and fur will they really be a kitty cat or a wolf?

    Chris you use situational logic and reason whenever you choose. You’re not objective. You’re a biased and opinionated bully.

    You believe that it is reasonable for someone to be in the wrong body and that surgery fixes that mixup. You claim to use critical thinking and logic to come to your conclusions and biases. Yet this is very inconsistent.

  146. #146 Jay Gordon
    September 2, 2010

    And yet you post comments here thus driving up Orac’s traffic and insuring this thread stays in the Top Five Most Active for longer. Methinks thou dost protest too much.

    I thoroughly enjoy participating in making this one of the top web sites on the Internet. Scorn and contempt for me deserve a far greater audience than I could ever attract on my own!

    Dr dcotler says: if were are going for experience, then here are my conclusions….dr j answers : you’re right! (totally missing the sarcasm, I would say in a sly not a naive way) oh but I have 31 years and you only 25 plus you are biased by your definitions and I’m sure that you consider all bullet wounds just minor scratches…

    Dr. Cotler’s comments were not meant sarcastically. Not one bit. I believe (below) he may be backpedaling a little and implying that they were. I can tell from his comments here and from reading his comments and a few medical columns elsewhere that he’s a smart experienced pediatrician just a few years younger than I. His bias is in one direction and mine in another. But we are both honest and sincere in our feelings about our experience as pediatricians caring deeply for the children for whom we are responsible.

    @jud A controlled study where there was one more individual showing the effect with substance X than showed the effect with a placebo wouldn’t meet the Daubert criteria and would never make it into court to become part of that “50% and a feather.” Clear so far, I hope?

    Well said! That “feather” metaphor Orac used originally is deceptive. If the studies being used were truly worth a feather they would not qualify for proof in a court of law or a scientific forum. Straw man! False dichotomy!! (Fill in the blank here with one of your favorite cliches please.)

    @LW I wonder just how much experience Dr. Gordon really has with vaccines. I know, I know, 31 years practicing, but I’ve been reading Respectful Insolence for years, and he’s always said that he vaccinates only rarely.

    I have a huge amount of experience with vaccines. I have been in private practice for only 31 years but involved in medicine and medical research since 1967.

    @dt Yet he fully accepts that before universal vaccination against Hib, kids in their thousands got invasive haemophilus infections and hundreds died. So why does he want to turn the clock back?
    I am totally bewildered.

    I don’t want to turn the clock back. I merely want to point out that medical progress often renders procedures and medications either obsolete or at the very least changes the application and utility of these things. Decades create new medical realities. That’s a very easy concept and you’re only pretending to be “bewildered” for effect. Fail.

    @Dangerous Bacon Jay seems to be jealous that despite posting provocatively idiotic articles on his own website he doesn’t get a lot of traffic (or compensation), while Orac’s detailed, well thought-out (and often provocative) articles do get attention. A number of obvious remedies suggest themselves.

    To be precise, Jay said that for kids under ten his “vaccine schedule” is either zero or a single DTP shot (which is woefully inadequate, as the American Academy of Pediatrics calls for five doses of this vaccine).

    Bacon, when I give vaccines–the DTaP for example–I give it in a series. I do the same for Hep B vaccines, Hep A, polio vaccines and others. And, by the way, my site gets a lot of traffic, too. For all I know, we get more there than here. And I know that if I were willing to abandon all semblance of fairness, civility and actual logic–as goes on here on RI–my traffic would go through the roof!

    @Jud I’m still waiting to hear why Jay is angry at Penn & Teller’s show for airing his (allegedly truncated) comment that “Children should not be vaccinated” when he’s admitted here that he essentially follows just that practice.

    I will repeat, P&T’s producers edited my interview to reverse the meaning of what I’ve said here countless times and what I say everywhere else: I vaccinate children every day, I do not think they “should not be vaccinated.” Listen to the show. It’s too obvious. Why would would they have cut off the first part of my sentence if it were something like, “In my opinion . . .”??

    @dcotler Jay, I have actually never seen anything resembling the “onset” of autism in any reasonable temporal relation to an immunization. Mario got it right @122. I will ignore my biased experience if you will ignore yours.

    Donald, you and I both know that you were not being sarcastic. Our experience is very valuable. Please retain your integrity in supporting the concept of decades of experience with tens of thousand of children being valuable data even while you vociferously oppose my specific biases. I’m counting on you here.

    @ORAC!!! Tell ya what, Dr. Jay. Give us a straight answer to questions you were asked first (such as our request that you provide concrete examples of “vaccine injury denialism” from this blog), and then maybe I’ll answer your question. Until then, my answer will be the same as yours: Search my archives. It’s in there.

    No answers, right David? You are probably making a huge amount of money for the kind of traffic you get here. Your posts keep getting more obsessively focused on your perceived enemies, outrageous, less scientific and soon you’ll just be the Glen Beck of the Science Blog/Seed world: Lots of money, a cult-like following and losing yourself in vitriol to increase popularity. You used to better than this.

    @Chris I am still wondering if Jay gave the MMR vaccine prior to 1998. Is he really more persuaded by Wakefield’s press conference that misrepresented his now retracted Lancet paper than all of the research done on the vaccine since before its approval in 1971? Seriously?

    I was always reluctant to give the MMR. I think that Wakefield’s study was badly flawed but that the data he generated, such as it was, bears further investigation and not the treatment it is receiving now.

    @Dangerous Bacon Dr Offit is a good man, a fine researcher, an honest scientist and, believe it or not, almost a friend. He erred here in his hyperbole and was suggesting very strongly that vaccines are so devoid of side effects that 10,000 could be given at once with 100,000 antigens. A simple excited mistake which he regrets because this type of exaggeration does not add anything to a reasoned discussion of an important topic.

    Have a Great Day My Dear Colleagues,

    Jay

  147. #147 Jay Gordon
    September 2, 2010

    Correcting one of the many typos above:

    [@ORAC] Your posts keep getting more obsessively focused on your perceived enemies, outrageous, less scientific and soon you’ll just be the Glenn Beck of the Science Blog/Seed world: Lots of money, a cult-like following and losing yourself in vitriol to increase popularity. You used to be better than this.

  148. #148 Scott
    September 2, 2010

    I will repeat, P&T’s producers edited my interview to reverse the meaning of what I’ve said here countless times and what I say everywhere else: I vaccinate children every day, I do not think they “should not be vaccinated.” Listen to the show. It’s too obvious. Why would would they have cut off the first part of my sentence if it were something like, “In my opinion . . .”??

    It is indeed too obvious. Too obvious that you’re lying through your teeth, and in fact were quoted with perfect accuracy.

  149. #149 Todd W.
    September 2, 2010

    @Dr. Jay

    Wow. Great big post and…zero answers to my questions at post 136. Here they are again, Jay, so they don’t get lost.

    * You say that VSEDs exist here at RI. Please provide a concrete example of VSED behavior.
    * What is your definition of “those at highest risk” (in the original context of the question – HiB)?
    * Am I correct that your recommendation is that except for people who meet that definition, everyone else should not bother with the [HiB] vaccine?

  150. #150 Science Mom
    September 2, 2010

    I have offered this before but the good Dr. Jay refuses to answer. Dr. Jay, please fill in the blank with what you feel has been edited out:

    “__________________Children should not be vaccinated; this is very much at odds with the mainstream medical point of view which says that there is no connection between vaccines and autism and I think that is a flat-out lie.”

    Oh, and Orac has posted before about the chump change he makes here at SciBlogs, you are sounding rather unhinged.

  151. #151 jay.sweet
    September 2, 2010

    @Shay #60:

    Thank you, Jay. I don’t suppose you care to comment on the fact that California is on the verge of breaking a fifty-year record for pertussis cases?

    *sigh*… I’ll just assume you hadn’t read my earlier comment, and took what I said out of context. Otherwise I’d have to call you an right idiot.

    I was referring to a friend who is extremely pro-vaccine (as am I) who had a severe reaction to the pertussis vaccine on the first go ’round, and is not supposed to get further pertussis vaccine on the strenuous recommendation of a legitimate non-quack doctor. The point I was making in relaying this anecdote was that the existence of rare-but-harmful side-effects does not have to put one off of the idea of vaccines even if you are the victim of one of those rare side-effects.

    The out-of-context quote you were responding to was my response to ebohlman who had some information suggesting that the newer pertussis vaccines would have been less likely to have provoked a reaction. I do think this is interesting, but I also do not think it changes the doctor’s recommendation for my friend. Whether it does or not, of course, is not germane to the general point that, barring specific medical exceptions, everyone should be getting vaccinated for pertussis. Of course.

    I almost mentioned the recent California pertussis outbreak in the very comment you took out of context — I was almost going to say, if my friend lived in California, where herd immunity is threatened, then I suspect it might be worth revisiting the issue with her doctor, to see if she ought to consider trying the newer vaccine in order to protect herself.

    Which makes yet another point in favor of routine vaccinations, of course: Even with the newer vaccine, it would undeniably be at least a little bit risky for my friend to repeat the pertussis vaccine, given the severe nature of the reaction she had on the first go-round. This is not a problem when compliance rates remain high — those few people for whom the vaccine is contraindicated are protected by herd immunity. But the fuckers in California forgoing vaccinations on ideological or fear-based grounds are undermining that protection, which forces those who do have legitimate medical issues that contraindicate some or all vaccination to weigh those against a much heftier risk.

    I think in your rush to jump on me, you are forgetting half the point of herd immunity. What makes inappropriate forgoing of vaccines so despicable is the fact that there are some individuals who legitimately must depend on herd immunity — those who are too young, those with a severe past reaction to vaccine, and those with various immune issues or other health issues. It ought to go without saying, but clearly there is a big difference between one of these individuals relying on herd immunity vs. someone who has no legitimate reason not to get vaccinated choosing to rely on herd immunity, i.e. free riders. Please try to distinguish better in the future!

  152. #152 augustine
    September 2, 2010

    [Thank you for your kind words Chris. Stick a fork in augie, he's done. He has disdain for those that are more educated than he, which is to say, nearly everyone here. But even more so for women. He rectally-sources all of his assertions and doesn't have a grasp of the most rudimentary principles of any scientific discipline. He is nothing more than a pathetic, attention-seeking, inferiority-complexed twerp.]

    Now that it what science blogging is all about. That is what skepticism, critical thinking, and a little science represents. That’s what I’m talking about, momma. It makes me laugh when I see this site referenced as a scientific authority.

  153. #153 Dangerous Bacon
    September 2, 2010

    Jay’s evasions continue.

    Jay in comments in this thread:“Bacon, when I give vaccines–the DTaP for example–I give it in a series.”

    Jay in the thread on “Vaccine Exemptions In California Threaten Herd Immunity” (post #293: “My vaccine schedule? Either none or just a DPT in the first 24 months of life.

    So, “just a DPT” actually means “a series”? By “series”, do you mean the number of doses (5) called for by the CDC and the American Academy of Pediatrics, or a non-evidence-based number you rely on for personal reasons?

    Jay: “Your posts keep getting more obsessively focused on your perceived enemies, outrageous, less scientific and soon you’ll just be the Glen Beck of the Science Blog/Seed world: Lots of money, a cult-like following and losing yourself in vitriol to increase popularity.”

    While this was aimed at Orac, it shows an amazing degree of unconscious self-awareness on Jay’s part.

    Jay: “@Dangerous Bacon Dr Offit is a good man, a fine researcher, an honest scientist and, believe it or not, almost a friend. He erred here in his hyperbole and was suggesting very strongly that vaccines are so devoid of side effects that 10,000 could be given at once with 100,000 antigens. A simple excited mistake which he regrets because this type of exaggeration does not add anything to a reasoned discussion of an important topic.”

    Show us any statement by Offit that he believes vaccines are “devoid of side effects” and/or that he “regrets” making his comments about immune capacity in kids. Handwaving about how “it’s in the record” and we should do your work and find it, is not acceptable.

    By the way, how are things going with your Incredible Morphing Convictions regarding vaccination and autism (you’re convinced, then you “abjure” the concept that a link is proven, then you’re sure it’s proven except “scientists” won’t accept it, but you yourself claim to be a scientist) – will there be some definitive pronouncement from you accompanied by declarations about how your previously differing remarks are now inoperable?

    (See post #444 in comments on the California vaccine exemptions thread for examples of Jay’s yes it’s true/no it’s not/yes it’s true comments on the subject).

    Seriously Jay, if you weren’t so hilariously inept in expressing yourself and high in entertainment value (as opposed to a useful source of trusted medical advice), Orac would have considerably less traffic and wouldn’t be raking in millions from all his pharma-clones.

  154. #154 dcotler
    September 2, 2010

    Dr Jay is a little bit right about me. I do believe my experience. Where he and I differ is in my knowledge that my expectation biases my interpretation of my experience, rendering it less persuasive, even to me. That’s how these matters should be approached.
    “Don’t believe everything you think.”

  155. #155 dt
    September 2, 2010

    I must take issue with Dr Jay’s response to my pointing out how he thinks we no longer need to vaccinate against Haemophilus infection.

    I said: Yet he fully accepts that before universal vaccination against Hib, kids in their thousands got invasive haemophilus infections and hundreds died. So why does he want to turn the clock back?
    I am totally bewildered.

    Dr Jay replied: I don’t want to turn the clock back. I merely want to point out that medical progress often renders procedures and medications either obsolete or at the very least changes the application and utility of these things. Decades create new medical realities. That’s a very easy concept and you’re only pretending to be “bewildered” for effect. Fail.

    Pray tell us, Dr Jay, exactly which medical advances have occured in the last 2 decades to render HiB vaccination “obsolete”?

    And do you think that if no-one vaccinated against HiB it would behave any differently than it did 20 years ago? Would it spontaneously, magically decide not to kill the babies it would infect any more?

    There is a major FAIL here, Jay, but it’s on your part as you try and worm your way out of the deep hole you have dug yourself.

  156. #156 grenouille
    September 2, 2010

    @dt Yet he fully accepts that before universal vaccination against Hib, kids in their thousands got invasive haemophilus infections and hundreds died. So why does he want to turn the clock back?
    I am totally bewildered.

    Dr Jay’s response:

    I don’t want to turn the clock back. I merely want to point out that medical progress often renders procedures and medications either obsolete or at the very least changes the application and utility of these things. Decades create new medical realities. That’s a very easy concept and you’re only pretending to be “bewildered” for effect. Fail.

    Um, but the only reason there has been such a huge reduction in Hib infection is the Hib vaccine. Things like orbital cellulitis are still a bear to treat with lots of possible complications. I don’t think any recent treatment options have made the Hib vaccine obsolete. To reduce herd immunity when countries around the world still struggle with Hib would indeed be turning back the clock.

    Despite what you implied on the other thread, I am in fact in my mid-thirties–since the vaccine was not released until the mid-eighties, I could be as young as mid-twenties. It was not the Dark Ages when I was treated for orbital cellulitis, and everyone recognized the seriousness of the situation. Even more so since the other child in the hospital with orbital cellulitis died while I was being treated.

    I am currently pregnant and it infuriates me that I have to worry more about measles and whooping cough than my mother did. Thanks to people like you, Dr. Jay.

    I had to recycle my issue of Fit Pregnancy when I saw you wrote the column on infant health. I just could not believe anything else I read in it.

  157. #157 brian
    September 2, 2010

    @143

    Jay Gordon wrote: “Offit] erred here in his hyperbole and was suggesting very strongly that vaccines are so devoid of side effects that 10,000 could be given at once with 100,000 antigens.”

    In response to the suggestion that simultaneous vaccinations could somehow “exhaust” the immune system, Offit actually wrote that (according the the calculations that he presented) the immune system would not be exhausted by the simultaneous presentation of even 100 000 antigens: “. . . each infant would have the theoretical capacity to respond to about 10 000 vaccines at any one time . . .” Since he addressed only the capacity of the immune system and NOT any potential side effects in that section of his paper, he did not in any way suggest that children could safely receive 10 000 vaccines simultaneously “because they were so devoid of side effects.”

    You either badly misread the paper or you intentionally misrepresented the information.

    Hyperbole, indeed.

  158. #158 Jud
    September 2, 2010

    @143, Dr. Gordon references me twice, and gets it wrong both times:

    @jud A controlled study where there was one more individual showing the effect with substance X than showed the effect with a placebo wouldn’t meet the Daubert criteria and would never make it into court to become part of that “50% and a feather.” Clear so far, I hope?

    Well said! That “feather” metaphor Orac used originally is deceptive. If the studies being used were truly worth a feather they would not qualify for proof in a court of law or a scientific forum. Straw man! False dichotomy!! (Fill in the blank here with one of your favorite cliches please.)

    Let me count the ways this is wrong. First, the “feather” metaphor was not used by Orac, it was used by an attorney representing vaccine claimants. Second, the metaphor was not being used to represent the value of a scientific study, but rather the amount by which the probative evidence of one party must exceed the probative evidence of the other in order to prevail in a civil action, or in the Vaccine Court absent a “table injury.” Third, as can be seen in the quote above, I was discussing the Daubert standard, which as Orac and I have both noted is not fully applicable to Vaccine Court claims. Fourth, the claimants’ attorney and I were both discussing U.S. jurisprudence, not the UK case in which compensation was granted. I have no idea if anything like the Daubert standard applies in the UK. Orac was careful to keep the discussion of the US and UK separate, and I was careful to note I was speaking of the US only. I didn’t wish to comment in an area (UK jurisprudence) where I have little or no expertise. (Dr. Gordon, please take a lesson.)

    @Jud I’m still waiting to hear why Jay is angry at Penn & Teller’s show for airing his (allegedly truncated) comment that “Children should not be vaccinated” when he’s admitted here that he essentially follows just that practice.

    I never said anything of the sort. Dr. Gordon, you may wish to have another look at who authored comment #131.

    At least five errors in that one comment. Dr. Gordon, this doesn’t fill me with confidence regarding the degree of care you take in your thinking and writing. Yes, I well understand this isn’t the practice of medicine, it’s just back-and-forth on an Internet blog. But many people manage to be pretty scrupulous about getting things right even in this rather informal context.

  159. #159 augustine
    September 2, 2010

    [grennoulle:I am currently pregnant and it infuriates me that I have to worry more about measles and whooping cough than my mother did. Thanks to people like you, Dr. Jay.]

    You should worry more about breast feeding than who is and who isn’t vaccinated.

    http://www.thelancet.com/journals/lancet/article/PIIS0140673603139864/fulltext

    “Why the rise in Haemophilus influenzae type b infections?”

    http://ije.oxfordjournals.org/cgi/reprint/26/2/443

    “Protective Effect of Breastfeeding on
    Invasive Haemophilus influenzae
    Infection: A Case-Control Study in
    Swedish Preschool Children”

  160. #160 Todd W.
    September 2, 2010

    @Jay

    One other quick side-note. You had a couple errors on your web site that, even though I was not specifically looking for them, jumped out at me:

    * I saw reference to the DPT as a current vaccine. This is inaccurate. DPT, as you were informed before, is no longer in use.
    * I saw reference to something you called the DPaT. Repeatedly, which makes me suspect it was not just a typo. There is no such thing as the DPaT (who here has heard of acellular tetanus?). There is, however, a DTaP.

    These are just side notes that do not require a reply from you. I am much more interested in your responses to the questions I have been asking you both in this thread and in the other thread, which you still have not actually answered.

  161. #161 René Najera
    September 2, 2010

    I also have a question for Dr. Gordon. You stated that you were misquoted in the “Bullshit!” episode in that your assertion about not going with the mainstream regarding vaccines was spliced the wrong way. However, several commentators here and in other blogs have pointed out that, if you said what you now say you said, the rest of your statement is completely nonsensical as follows:

    [I'm certainly not saying that] children should not be vaccinated.This is very much at odds with the mainstream medical point of view, which says that there’s no connection between vaccines and autism. I think that that is a flat out lie.

    Can you clear that up for us, Dr. Gordon? Is certainly not saying that children should not be vaccinated very much at odds with the medical establishment?

  162. #162 Orac
    September 2, 2010

    No answers, right David? You are probably making a huge amount of money for the kind of traffic you get here. Your posts keep getting more obsessively focused on your perceived enemies, outrageous, less scientific and soon you’ll just be the Glen Beck of the Science Blog/Seed world: Lots of money, a cult-like following and losing yourself in vitriol to increase popularity. You used to better than this.

    Oh, spare me. My style has evolved over the years, but, if anything, now that so many people know my real identity and as my profile has grown, I tend to be a bit more careful about what I write than I used to be in the past. Go back and peruse the archives back around 2005-2007 if you don’t believe me.

    As for the “lots of money,” geez, how much do you think Seed’s paying me, anyway? Seriously.

  163. #163 Lawrence
    September 2, 2010

    Good call Rene – reading the way he claims it should be, it doesn’t make any sense (though I’m sure augie would approve).

  164. #164 Joseph
    September 2, 2010

    There’s enough of an appearance that it did that, on a legal grounds and a societal basis, he should be given the benefit of the doubt and compensated.

    I’m not so sure about that. There are parents who seem to be pretty sure their kids were made autistic by vaccines. What if they made the same argument? “Give us the benefit of the doubt. We might be right. We need the money.” And so on.

  165. #165 colmcq
    September 2, 2010

    I’m not sure what Orac getting pais or not getting paid has to do with it

  166. #166 Todd W.
    September 2, 2010

    @colmcq

    I’m not sure what Orac getting pais or not getting paid has to do with it

    My guess is that Jay’s feathers got a bit ruffled when some of the commenters suggested that he might be making more money because of his anti-vaccine views. Why he then decided to target Orac, I have no clue.

  167. #167 titmouse
    September 2, 2010

    Dr Offit is a good man, a fine researcher, an honest scientist and, believe it or not, almost a friend. He erred here in his hyperbole and was suggesting very strongly that vaccines are so devoid of side effects that 10,000 could be given at once with 100,000 antigens. A simple excited mistake which he regrets because this type of exaggeration does not add anything to a reasoned discussion of an important topic.

    You just pull stuff out your ass, don’t you.

    I know of two ways to get crazy talk out of reasonably intelligent, sane people:

    1. brain damage
    2. cults.

  168. #168 Doctor Smart
    September 2, 2010

    Speaking of vaccine injuries, America has had 67 garasil deaths/injuries and counting. Why is this dangerous and unnecessary drug being pushed on people? Keep it zipped and avoid the disease. DUH!

  169. #169 Science Mom
    September 2, 2010

    Speaking of vaccine injuries, America has had 67 garasil deaths/injuries and counting. Why is this dangerous and unnecessary drug being pushed on people?

    VAERS reports =/= deaths due to Gardasil.

    Keep it zipped and avoid the disease. DUH!

    Riiiiight, cause abstinence works so well.

  170. #170 Fuzzzone
    September 2, 2010

    “Keep it zipped and avoid the disease. DUH!”

    Just drive safely, then you don’t need those seat belts and air bags. DUH!

    Eat a healthy diet and get plenty of rest and exercise and you don’t need that health insurance. DUH!

    Live in a decent neighborhood and you don’t need to lock your front door. DUH!

    Man, we can do these all day!

  171. #171 Chris
    September 2, 2010

    So where is that fantastic future prediction machine to tell me who my daughter will marry in ten to twenty years so I can tell him to “keep it zipped”!?

    Fuzzone:

    Live in a decent neighborhood and you don’t need to lock your front door. DUH!

    Funny you should mention that. The much nicer neighborhood between us and the lake has the largest number of cars broken into!

  172. #172 augustine
    September 2, 2010

    [Chris: So where is that fantastic future prediction machine to tell me who my daughter will marry in ten to twenty years so I can tell him to "keep it zipped"!? ]

    Where is YOUR future predictor machine that says your daughter will not clear HPV like the vast majority of other healthy people? Statistically speaking she has a very low chance of getting cervical cancer or a persistent infection.

    What if her husband has HIV, gonorrhea, syphilis, pubic lice, a wife beater t-shirt, a prison record, or worse a PREACHER?

    What are you going to do? Screw it just get her vaccinated against everything. She’ll hug you for it.

  173. #173 augustine
    September 2, 2010

    [Chris: So where is that fantastic future prediction machine to tell me who my daughter will marry in ten to twenty years so I can tell him to "keep it zipped"!?]
    ————–
    Mama’s gonna make all of your
    Nightmares come true
    Mama’s gonna put all of her fears into you
    Mama’s gonna keep you right here
    Under her wing
    she won’t let you fly but she might let you sing
    Mama will keep baby cosy and warm

    Mother do think she’s good enough for me
    Mother do think she’s dangerous to me
    Mother will she tear your little boy apart
    Oooh aah, mother will she break my heart
    Hush now baby, baby don’t you cry
    Mama’s gonna check out all your girl friends for you
    Mama won’t let anyone dirty get through
    Mama’s gonna wait up till you get in
    Mama will always find out where
    You’ve been
    Mamma’s gonna keep baby healthy and clean
    Ooooh Babe Ooooh Babe Ooooh Babe
    You’ll always be a baby to me
    Mother, did it need to be so high.

  174. #174 JohnV
    September 2, 2010

    Do not sully Pink Floyd by associating them with your anti-vaccine pro-disease paranoia.

  175. #175 augustine
    September 2, 2010

    [John v :Do not sully Pink Floyd by associating them with your anti-vaccine pro-disease paranoia. ]

    I’m not anti vaccine. And please show me your critical thinking skills and the logic of how you came to the conclusion that I’m pro-disease. No logical fallacies allowed.

    You can’t. You’re not a scientist.

  176. #176 Chris
    September 2, 2010

    Fortunately my daughter is very intelligent, and vaccinated for HPV (along with the Tdap). Little Augie is one of those creeper boy twerps that are beneath her contempt, but who she can insult in at least three languages (each with their own alphabet, which she sometimes switches to on a computer we share).

  177. #177 augustine
    September 2, 2010

    [chris: Fortunately my daughter is very intelligent, and vaccinated for HPV]

    They don’t necessarily go hand n hand.

    [Little Augie is one of those creeper boy twerps that are beneath her contempt, but who she can insult in at least three languages ]

    If she’s 16 she probably has more contempt for you than me.

  178. #178 Calli Arcale
    September 2, 2010

    Jay Gordon (in an old comment):

    If so, your grandfather died somewhere in the late 1920s or 1930s. Medical changes not only include vaccination but antibiotics, ventilators and many other interventions which would have save your grandfather. Your error is common around here.

    A couple of points:

    1) As you are a highly experienced pediatrician, you are no doubt familiar with the fact that antibiotics are not useful in viral infections. While they can treat secondary bacterial infections, they are useless against influenza, and administering them without reasonable suspicion of a bacterial infection is foolhardy.

    2) Ventilators and ECMO machines have saved a lot of lives, but they are not exactly a picnic. Again, I expect you are aware of this, given your extensive experience. (This includes hospital experience, I assume? Not just well-child visits?) My brother was on a ventilator for two months as an infant. (Not due to any infection; it’s a long story.) To this day, he carries the scars. Ventilators themselves can injure the patient, and they can be very unpleasant; patients often need to be sedated so they don’t keep pulling out the endotracheal tube. And of course, sedation isn’t without risk either — this is an intervention only to be used when the alternative is death.

    Frankly, a vaccine is a hell of a lot better than “oh, I’ll just use a ventilator if it comes to that”.

    I’ve really never understood why being able to just barely survive these diseases, in very dire, extreme circumstances, is upheld as some reason to suggest vaccines may not be necessary, as if the disease isn’t to be feared. “Oh, don’t be such a baby; it’s not like you’ll *die*. Probably.” Most will turn out fine. Some will get severe cases. Today, thanks to modern medicine and a great deal of money, very few of those will perish. But it would be better if they hadn’t gotten sick in the first place. Vaccines have small risks. Influenza has more. Hell, a ventilator has more risks. It can give you pneumonia. (Rather a common complication, actually, and sometimes fatal given the weakened condition of anyone forced to rely on a vent.) Collapsed my brother’s trachea. Also, it hurts, and you have to be fed via a naso-gastric tube because you’ve got this *thing* in your mouth all the time. Yay.

  179. #179 ebohlman
    September 3, 2010

    Calli: Don’t forget that there’s a limited supply of ventilators. In fact, our current system of hospitals wouldn’t be able to cope if childhood diseases came back at their old rates; there just wouldn’t be enough beds, as capacity planning has been based on the assumption that hospitalization for measles, etc. will be fairly rare.

  180. #180 Drivebyposter
    September 3, 2010

    Dr. Jay: thank you for responding to my questions in such a timely manner. I have a few more questions, if you don’t mind.
    What do you think the odds are that a child will become autistic after receiving a vaccine?
    Also, are there any vaccines that you feel are more likely to cause this?

    Augie:(or should I say Auger, since you’re so good at boring)
    “What if her husband has HIV, gonorrhea, syphilis, pubic lice, a wife beater t-shirt, a prison record, or worse a PREACHER?
    What are you going to do? Screw it just get her vaccinated against everything. She’ll hug you for it.”

    Can you get vaccines to keep preachers away? What about trolls? Maybe our BIGPHARMA!!!111ONE!!!!!! overlords can help us out with those things.

    Chris: You said “Funny you should mention that. The much nicer neighborhood between us and the lake has the largest number of cars broken into! ”
    Are worse neighborhoods nearby? Or maybe a lot of bored teens?

  181. #181 Chris
    September 3, 2010

    Exactly, ebohlman. Mark Crislip mentioned that his hospital was stressed with H1N1 cases:

    A month ago all the ICU beds were full, most of the ventilators were in use and we were wondering how we were going to triage the next batch of patients who needed advanced life support and we had none to offer. Then, right as we reached maximum capacity and had no more wiggle room, the rates plummeted. We skated right up to the edge of the precipice, looked down, and did not have to jump.

    The lack of capacity for hospitals to handle the extra load if herd immunity was reduced to the point that diseases will come back is the reason I want to ask: So how much stock do you own in hospital supply companies?

  182. #182 Chris
    September 3, 2010

    Drivebyposter:

    Are worse neighborhoods nearby? Or maybe a lot of bored teens?

    The neighborhoods are not that low rent (the new house next door went for over three quarters of a million dollars, and we have a better view of the lake — though we have less than a third of their mortgage!). There is a university and a very good public transit system. And, yes, there are plenty of bored teens. Perhaps that is what Little Augie did before his parents got dial-up.

    I did say between us and the lake. Property values go up if you are closer to the lake, and there is a state highway that separates the neighborhoods (it looks like a four lane arterial).

  183. #183 Drivebyposter
    September 3, 2010

    Chris:
    That is pretty interesting. I wonder if there is an actual cause to the increase in crime there, or if it’s more of a random thing…
    Mmmm…sociology…

  184. #184 Jay Gordon
    September 3, 2010

    @drivebyposter

    “Dr. Jay: thank you for responding to my questions in such a timely manner. I have a few more questions, if you don’t mind.
    What do you think the odds are that a child will become autistic after receiving a vaccine?
    Also, are there any vaccines that you feel are more likely to cause this?”

    I think the odds are about one in 100-200 but there may be families with a strong history of autoimmune problems at far greater risk. We take family history into consideration when we do surgery, prescribe meds and everything else we do in medicine and I think we should take those data into consideration when we vaccinate kids. As usual, no scientific proof here but you asked what I thought and I’ll gladly tell you in good faith.

    I think it’s possible that live virus vaccines pose a greater risk but I also think that giving a large number of antigenic challenges at a very young age may trigger genetic autoimmune tendencies. Possibly aluminum contributes to harm and this facet of the discussion has generated many studies in mainstream journals. Once more, no adequate proof but my same reason for answering. I really appreciate the tone of your questions.

    @Calli The diseases are very rare. New treatment modalities make discussions of mortality and morbidity rates from the thirties, forties, fifties pointless.

    I will take a brief vacation soon. Think of the lives that will be saved by my absence!

    Best,

    Jay

  185. #185 Julian Frost
    September 3, 2010

    @ Jay Gordon on vaccines causing autism:

    I think the odds are about one in 100-200 but there may be families with a strong history of autoimmune problems at far greater risk.

    The science is against you, as has been pointed out numerous times.
    Your response to Calli:

    The diseases are very rare. New treatment modalities make discussions of mortality and morbidity rates from the thirties, forties, fifties pointless.

    The diseases are “very rare”? Why is that? Oh yes… As to new treatment modalities, exactly how much more effective and an improvement are they, statistically speaking? I’m sure someone else can pull up the numbers if you can’t.

  186. #186 Matthew Cline
    September 3, 2010

    @Dr Gordon:

    We take family history into consideration when we do surgery, prescribe meds and everything else we do in medicine and I think we should take those data into consideration when we vaccinate kids.

    What family history could be taken into account (except for adverse vaccine reactions and allergies to vaccine ingredients)?

    I think it’s possible that live virus vaccines pose a greater risk but

    If an attenuated virus vaccine posed a greater risk of causing autism than a innactivated virus vaccine, then wouldn’t the infection by the wild type virus pose an even greater risk? But if full blown infections could cause autism, wouldn’t reducing the rate of the full blown wild type diseases via vaccines have reduced autism rates? Unless there’s some weird thing about attenuated viruses that make them more likely to cause autism…

    I also think that giving a large number of antigenic challenges at a very young age may trigger genetic autoimmune tendencies.

    The antigenic challenge from a vaccine isn’t going to be any larger than that from a baby catching a cold. Or are you concerned about the frequency of antigenic challenges, rather than the magnitude?

    Also, since (as far as I can tell) you haven’t answered these questions yet:

    1) Who are the “high risk children” who are the only ones you give the HiB vaccine?

    2) What medical advances have happened over the past thirty years which make a child having HiB a less of a problem than it was when the HiB vaccine first came out?

  187. #187 K0ilar
    September 3, 2010

    @Dr Jay: Is it possible that math was never your strongest subject? If your high estimate was true, and we assume that 99% of children are (or were…) vaccinated, then 1:101 of them would develop autism… As your friends do not get tired of repeating, actual autism prevalence is 1:110. I don’t know how to tell you that, but YOU ARE WRONG! YOU FAIL BASIC MATH! (don’t get me started on science) And exactly because of such high estimates, you should distrust your anecdotal, selective “experience”. You’re not gonna tell me, that basically ALL the autism we see is caused by vaccines, are you?

  188. #188 colmcq
    September 3, 2010

    @Augie

    [Chris: So where is that fantastic future prediction machine to tell me who my daughter will marry in ten to twenty years so I can tell him to "keep it zipped"!? ]

    Where is YOUR future predictor machine that says your daughter will not clear HPV like the vast majority of other healthy people? Statistically speaking she has a very low chance of getting cervical cancer or a persistent infection.

    Listen girl, the first prediction is an event open to a myriad of possible variables and confounders, the second scenario can be predicted based upon scientific research we already have – which I won’t bother to reference because a)you won’t look at it b)won’t understand it c)will discount it regardless…

    What this means is that we have a great opportunity demonstrating why #augie #analogy #fails!

  189. #189 colmcq
    September 3, 2010

    ach #fail

  190. #190 mario
    September 3, 2010

    Dr J G: waaay back at comment 95, chris pointed you to a bunch of studies. Nevermind the other stuff, you have managed to steer right around the thing that a researcher and medical practioner should care about the most. Let me give you a clue sir: it starts with SCIENC and ends with an E.

  191. #191 Todd W.
    September 3, 2010

    Questions that Dr. Jay Gordon, MD, FAAP has still failed to answer:

    * You say that VSEDs exist here at RI. Please provide a concrete example of VSED behavior.
    * What is your definition of “those at highest risk” (in the original context of the question – HiB)?
    * Am I correct that your recommendation is that except for people who meet that definition, everyone else should not bother with the [HiB] vaccine?

  192. #192 Todd W.
    September 3, 2010

    For those keeping score, by the way, the questions listed by me in post #191 were asked on August 29 and can be found in this post on the Vaccine Exemptions thread.

  193. #193 augustine
    September 3, 2010

    [colquom, priest of scientism: the second scenario can be predicted based upon scientific research we already have – which I won’t bother to reference because a)you won’t look at it b)won’t understand it c)will discount it regardless…}

    You won’t bother with references because you don’t have ANY. You believe someone can PREDICT who will or who won’t clear HPV and who will or won’t get CERVICAL CANCER? You sound silly.

    See Matthew, this is prophetic medicine. So what this genius will say is that we can’t tell who actually will get HPV, after she just insinuated we could, so we MUST vaccinate EVERYONE because we can’t be sure. How very scientific. Save you numbers. They’re just a distraction of how you came to a predetermined conclusion.

  194. #194 Scott
    September 3, 2010

    I think the odds are about one in 100-200 but there may be families with a strong history of autoimmune problems at far greater risk.

    The two obvious followup questions.

    1. What do you believe are the odds that an unvaccinated child will develop autism?

    2. Anyone “may” be at “far greater risk.” Wearing blue socks at conception “may” increase the odds that the child will be autistic to 100%. What’s your evidence for the proposition, or for that matter that there’s any link at all between autoimmunity and autism? And if you have no evidence, why even bother talking about it?

  195. #195 Todd W.
    September 3, 2010

    @Scott

    What’s your evidence for the proposition, or for that matter that there’s any link at all between autoimmunity and autism?

    What’s his evidence? You should know by now. It’s his 31 years of clinical experience, as he’s told us so often. Remember, his experience is all he needs. He don’t need no steenkin’ science! Of course, Jay, feel free to contradict me and present some actual, real, honest-to-goodness science that backs up your assertion.

  196. #196 Composer99
    September 3, 2010

    ugh troll:

    The inference that you are anti-vaccine and pro-disease (and, for that matter, a very poor critical thinker) is very straightforward. The premises are:

    (P1) You ignore evidence presented to you showing that (a) vaccines work and (b) are safer than the diseases they protect against. That is to say, you are unwilling or unable to overcome your own confirmation biases.
    (P2) You cherry-pick and quote-mine sources (don’t try to deny it, you’ve been caught at it) in an effort to minimize the risks and dangers of getting diseases which are now rare due to vaccination.
    (P3) You reverse the logical burden of proof. People advocating the safety and efficacy of vaccines compared to the state of affairs that prevails when they’re not around are drawing on decades of practice and accompanying research. People presenting the claims that vaccines have dangerous side-effects which numerous epidemiological studies have failed to corroborate are the ones who have the burden of making their case, not the other way around.
    (P4) You fall back on argument by assertion and insults (and rather poor ones, at that) as a first, last, and indeed only line of defence when any of your more substantial claims are challenged.

    From premises (P1) through (P4) one infers conclusion (C):

    (C) you are anti-vaccine, which implies being pro-disease, particularly given your tendency to quote mine in order to suggest that diseases such as measles are not ‘serious’.

  197. #197 Scott
    September 3, 2010

    @ Todd:

    That is indeed the answer I was expecting, in which case I was intending to inquire what his statistical significance looks like given how many patients he has with autoimmune issues, and potential selection effects. Then when he said he didn’t calculate one I intended to point out that he therefore can’t draw any robust conclusions.

  198. #198 Pablo
    September 3, 2010

    We all remember the Swine Flu vaccine from the 70s, right? You know, the one that the anti-vaxxers love to bring up because it was SO dangerous, apparently triggering GBS? And it ultimately got pulled because of the problem.

    Do you know how dangerous that was? If you dig through the studies, you can find out that the number of GBS cases that could be attributed to this supposedly dangerous vaccine was … somewhere in the range of 18 – 30. Not 30 thousand, but 30 cases. In 5 million vaccines, maybe 30 extra cases of GBS was enough to get the vaccine pulled.

    The reason I bring this up is the following: there was a vaccine side effect that occurred on the level of 1 in about 200 000. And it was found, by using simple epidemiological studies.

    Yet, Jay Gordon thinks that some unspecified vaccine causes autism at a rate of 1 in 100, but it doesn’t show up in the epidemiology? That is mental. That makes no sense at all.

    If something were causing an adverse effect in 1% of the cases, it would easily show up in studies. Jeez, look at the side effects listed on the vaccine insert, they talk about things that happen at the one-in-ten thousand rate, but they can’t see a 1 in 100?

    But there is a problem, and Scott has hit on it…

    What do you believe are the odds that an unvaccinated child will develop autism?

    Look at Jay’s range. 1 in 100-200 vaccinated kids will develop autism. What does that tell us about vaccination and autism?

    NOTHING

    Because that number, in itself, means nothing without knowing what rate of unvaccinated kids get autism. For example, if the overall autism rate is 1 in 150, and vaccinated kids have a rate of 1 in 200, then that would require that vaccination actually prevents autism (because the majority of kids are vaccinated).

    If vaccinated kids have an autism rate of 1 in 100-200, and unvaccinated kids have an autism rate of 1 in 100-200, then there is no indication that vaccination causes autism.

    And that is what is found.

  199. #199 passionlessDrone
    September 3, 2010

    Hi Scott –

    What’s your evidence for the proposition, or for that matter that there’s any link at all between autoimmunity and autism? And if you have no evidence, why even bother talking about it?

    I’ll bother to talk about it. The facts on the ground are that our evidence for a link between autoimmunity and autism is overwhelmingly voluminous.

    If, for example, we wanted to only focus on associations with autoimmune disorders in the parents and having a child with autism, we might use these studies as evidence for this proposition:

    The link of C4B null allele to autism and to a family history of autoimmunity in Egyptian autistic children. [PMID: 20452682]

    The frequency of C4B null allele was significantly higher in autistic patients (37.5%) than healthy controls (8.75%), P<0.001. The frequency of autoimmune diseases in families of autistic children (40%) was significantly higher than healthy children (10%), P<0.001.

    Parental Autoimmune Diseases Associated With Autism Spectrum Disorders in Offspring [PMID: 20798635]

    Parental autoimmune disorder was weakly associated with autism spectrum disorders in offspring (maternal OR = 1.6 [95% confidence interval = 1.1-2.2]; paternal OR = 1.4 [1.0-2.0]). Several maternal autoimmune diseases were correlated with autism. For both parents, rheumatic fever was associated with autism spectrum disorders

    Association of family history of autoimmune diseases and autism spectrum disorders [PMID: 19581261]

    A total of 3325 children were diagnosed with ASDs, of which 1089 had an infantile autism diagnosis. Increased risk of ASDs was observed for children with a maternal history of rheumatoid arthritis and celiac disease. Also, increased risk of infantile autism was observed for children with a family history of type 1 diabetes.

    Familial autoimmune thyroid disease as a risk factor for regression in children with Autism Spectrum Disorder: a CPEA Study [PMID: 16598435]

    Regression was significantly associated with a family history of autoimmune disorders (adjusted OR=1.89; 95% CI: 1.17, 3.10). The only specific autoimmune disorder found to be associated with regression was autoimmune thyroid disease (adjusted OR=2.09; 95% CI: 1.28, 3.41).

    Increased prevalence of familial autoimmunity in probands with pervasive developmental disorders [PMID: 14595086]

    The frequency of autoimmune disorders was significantly higher in families of the PDD probands compared with families of both the autoimmune and healthy control probands. Autoimmunity was highest among the parents of PDD probands compared with parents of the healthy control subjects. Hypothyroidism/Hashimoto’s thyroiditis and rheumatic fever were significantly more common in families with PDD probands than in the healthy control families.

    Familial clustering of autoimmune disorders and evaluation of medical risk factors in autism [PMID: 10385847]

    An increased number of autoimmune disorders suggests that in some families with autism, immune dysfunction could interact with various environmental factors to play a role in autism pathogenesis.

    If, on the other hand, we wanted to look for ‘any link at all between autoimmunity and autism‘, we quickly begin to run out of bandwidth with which to go through the studies.

    Just for kicks, how about we list the ones that provide evidence of an ongoing immune reaction in the brain of people with autism?

    Microglial activation and increased microglial density observed in the dorsolateral prefrontal cortex in autism [PMID: 20674603]

    Elevated immune response in the brain of autistic patients [PMID: 19157572]

    Immune transcriptome alterations in the temporal cortex of subjects with autism [PMID: 18378158]

    Elevation of tumor necrosis factor-alpha in cerebrospinal fluid of autistic children [PMID: 17560496]

    Glial fibrillary acidic protein is elevated in superior frontal, parietal and cerebellar cortices of autistic subjects [PMID: 16147953]

    Neuroglial activation and neuroinflammation in the brain of patients with autism [PMID: 15546155]

    What if, instead, we wanted to look for evidence that shows a correlation between autism severity and discrete measurements of immune dysfunction in children with autism?

    Elevated plasma cytokines in autism spectrum disorders provide evidence of immune dysfunction and are associated with impaired behavioral outcome [PMID: 20705131]

    Increased serum levels of high mobility group box 1 protein in patients with autistic disorder [PMID: 20302902]

    Macrophage migration inhibitory factor and autism spectrum disorders [PMID: 18676531]

    Reduced levels of immunoglobulin in children with autism correlates with behavioral symptoms [PMID: 19343198]

    Decreased transforming growth factor beta1 in autism: a potential link between immune dysregulation and impairment in clinical behavioral outcomes [PMID: 18762342]

    Or what if, instead, we wanted to look for studies that showed that children with autism respond with differential immune response than children without autism, in vitro?

    Differential monocyte responses to TLR ligands in children with autism spectrum disorders [PMID: 19666104]

    Decreased cellular IL-23 but not IL-17 production in children with autism spectrum disorders [PMID: 19800697]

    I see little point in going on, but to do so would be quite easy. [Not linking due to spam filtering concerns]

    I’m not sure where you have gotten the idea that we have no evidence of an association between autism and autoimmunity, but it certainly seems to be at odds with the vast majority of the literature. You might reconsider your sources of your information about the science of autism.

    – pD

  200. #200 augustine
    September 3, 2010

    [Compost: you are anti-vaccine, which implies being pro-disease, particularly given your tendency to quote mine in order to suggest that diseases such as measles are not 'serious'.]

    You need to hand in your critical thinking card back to ORAC. If this is your evidence of logic then you should not be a card carrying member of the critical thinking club.

    This is a classic example of a logical fallacy. I hope you know this. I don’t think you do. Straw men arguments are not allowed by champions of critical thinking. I find it ironic. Maybe critical thinking isn’t what SBMers really represent. Maybe they overlook these types of things because they champion something else. Yes that is why they can’t help themselves to indulge in logical fallacies and ad hominem attacks.

  201. #201 Dangerous Bacon
    September 3, 2010

    I think the problem with pD’s “voluminous” list of citations is that while they show varying evidence of a correlation between autoimmune dysfunction/disorders and autism, they are ineffectual in demonstrating that autoimmune problems cause autism, much less that vaccines interact with autoimmunity to do so.

    There’s nothing terribly wrong with Jay’s “math”; his odds numbers are carefully tailored to suggest that vaccines cause some or all of autism cases. Rather, the problem is that he pulled those numbers out of his nether region* without evidence to substantiate them.

    I’d also like to see Jay answer Todd W.’s questions, as well as tell us if his DTaP “series” follows the AAP/CDC guidelines for 5 doses, or whether (and why) he thinks fewer shots suffice for protection.

    *this is also the source of his recommended staggered/reduced/no vaccine schedule and many other pronouncements. It’s a prolific generator of Jay-wisdom.

  202. #202 augustine
    September 3, 2010

    [Pablo: For example, if the overall autism rate is 1 in 150, and vaccinated kids have a rate of 1 in 200, then that would require that vaccination actually prevents autism (because the majority of kids are vaccinated). ]

    Have you lost all sense of logic? That is how pharma scientist’s think though so I’m not surprised.

    Btw I would love to see that study on unvaccinated (zero vaccines) kids. Do you have a reference?

  203. #203 Kristen
    September 3, 2010

    I can’t help but comment on Dr. Jay’s behavior on this thread. In previous threads (I have been reading RI for about 15 months) he has seemed stuck in his beliefs, but at least somewhat respectful of most of the other commentators.

    Now he has reduced himself to insults and sarcasm. Accusations and veiled threats. If he were my children’s pediatrician I would be appalled. I can’t even imagine our (wonderful) pediatrician stooping to such levels.

    He has been in practice for almost as long as Dr. Jay but he is reasonable and takes time to keep educated, he noticed my son’s autism long before I did, but never tried to diagnose him. He gave me the name of a good (the only one in central Virginia at the time) developmental pediatrician and said I should set up an interview (they both wear cool bow-ties).

    He never once has given me advice on Gabriel’s autism, he has left that to the expert. Dr. Jay is arrogant, he is not qualified to do what he is doing. Being a pediatrician does not automatically make him an expert on neurodevelopmental disorders. He is also not an immunologist IIRC.

    It seems to me, a good doctor knows when he is outside his skill-set and will refer a patient to the proper expert.

    If I discovered my children’s doctor acting in such an asinine mannor, I would find another. Truthfully I would probably find another practice all together.

    BTW, why don’t the regular trolls learn HTML, it is easy and makes one so much easier to understand (at least learn to blockquote-follow the link). If you can copy-paste and use the shift key, you can do HTML tags.

  204. #204 K0ilar
    September 3, 2010

    well, I still see a problem with the math, but another question comes to my mind: What does he mean by 1:100-200?
    a) for every vaccination the probability for each kid to develop an ASD is that high?
    b) 1 in 100-200 kids is pre disposed to ASD if ever vaccinated?

    a) can obviously not be true, seeing how many vaccinations the average kid gets (after 5 vaccs you would get 5:100 or 1:25 kids with ASD), and if b) was true than you could give the non-predisposed kids any number of vaccs…

    Of course nothing is ever this simple, but still I’d like to see dr Jay pull another explanation out of his “nether region” (Dangerous Bacon is so much better at prose than me…).

  205. #205 passionlessDrone
    September 3, 2010

    Hi Dangerous Bacon –

    I think the problem with pD’s “voluminous” list of citations is that while they show varying evidence of a correlation between autoimmune dysfunction/disorders and autism, they are ineffectual in demonstrating that autoimmune problems cause autism, much less that vaccines interact with autoimmunity to do so.

    A statement was made that is in startling contrast to the literature:

    What’s your evidence for the proposition, or for that matter that there’s any link at all between autoimmunity and autism?

    This is a forum where statements so wildly at odds with the available evidence are usually shown to be fallacious with great glee and, indeed, insolence; at least when expedient to a particular point.

    The causal link between autism and observed autoimmune dysfunction is difficult to detangle, but that is no reason that we should let obviously unsupportable assertions to lay uncontested simply because they fit the over riding meme of the environment.

    – pD

  206. #206 Scott
    September 3, 2010

    pD,

    You need to learn some basic English. Asking for the evidence supporting a claim is a different thing from claiming that there IS no evidence. It cannot, in any way, be in ANY contrast to ANY body of literature or evidence. There is NO assertion there!

    In other words, you’re an idiot who can’t read. But we already knew that.

  207. #207 Calli Arcale
    September 3, 2010

    Dr Gordon:

    @Calli The diseases are very rare. New treatment modalities make discussions of mortality and morbidity rates from the thirties, forties, fifties pointless.

    It is true that the diseases are now rare, but you’ll note that I was not talking about mortality and morbidity rates from the thirties, forties, and fifties. I was talking about what they would be now if herd immunity declined. You seemed to be arguing that current technology for saving lives (and you specifically mentioned ventilators) meant that these diseases need not be feared. Perhaps a child would have died in the 1930s, but today, that same child might survive thanks to a ventilator.

    That’s what you were arguing. You were arguing that people who do contract measles etc. don’t die in such high percentages nowadays. And that’s true. Our ability to keep people alive at the brink of death is vastly greater today than it was then. But it is either callous or extremely ignorant of you to disregard the price that is paid, both the obvious financial cost and, more importantly, in the pain and suffering endured by the patient.

    A dear relative passed away a couple of years ago. She was on a ventilator for her last month. She stuck it out, but hated it; the tracheotomy they finally did came as a huge relief, because she loathed having that thing down her throat, but it rendered her mute, and she was always a talkative lady. Vivacious, loquacious, and an amazingly determined person. When all avenues had been exhausted and it became clear she’d live out her days, possibly for months or years, on a ventilator in a nursing home (as she had not regained the ability to breathe on her own), she made the decision to turn the ventilator off. She was willing to put up with it if it meant she could get better, but once she knew she wasn’t going to get any better, she preferred death.

    It’s great that kids with severe respiratory infections due to vaccine-preventable disease won’t necessarily die. But the price paid is very high, and you should not casually dismiss that.

    I hope you remember that the first time you have a patient hospitalized and put on a vent. I can only assume it has not happened to any of your patients yet. Note that it isn’t just vaccine-preventable diseases that can leave a child needing a vent. My brother’s condition was purely mechanical, and I have a friend whose daughter was comatose after a terrible injury due to severe weather; could have been any child, really. You take it too lightly, if you think being able to be saved by a vent is a reason to be more casual about vaccination. If you need a vent, you are in imminent danger of dying; this is not something to idly dismiss, as you have.

  208. #208 Science Mom
    September 3, 2010

    In other words, you’re an idiot who can’t read. But we already knew that.

  209. #209 Scott
    September 3, 2010

    Yes, it’s harsh. Deliberately so. Because that sort of deliberate gross misrepresentation is truly despicable and deserves nothing less.

  210. #210 Pablo
    September 3, 2010

    Yes, it’s harsh. Deliberately so. Because that sort of deliberate gross misrepresentation is truly despicable and deserves nothing less.

    Interesting. That’s how I feel about Jay Gordon…

  211. #211 passionlessDrone
    September 3, 2010

    Hi Mathew Cline –

    I don’t want to be seen as taking Dr. Gordon’s position(s) per se, but I had a few thoughts about your analysis that you might consider.

    If an attenuated virus vaccine posed a greater risk of causing autism than a innactivated virus vaccine, then wouldn’t the infection by the wild type virus pose an even greater risk? But if full blown infections could cause autism, wouldn’t reducing the rate of the full blown wild type diseases via vaccines have reduced autism rates? Unless there’s some weird thing about attenuated viruses that make them more likely to cause autism…

    I think a complete analysis would also need to take time dependent effects into consideration; i.e., having a robust immune response at two months of age may lead to different trajectories than a year, or four years of age. Obviously vaccination is given early in life for protective reasons, but in the past, lots of kids never got the measles, or any of our vaccine preventable diseases until they were much, much older. In complicated systems, we ignore factors such as time of insult and associated developmental status at great risk.

    The antigenic challenge from a vaccine isn’t going to be any larger than that from a baby catching a cold.

    I do not believe that you could validate this with any studies, though I would be genuinely interested in reading any links you could post to support this assertion.

    The bigger problem to my mind, is that the notion of simply counting antigens is a gross over simplification. I can think of four big reasons why our vaccine schedule does not lend itself well to a model of antigen counting.

    1) Antigens aren’t the only thing in vaccines; we also have aluminum salts designed to insure a robust immune response is generated. Because of this, simply counting the number of antigens in a vaccine may not necessarily be a meaningful metric for understanding the strength of the immune challenge. Again, I’d be happy to see a link, if possible, that details, for example, cytokine generation from a pediatric vaccine compared to a similar sickness. [tough one to do ethically]. For that matter, however, I’d love to see any study on a pediatric vaccine that detailed the level of the immune response in a metric other than antibody generation. Do you know of any?

    2) Our vaccination schedule, as you are aware, confers protection from several different pathogen types during a single visit; i.e., you get vaccinated against many types of bacteria and viruses simultaneously. We have evidence that when your immune system detects multiple types of pathogens at the same time, the resultant immune response is synergistically increased.

    For examples of the synergistic response of the immune system to multiple pathogen types, you might evaluate,

    Toll-like receptor (TLR)2 and TLR3 synergy and cross-inhibition in murine myeloid dendritic cells [PMID: 18166232]

    Release of IL-12 by dendritic cells activated by TLR ligation is dependent on MyD88 signaling, whereas TRIF signaling is indispensable for TLR synergy [PMID: 20360404]

    Cooperation between MyD88 and TRIF pathways in TLR synergy via IRF5 activation [PMID: 17275788]

    For this reason, trying to compare the immune response between a common cold, and simultaneous vaccination for Hep-B, Hib, diptheria, tetanus, pertussis, rotavirus, and the flu may not necessarily be a useful model if our goal is to understand the relative immune impact.

    3) Some of our vaccines with the most antigens (varicella, with 75) cause relatively infrequent side effects when compared to our vaccines with very few antigens (DTP with 5). Clearly something is at work other than the number of antigens if we are to believe the CDCs values regarding antigen counts and adverse reactions (i.e., fever, fussiness).

    4) The time dependent problems I discussed above.

    Or are you concerned about the frequency of antigenic challenges, rather than the magnitude?

    The aggressive increase in our vaccine schedule at two, four, and six months represents something very different than what most infants encountered for most of human history. Of course, some were sick at two, four, and six months, but we’ve changed that to the point where nearly every infant is challenged during the first months of life.

    I’m not sure we are nearly clever enough to understand the implications of this, and as such, I guess I’d say I am worried about both. This belief, however, does not keep me from believing that vaccines work, that herd immunity is real, and that a large reduction in vaccinated children could lead to the return of very dreadful diseases.

    As for the rest, I think that Hib is still a big problem and I don’t think there are any medical advances in the past, besides vaccination which make it benign. Similarly, I have no idea how one would quantify a high risk infant. (?)

    – pD

  212. #212 Scott
    September 3, 2010

    Interesting. That’s how I feel about Jay Gordon…

    Well, I feel Jay deserves a lot more. Having his medical license taken away, being sued to within an inch of his life for malpractice, and then locked up for negligently endangering hundreds or thousands of children. For starters.

  213. #213 passionlessDrone
    September 3, 2010

    Hi Scott –

    Asking for the evidence supporting a claim is a different thing from claiming that there IS no evidence. It cannot, in any way, be in ANY contrast to ANY body of literature or evidence. There is NO assertion there!

    In other words, you’re an idiot who can’t read. But we already knew that.

    In this instance, I was simply trying to detail the a fraction of our existing evidence linking autism and autoimmune conditions. My assumption was that you did not believe there to be any such as evidence when you said:

    And if you have no evidence, why even bother talking about it?

    It would seem this was an inaccurate assumption on my part; though I will admit some confusion to the scenario where you thought there was such evidence, but felt someone else needed to present it in order for it to be relevant. In any situation, there is sufficient vitriol in this debate already, something I find very unfortunate. I should have worded my response to Dangerous Bacon more concisely.

    – pD

    @ScienceMom – Thank you.

  214. #214 Scott
    September 3, 2010

    pD,

    Such “assumptions” are grossly unjustifiable when used to justify terminology like “statement [] in startling contrast to the literature … statements so wildly at odds with the available evidence … obviously unsupportable assertions”. So I still consider the “vitriol” fully justified. If you’d simply presented evidence without falsely claiming that I had made a statement which I manifestly did NOT, and which you have now admitted you were simply assuming I meant, that would have been perfectly fine. For that matter, if I’d actually MADE such a statement I’d be more than willing to admit that it was mistaken.

    That said, the reason for presenting the question in that form was to challenge Jay to actually respond meaningfully. If he’d actually had the wit and knowledge to present such evidence from the literature, I would have altered the plan I mentioned to Todd and instead proceeded to the next question in line, which I now present to you:

    Now, show the evidence that such association is causal in a way that means vaccination is a risk factor.

  215. #215 Dangerous Bacon
    September 3, 2010

    pD is amped up about dreadful “aluminum salts” used as vaccine adjuvant (and which have an extensive record of safety in vaccination), while seemingly far less concerned about toxic products of bacterial and viral infection, whose deleterious effects are well-documented.

    While pD is going on about our “aggressive” vaccine schedule and busy “detangling the causal link between autism and observed autoimmune dysfunction” (i.e assuming there is one and making lists of studies that do not support the assumption), it’s notable that controlled studies continue to fail to demonstrate causative links between vaccination and known autoimmune diseases (such as type I diabetes) that antivaxers fulminate about. In fact, vaccination may one day hold the key to preventing such diseases (something that would undoubtedly drive antivaxers stark raving mad.*

    *assuming one could tell the difference between that consequence and their current condition.

  216. #216 Enkidu
    September 3, 2010

    Calli said: ” If you need a vent, you are in imminent danger of dying; this is not something to idly dismiss, as you [Dr. Jay] have.”

    Amen. My daughter spent 5 days on a vent. While I am thankful that it helped to save her life, I would much rather that she never had to go through that in the first place.

    I wonder if anti-vaxers think the same way about all preventative medicine. My daughter was 3 months premature. The docs told me that I should take progesterone shots if I ever get pregnant again to reduce the risk of premature delivery (even though my levels were okay, there is evidence that the shots still help). In Dr. Jay’s world, I guess he would rather take the 3 month preemie who spent 2 months in the NICU – firsy on a vent, then CPAP, then nasal cannula; 1 month in an incubator; two weeks on an IV; who was fed through a tube for 2 months; who needed blood tranfusions; who needed to have her eyes constantly monitored for ROP. Since everything “worked out” in the end, I guess this journey is acceptable over a series of shots during pregnancy.

    [feel free to find fault with my analogy, I'll admit they are not my strong suit]

  217. #217 Jud
    September 3, 2010

    augustine writes:

    You believe someone can PREDICT who will or who won’t clear HPV and who will or won’t get CERVICAL CANCER? You sound silly.

    Sigh. augustine, there is a tremendous difference between what you are ranting about and known statistical efficacy of treatments or preventive measures, incidence and severity of side effects, etc., over large populations. In fact there is a quite profitable large industry built on the ability to reliably predict such statistics in large populations to within less than a percentage point. You may have heard of it, it’s called health insurance. People getting vaccines are relying on this same information (which works quite well – seen a lot of impoverished health insurance companies lately?) to become part of a vaccinated group that on a reliable basis has better disease outcomes among its members.

    Is it very, very likely that each member of the vaccinated group will have good outcomes re disease and side effects? Yep. Does this give us information regarding which particular individuals will be the rare ones to suffer from a disease or a specific side effect? Nope. It’s not necessary to have such predictive information about a specific individual to know that overall outcomes are far better, any more than it’s necessary for an insurance company to know exactly who’s going to get sick in order to set its health insurance premiums correctly.

    So you see, all that stuff about “prophetic medicine” and having to predict which particular individuals will or won’t get a disease just doesn’t hold water.

    Instead of coming up with scenarios that impress you as difficult (“Hah! Let’s see ‘em claim they can predict who’ll get sick!”), but are really not serious contributions to a discussion of the pros and cons of vaccination, your time would be better spent learning about the subject you like to discuss so much. Once again I’d point to passionlessDrone as an example, who as ScienceMom mentioned upthread, deserves tremendous respect for marshalling actual studies and data to make us all think seriously about the potential health impacts of vaccines.

  218. #218 Captain Obvious
    September 3, 2010

    The aggressive increase in our vaccine schedule at two, four, and six months, near-eradication of nasty diseases like diptheria, pertussis, and polio in the U.S., a significant decline in infant mortality, and a sharp increase in life expectancy at birth, represent something very different than what most infants encountered for most of human history.

  219. #219 Jr
    September 3, 2010

    Some legal notes:

    First a minor correction: the Supreme Court will not decide whether the Vaccine Court is unconstitutional since no one has argued that it is.

    The question is only about the statue Congress passed. Specifically, whether it was intended to block all suits in state court. Specifically, whether Congress intended to block suits claiming that the manufacturer could have made a safer vaccine.

    Secondly, the fact that plaintiffs only need to have “50% plus a feather” of evidence is not unusual but the normal standard in tort cases.

  220. #220 passionlessDrone
    September 3, 2010

    Hi Dangerous Bacon –

    pD is amped up about dreadful “aluminum salts” used as vaccine adjuvant (and which have an extensive record of safety in vaccination), while seemingly far less concerned about toxic products of bacterial and viral infection, whose deleterious effects are well-documented.

    I’m not amped up about anything, I simply pointed out that a conversation about the strength of an immune response needs to include adjuvants, not just counting antigens. Again, this is (supposedly) a forum where arguments are formed on the basis of critical analysis and common sense conclusions must be reached with great caution. If our area of concern is the quantification of an immune response, adjuvants must be included in that discussion. Acknowledging the compexity of the situation doesn’t only apply if we are deconstructing a post from AOA.

    I have never said that I am unconcerned with the effects of actual infection, in fact, quite the opposite, though I don’t take the same umbrage with you that Scott seems to have taken with me.

    My primary concern with our relative lack of knowledge lies not with the toxic products of bacterial or viral infections, but rather, with potentially deliterious effects of the immune response itself, which I will attempt to detail in more depth in a response to Scott. My concerns are perfectly in line with the idea that an infection, any infection, during early life could cause developmental problems due to a vigorous immune response; something that happens regardless of the trigger, especially in a subset of indivduals shown to produce more inflammatory cytokines than their undiagnosed peers.

    While pD is going on about our “aggressive” vaccine schedule and busy “detangling the causal link between autism and observed autoimmune dysfunction” (i.e assuming there is one and making lists of studies that do not support the assumption), it’s notable that controlled studies continue to fail to demonstrate causative links between vaccination and known autoimmune diseases (such as type I diabetes) that antivaxers fulminate about.

    Perhaps a better wording would have been ‘detangling if there is a causal link. . . ‘. Is that better?

    In any situation, I will be quite clear in stating that a causal relationship between immune dysfuction and autism cannot be proven at this point; however, there are a great number of very well respected researchers who believe that an immune mediated cause is a biologically plausible possibiility requiring additional analysis. An intellectually honest reading of any of the articles I referenced above will support this statement. At this point, the only real question is if our only window of vulnerability is prenatal or not.

    – pD

  221. #221 Scott
    September 3, 2010

    At this point, the only real question is if our only window of vulnerability is prenatal or not.

    And even if it’s postnatal, what risk is posed by vaccines.

  222. #222 Chris
    September 3, 2010

    pD, since my son’s seizures were caused before he had a vaccine, I am not convinced that every seizure is associated with a vaccine. Especially since he another very major seizure while suffering from a real disease.

    Young Robert Fletcher has a seizure disorder, not autism.

    So I am going to ask you again: Why do vaccines have to be the only possible cause?

    Also, Jr, the government and courts in the UK is not covered by the American Constitution. Robert Fletcher is not American.

  223. #223 augustine
    September 3, 2010

    [Sigh Jud: In fact there is a quite profitable large industry built on the ability to reliably predict such statistics in large populations to within less than a percentage point.]

    That’s great. That industry should cooperate and communicate with the medical industry to vastly improve health care outcomes and drastically reduce the number of poor treatments that cause harm and do no good. They could also tell who needs a vaccine who doesn’t.

    [You may have heard of it, it's called health insurance.]

    Doh! Really?

    [ People getting vaccines are relying on this same information (which works quite well - seen a lot of impoverished health insurance companies lately?) to become part of a vaccinated group that on a reliable basis has better disease outcomes among its members.]

    You mean vaccine manufacturers in collaboration with insurance companies are doing quite well. So all of this detailed elaborate information about risks and the end result is f*%k it? Everybody get’s all of the vaccines. Paul Offit could have told you that. Hell, Brian Deer could have told you that. Even Chris could have told you that. There’s no need for a fancy calculator. Just use mass vaccine ideology. You get the same conclusion. Who needs science when ideology can get the job done.

    [Is it very, very likely that each member of the vaccinated group will have good outcomes re disease and side effects? ]

    So all I have to do is listen to my insurance company to be the healthiest that I can be? Then I’ll thrive. My insurance company has MY best interest as their main priority. Their profit really is secondary to me having the best health. Gee, I never though of that way before. I take back everything I’ve said. I’m going to call my insurance auditor and apologize for not appreciating him/her as I should have. Then I’m going to spread the good word about how insurance is going to save this country if we all just do what they say.

    Thanks, JUD. You’re swell guy.

  224. #224 augustine
    September 3, 2010

    Every seizure is not associated vaccines. But vaccines are associated with seizures.

    I don’t know why you would be hung up on that. It’s pretty straight forward.

  225. #225 Bronze Dog
    September 3, 2010

    Sneaking in a peek, and I’m facepalming over augie going on about “prophetic medicine.” How can this guy function in the real world?

    When he goes to buy a car, will he try to buy one without seatbelts, airbags, or crumple zones because he can’t predict whether or not he’ll be in an accident? Or does he make a case-by-case decision to not buckle every time he gets in a car?

    We’re in favor of playing the best odds and minimizing the risks while augie seems to live his life by blindly rolling the dice and hoping (without bothering to look at or understand probability) that the universe is feeling generous.

  226. #226 Sid Offit
    September 3, 2010

    @Pablo

    If vaccinated kids have an autism rate of 1 in 100-200, and unvaccinated kids have an autism rate of 1 in 100-200, then there is no indication that vaccination causes autism.

    And that is what is found.
    —————-
    Found where?

  227. #227 augustine
    September 3, 2010

    [Doggy Dog: When he goes to buy a car, will he try to buy one without seatbelts, airbags, or crumple zones because he can't predict whether or not he'll be in an accident? Or does he make a case-by-case decision to not buckle every time he gets in a car?]

    293 posts without a seatbelt gambit analogy. I knew it. Can’t have an good Sceptic based medicine post on vaccines without one.

    What I usually ask the car salesman is “how many of your customers have sat in one of your cars, put the seatbelt on and had a seizure BEFORE they got into a wreck or without ever having a wreck?”

    I also ask “how many customers have contracted a severe permanent neurological disease in the same scenario? How many have died by just putting on the seatbelt.”

    He says “NONE!” and I believe him. If the doctor says “NONE” I don’t believe him.

    [We're in favor of playing the best odds and minimizing the risks]

    That’s what he said too
    “Stock Market and Securities Fraud”
    http://www.greekshares.com/fraud.php

    http://www.investorhome.com/scam.htm

    “The Stock-Market Scam is a classic numbers game illustrating how investors can be fooled into believing someone possesses predictive ability.”

  228. #228 passionlessDrone
    September 3, 2010

    Hi Scott –

    Now, show the evidence that such association is causal in a way that means vaccination is a risk factor.

    As I tried to mention to Dangerous Bacon previously, my concern is primarily in the relative dearth of our knowledge of vaccination. We know it works at preventing disease. And that’s good, but I’m not sure we understand if it may be doing something else. Furthermore, at this point, a causal relationship between autism and immune dysfunction cannot be proven. However, there is, as I tried to display, an abundance of evidence of a linkage, and many researchers believe that the possibility is biologically plausible from several different avenues.

    So why am I such a skeptic on our existing research set concerning vaccination? Because it fails to take into consideration a commonality between all vaccines; the generation of an immune response, and the intersection with our observations within autism, particularly a dysregulated immune response with much evidence of a propensity towards an exaggerated inflammatory response in the innate arm of the immune system (see PMIDs: 20705131, 20302902, 18676531, 19666104 for supporting references on this claim). But even that isn’t much without our existing animal studies that tell us that even a faux infection may not necessarily be harmless if it occurs within critical developmental windows.

    By way of example, check out these two studies:

    Viral-like brain inflammation during development causes increased seizure susceptibility in adult rats [PMID: 19660546]

    Postnatal inflammation increases seizure susceptibility in adult rats [PMID: 18596165]

    Here researchers report that a single bout of inflammation during development (post natal day 14 in rodents) induced by either bacterial mimics (LPS/TLR4 agonist), or viral mimics (Poly:IC / TLR3) was sufficient to permenantly alter the suceptibility to seizures in treatment animals. Remember, these animals were not getting sick, a pathogen attack was simulated. Of particular salience is that the researchers found that different anti-inflammatory agents were capable of attenuating the effect; this tells us that it was the immune response was responsible for changing the underlying neurological function.

    Besides the fact that we know that seizures, epilepsy, and abnormal eegs are highly associated with autism (voluiminous references provided upon request); we also know that when challenged, children with autism respond with more pro-inflammatory cytokines than their undiagnosed peers. If a similar mechanism of early life vulnerability to immune challenge exists in human infants, the autism population is a subgroup of individuals predisposed to be more at risk of developing reactions of this type.

    Similar findings involving immune response and persistent effects are available in the animal relam involving alterations to the HPA-Axis [PMID: 20534845, 19524372], neuroimmune functions [PMID: 19782746, 19738918], among others. (References for altered HPA-Axis function in autism provided upon request).

    I cannot make the claim to prove that immune dysfunction in autism is causal. Similarly, I cannot prove that vaccination can cause autism. I am not advocating stopping vaccination.

    That being said, I can make the claim that the overwhelming majority of our existing research is completely blind to the possibility of innate immune responses altering development in a meaningful way. Here is a completely genuine request that you might find enlightening, try to find a single study on the pediatric vaccine schedule that measures innate immune system components. They aren’t there. The notion that immune response, sans actual pathogenic effects from microbial invaders could cause persistent changes is a relatively new idea, one that significantly postdates the additions to our vaccine schedule; and indeed, proclomations that the science has spoken.

    It looks as if some people are catching on that this might be something worth evaluating, at least in the sense of gathering general information. On August 11 of this year the NIH announced an initiative to gain more understanding of the effects of infection and vaccination on immune profiles (google if you want, not linking to avoid the filter). A great step, in my opinion; but one that ought to tell you something about how good our research actually is regarding the effects of vaccination in areas other than their designed use, antigen presentation.

    I don’t have to claim that all autism, or even a tiny fraction of it is caused by vaccination to make our lack of research coupled with our recent findings in the animal realm any less alarming.

    – pD

  229. #229 Sid Offit
    September 3, 2010

    @pD.

    Great post. Very though provoking. It is however amusing to see how hard this group tries not to be provoked into thinking.

    Vaccines good. Don’t hurt vaccine. Anti vaccine bad.

  230. #230 passionlessDrone
    September 3, 2010

    Hi Chris –

    So I am going to ask you again: Why do vaccines have to be the only possible cause?

    I have given you the same answer many, many times and it hasn’t changed. They do not have to be. I don’t know how else to tell you that. (?)

    I have absolutely no problem with a bazillion other mechanism of action; pure genetics, the environmental ubiquity of endorcrine disruptors, pesticides, and other chemicals, the fattening of the populace, actually getting a viral or bacterial infection, difficulties in birthing and/or gestation, epigenetic alterations from any combination of the above, whatever. My worldview is far, far away from a place where vaccines are the only potential problem.

    What you are seeing is a reflection of the fact that most of the discussion about autism seems to center on vaccines; the intellectual disingenuousness that seems part and parcel of these discussion does get me fiesty from time to time.

    Jesus Christ, if Orac or someone else would start a discussion about the potential for things like PDBEs potentially contributing to our observations of apparent increase in autism, I would be all over it. That never happens though; it’s always about bashing Wakefield, cheerleading the goalpost shifting of expanded criteria, or deconstructing something written by AOA. Frankly, I think that’s a shame and a waste.

    I wish I had a way to rephrase this in a way that would convince you. I don’t seem to have that ability, unfortunately. (?)

    – pD

  231. #231 augustine
    September 3, 2010

    ditto Sid

  232. #232 Todd W.
    September 3, 2010

    @pD

    Interesting post, regarding the role of innate immune responses. Certainly there are interesting questions to be asked and investigated, particularly in light of what we know about infectious agents and autism, namely, that congenital rubella syndrome is one known cause of autism, though by no means the only one.

    We also know that individuals who do not receive any vaccinations or whose mothers did not contract rubella while pregnant can still be autistic (see Kim Stagliano’s daughter as a well-known example, as well as a number of studies). Whether other infections or immune responses in these children played a role, who knows.

    The question then, is, are the immune dysfunctions noted in the studies you cited causal of autism, a result of whatever is causing the autism, or just coincidental due to some unrelated factor.

  233. #233 Science Mom
    September 3, 2010

    Great post. Very though provoking. It is however amusing to see how hard this group tries not to be provoked into thinking.

    Vaccines good. Don’t hurt vaccine. Anti vaccine bad.

    Careful with that broad brush-stroke Sid, you will invariably be wrong. But you’re used to that.

  234. #234 Chris
    September 3, 2010

    pD:

    I wish I had a way to rephrase this in a way that would convince you. I don’t seem to have that ability, unfortunately. (?)

    You would be more convincing if you did not try to find the most oblique (though thought provoking) connections to just vaccines. Or if you actually answered the question. You make it like the other factors are possible, but you don’t seem to follow through. And there seems to be a missing bit about relative risks.

    It is more probable that Mr. Fletcher would have had a seizure disorder even without the vaccine. The fact that it happened at a time shortly after his vaccine may have been pure coincidence. My son’s later seizures were also shortly after his MMR vaccine (in 1989), it just happened that he caught another disease a week later (I actually did a double take when I looked at his shot record after the Wakefield press conference when he was between eight and ten years old and noticed the dates).

  235. #235 Dangerous Bacon
    September 3, 2010

    pD: “I have absolutely no problem with a bazillion other mechanism of action (causing autism…My worldview is far, far away from a place where vaccines are the only potential problem.

    What you are seeing is a reflection of the fact that most of the discussion about autism seems to center on vaccines; the intellectual disingenuousness that seems part and parcel of these discussion does get me fiesty from time to time.”

    So your response is to “just ask questions” about…vaccines. I’d find it more intellectually ingenuous if your posts were directing us towards non-blame-the-vaccine causes of autism.

    pD:“:Here is a completely genuine request that you might find enlightening, try to find a single study on the pediatric vaccine schedule that measures innate immune system components. They aren’t there.”

    I don’t find this to be the case, depending on just what you mean by “innate immune system components”. I easily can locate studies in PubMed that study pediatric vaccines’ effect on human humoral and cell-mediated immune response components. It’s a routine part of effectiveness and safety testing for vaccines. The NIH study you referred to will provide welcome information to help us improve vaccines and make them more effective in protecting us against disease, notably in subsets of people (i.e. elderly, immunocompromised) that may not derive optimal benefit from today’s vaccines.

    One other thing that may help increase your understanding of immunization is if you stop seeing it as inducing “disease”. Getting vaccinated is not the equivalent of contracting a disease, or even a “faux” disease (as you put it). The potential for harm from a high antigenic load and dealing with toxigenic effects are claims that antivaxers (and the “just asking questions” folks) use to damn vaccines, but they seem oblivious to the fact that these concerns are vastly more applicable to the diseases vaccines prevent.

  236. #236 dt
    September 3, 2010

    @pD
    Your point that vaccines may provoke an autoimmune response is not really something up for debate – they might indeed do this. But natural infection with pathogens is a recognised cause of autoimmunity. Indeed, many of the complications/problems following infection are precisely due to this phenomenon, be they GBS after influenza or campylobacter, or ADEM after measles virus infection to take but 2 examples.

    Now you may talk about artificially induced immunity causing these problems (and they can do) but you seem to imagine that because vaccines contain substances that help boost the predicted immune response (adjuvants) they are somehow “more” likely to provoke auto-immunity than natural infection. I assume you think this – if you do please provide evidence for it, if you don’t, then stop implying it.

    You see, it is a well-known fact (and a mantra oft repeated by antivaxers) that even with the assistance of adjuvants, artificial vaccination-induced immunity is less robust and less durable than natural immunity.

    Now if you can somehow shoe-horn this fact into your theory that vaccine-induced auto-immunity is a significant problem (and more so that with natural infection) then I’d be pleased to see you do so. This is the elephant in the room, and you are ignoring it.

  237. #237 passionlessDrone
    September 3, 2010

    Hi Dangerous Bacon

    So your response is to “just ask questions” about…vaccines. I’d find it more intellectually ingenuous if your posts were directing us towards non-blame-the-vaccine causes of autism.

    Well, my blog is slightly less visited than Oracs, but if you were to visit it, you would find entries epigenetics, genetic expression studies, environmental pollutants, and others. I genuinely welcome skeptical viewpoints.

    I don’t have many other options to convince you; my post in this thread started as I tried to illustrate the amount of data that clearly links autism to autoimmnity. I was subsequently challenged to provide a link to vaccination. (?)

    I don’t find this to be the case, depending on just what you mean by “innate immune system components”. I easily can locate studies in PubMed that study pediatric vaccines’ effect on human humoral and cell-mediated immune response components. It’s a routine part of effectiveness and safety testing for vaccines.

    OK. This was a problem on my part, what if I said, ‘proinflammatory cytokine generation’? What then? Can you point me to a pre / post vaccination study with pediatric vaccines that measures those? Some of the studies I referenced above found specific inflammatory cytokines, such as tnf-alpha alone was capable of causing persistent effects [18596165]. Considering I specifically mentioned that several studies showed attenuation of effects based on administration of anti-inflammatory agents, could you should me any studies on innate immune functioning that would be affected by similar agents with vaccination?

    One other thing that may help increase your understanding of immunization is if you stop seeing it as inducing “disease”. Getting vaccinated is not the equivalent of contracting a disease, or even a “faux” disease (as you put it).

    I called it a faux infection, and our functional end point, generation of an inflammatory response, is the same from vaccination or wild infection. Generating an immune response is part and parcel to the process of vaccination, you don’t get one without the other. Despite my repeated requests that someone, anyone show me a link that can actually demonstrates the robustness of an inflammatory response between vaccination and illness, no one has seen fit to do so. Can you?

    – pD

  238. #238 Antiquated Tory
    September 3, 2010

    I’m just about to go to bed, but it seems to me that pD is talking about two separate issues, and they would have to be addressed in this order:
    1) What is the causal connection, if any, between autoimmune responses and autism?
    2) What contributing factors are there to this connection, provided one is established in sufficient detail? (Vaccines might be a contributing factor, but this appears to be contrary to the mass of epidemiological research on vaccines and autism.)
    Also note that even if it turned out that despite the epidemiological evidence, vaccines were established as a contributing factor to immune responses that increased the risk of autism, the increased risk of autism would have to be compared against the risk of vaccine preventable disease.
    All in all, I don’t see why pD’s concerns should focus on vaccines at all at this point.

  239. #239 passionlessDrone
    September 3, 2010

    Hi dt –

    Now you may talk about artificially induced immunity causing these problems (and they can do) but you seem to imagine that because vaccines contain substances that help boost the predicted immune response (adjuvants) they are somehow “more” likely to provoke auto-immunity than natural infection.

    I have made no such assertion or imagination; please re-read my post @221. The only reason adjuvants were discussed was because they are a necessary parameter to any discussion that involves drawing equivalencies between natural infection and vaccines regarding the strength of the immune response; a discussion that frequently focuses on counting antigens, which, as I tried to explain, is a gross over simplification. I don’t know if they are more likely to promote auto-immunity or not, but I do know that reducing interactions as complex as the immune response to addition is poor methodology and ignores the messy reality of trying to understand biological systems. That isn’t supposed to happen here.

    Now if you can somehow shoe-horn this fact into your theory that vaccine-induced auto-immunity is a significant problem (and more so that with natural infection) then I’d be pleased to see you do so. This is the elephant in the room, and you are ignoring it.

    Your analysis still fails to take into consideration time dependent effects. Why? Do you believe it might be possible that the effects of an immune challenge at two months of age might be different than one at a year, or at five years, or twenty? Seriously, please consider this.

    How many infants were naturally infected with Hep-b, influenza, rotavirus, diptheria, pertussis, tetanus, and hib on their sixtieth day from the womb? Do you think it was a large percentage? Even getting infected by a single one of those diseases at that age was very rare, pre vaccination; it happened, but no where close to the 90%+ range we currently have for vaccinations. You are trying to take massively important variables, time and associated developmental status, and color all things equal with infections that children were getting years into childhood. Talk about shoe horning!

    This is particularly salient because several of the papers in the animal realm show very clear time specific time periods during which an effect was observed. PMID 18596165 is a particularly good example of this; also 16395304.

    – pD

  240. #240 Matthew Cline
    September 3, 2010

    In my opinion you all should lay off pD:

    1) Talk about autoimmune disease, vaccination and autism is a lot more on topic than, for example, jen’s claim about Tylenol causing autism.

    2) pD doesn’t seem to be saying that autoimmune disease does cause autism, but that it might, and that there should be research into it.

    3) pD doesn’t ignore questions like Dr Jay is doing.

  241. #241 dedicated lurker
    September 3, 2010

    Jen brings up the tylenol thing in vaccine threads because tylenol is sometimes given before a vaccine in case of fever. She’s arguing that there might be a correlation with vaccines and autism onset, but it is caused by another factor instead of the vaccine itself.

    I’m not sure how convincing that argument is, but it’s partially on topic.

  242. #242 ERV
    September 3, 2010

    … Um, do you all want me to do more immunology posts? Cause we actually learn about this stuff (when to vaccinate and why, vaccines and autoimmunity, how adjuvants work, etc) in school and seminars… I just prefer to write about viruses :-/

    Theres nothing wrong with pDs questions– the answers require advanced/modern immunology. I mean its not like a Creationist bringing up the second law of thermodynamics or anything. I just hope pD isnt confusing their ignorance with ‘problems for the field’.

  243. #243 Drivebyposter
    September 3, 2010

    Jen brings up the tylenol thing in vaccine threads because tylenol is sometimes given before a vaccine in case of fever. She’s arguing that there might be a correlation with vaccines and autism onset, but it is caused by another factor instead of the vaccine itself.

    Holy crap. I read her posts mentioning it a time or two and thought she was being sarcastic.
    I’m making a prediction that eventually someone will claim the active ingredients in placebos can cause infertility. If I’m right I get to ride Orac’s pony.

  244. #244 augustine
    September 3, 2010

    [grad student:.. Um, do you all want me to do more immunology posts? Cause we actually learn about this stuff (when to vaccinate and why, vaccines and autoimmunity, how adjuvants work, etc) in school and seminars... I just prefer to write about viruses :-/]

    Um, no. It would be better if your professors chimed in instead of you. You’re just a student.Shouldn’t you be registering for class or something? Don’t you need some more college cash? You should be working on better topics for your own blogs instead of XMRVs ad nauseum. Don’t you bloggers get paid for traffic? Looks like you need to drum up more traffic.

    BTW, How big are you?

  245. #245 Jay Gordon
    September 4, 2010

    passionlessDrone has written some words worth considering:

    “I cannot make the claim to prove that immune dysfunction in autism is causal. Similarly, I cannot prove that vaccination can cause autism. I am not advocating stopping vaccination.”

    [So I am going to ask you again:
    Why do vaccines have to be the only possible cause?]

    “I have given you the same answer many, many times and it hasn’t changed. They do not have to be. I don’t know how else to tell you that.”

    I support the above statements completely. I’m sorry that you’re tarring a well-informed, well read fellow poster like pD with the same brush you use for me. As you persistently know (and vilify) my posts here are, for the most part, to mention that my experience is at odds with your version of science. (“Science: The Monolithic Idea”) pD, on the other hand, supports his ideas with peer-reviewed research and a questioning point of view. He is correct: Most people here want fuss and fight rather than being provoked into thinking. Vaccines are obviously not the only cause of autism and may not even be a cause of autism at all! I think they are one of the environmental triggers to genetic predisposition but I have insufficient proof right now.

    “Jesus Christ, if Orac or someone else would start a discussion about the potential for things like PDBEs potentially contributing to our observations of apparent increase in autism, I would be all over it.”

    Again, great thought. Please understand that neither Orac nor most of the other “scientists” here are interested in thoughtful discussion. Just speculative and vituperative narrative about possible toxins (vaccines, aluminum) rather than a reasoned debate about known toxins like PDBEs. The goal is getting others angry and generating traffic.

    Jay

  246. #246 Sid Offit
    September 4, 2010

    @ERV
    Um, do you all want me to do more immunology posts? Cause we actually learn about this stuff (when to vaccinate and why, vaccines and autoimmunity, how adjuvants work, etc) in school and seminars…
    —————————-

    I’m glad you have it all figured out. I hope you’ll share more with those of us not having access to the “seminars” in which the mysteries of the immune system have been revealed to you

    P.S.
    ————————-
    Discov Med. 2010 Feb;9(45):90-7.
    Vaccines and autoimmune diseases of the adult.
    it is feasible that vaccinations may also contribute to the mosaic of autoimmunity
    ————————-
    How Do Adjuvants Work? Important
    Considerations for New Generation Adjuvants

    Despite its long use, we still do not know exactly how alum mediates its adjuvant effects.
    ————————-
    Littman says he continues to be fascinated by the immune system. “While we know far more about the immune system than any other complex system in the body, I am astounded by how limited our knowledge really is,”
    Dr. Littman is also Professor of Pathology and Microbiology at the Skirball Institute of Biomolecular Medicine of New York University School of Medicine

  247. #247 Dangerous Bacon
    September 4, 2010

    pD: “…what if I said, ‘proinflammatory cytokine generation’? What then? Can you point me to a pre / post vaccination study with pediatric vaccines that measures those?”

    Here’s one that deals with measles vaccination in infants. A quick search on PubMed turns up several others, dealing with cytokine generation following measles, mumps and rubella vaccine. I only used one set of search terms and looked at the first page and a half of results, so there should be quite a few more papers out there.
    I expect the NIH study previously referenced to build on this research to develop even more effective and safe vaccines in the future.

    “I called it a faux infection, and our functional end point, generation of an inflammatory response, is the same from vaccination or wild infection.”

    I hope you’re not equating the “inflammatory response” from immunization with the body’s reaction to developing a full-blown infection. I suggest you spend some time studying the pathology of infectious diseases and the medical struggle to contain and eradicate them.

    You might develop a newfound appreciation for our “aggressive” vaccine schedule. This would be a worthwhile endeavor after you “detangle” the difference between correlation and causation as it applies to immune parameters in autistic children.

    I would also welcome your discussion here of the potential etiologies of autism that you say you’d love to get into, but have unaccountably gotten sidetracked into pointing a finger at vaccines.

  248. #248 Gonzo
    September 4, 2010

    From Dr. Jay Gordon’s comment all the way back at 101:
    —————————

    I don’t support blanket exclusion of unvaccinated children [from public schools] any more than I support exclusion of HIV positive children from schools.

    —————————

    How is it possible to conflate the presence of children that have a higher likelihood to have (and spread) very contagious diseases with children that have a disease transmitted sexually/by direct fluids exchange? Did a medical doctor actually write that? Holy mackerel, that’s just unbelievable.

  249. #249 adelady
    September 4, 2010

    “…known toxins like PDBEs…”

    Now you’re talking. If you’re seriously considering environmental or dietary toxins, I doubt you’ll get very far with parents who have convinced themselves that an *external* agent has invaded their child’s body to cause autism.

    The driving force underlying many parents’ anguish over this is not just the disability, it’s the fear that it might be something they did or failed to do to cause it themselves. I’m not involved with health but with learning difficulties.

    The number of parents who refuse point blank to believe that there’s anything amiss with little Johnny is extraordinary. Let alone that little Johnny would do better with a caffeine free diet and a good night’s sleep. “Nothing wrong with my boy,” says dad who’s just been (politely) told that the child is as blind as a bat, and will not, under any circumstances, take him to an optometrist. He’s not doing well at school because he has a personality clash with the teacher – therefore the teacher’s fault.

    Someone might come up with an explanation for autism that tells parents that the mother’s pregnancy diet and home environment with the usual load of chemicals could be responsible if she herself absorbs them in a particular way. These might possibly be absorbed into her body and then through the placenta to affect the foetus.

    Too confronting.

    It’s much, much more reassuring to believe that malign outside forces caused such problems. If there’s trouble believing it’s just the luck of the draw, there’ll be worse in store if someone tries to say that eating your favourite food or buying the furniture you fell in love with could be as damaging as boozing throughout pregnancy.

  250. #250 passionlessDrone
    September 4, 2010

    Hi Dangerous Bacon –

    Here’s one that deals with measles vaccination in infants. A quick search on PubMed turns up several others, dealing with cytokine generation following measles, mumps and rubella vaccine. I only used one set of search terms and looked at the first page and a half of results, so there should be quite a few more papers out there.
    I expect the NIH study previously referenced to build on this research to develop even more effective and safe vaccines in the future.

    Thanks for the link. It isn’t quite what I’m looking for; but I think that I am starting to understand why we aren’t seeing the same thing. I’m much more interested in the immediate, pro-inflammatory release of things like tnf-alpha, IL-6 or IL-1B following vaccination.

    Something along the lines of this study: Effect of influenza vaccine on markers of inflammation and lipid profile [PMID: 15976761]

    Check out the first sentence from their abstract:

    Despite wide use of the influenza vaccine, relatively little is known about its effect on the measurement of inflammatory markers.

    No kidding. The study you linked to is primarily concerned with T and B cells, not the initial inflammatory response. I think I needed to bee even more concise with my thoughts. Sorry.

    I hope you’re not equating the “inflammatory response” from immunization with the body’s reaction to developing a full-blown infection. I suggest you spend some time studying the pathology of infectious diseases and the medical struggle to contain and eradicate them.

    OK. I think this is where a disconnect might lie; it probably seems to you as if I’m narrowing down on something seemingly innocous, (and goal shifty). But I’m not. A lot of our newer research in the animal realm suggests that an inflammatory response during development need not be robust nor pro-longed in order to have persistent effects, if the challenge occurs during critical timeframes.

    We know that vaccines often times cause mild reactions; i.e., fevers, and this is likely due to induction of the immune response and associated creation of inflammatory and pyrogenic cytokines. This would seem to be straightforward with how we think vaccines are actually marshalling an immune response. Can we agree on that?

    So what? Well, I’m going to dare the spam filter gods here with this paper, Postnatal Inflammation Increases Seizure Susceptibility in Adult Rats

    From the discussion section:

    The most exciting finding of the present study is that a mild inflammatory response evoked by LPS during a critical period of development causes a long-lasting increase in hippocampal excitability in vitro, and enhanced seizure susceptibility to the convulsants LI-PILO, KA, and PTZ in vivo. The latter effect was observed over a range of mildly inflammatory doses of LPS and was only evident if administered during the second postnatal week (P7 and P14), and not before (P1) or after (P20) this time. Importantly, inactivation of the proinflammatory cytokine TNF with an intracerebroventricular TNF antibody blocked the long-term changes to seizure susceptibility induced by LPS, whereas intracerebroventricular administration of rrTNF alone mimicked the effect of LPS on seizure susceptibility. These novel results indicate that a single transient inflammatory episode during development can modify the brain through a TNF-dependant mechanism, making it more susceptible to generate seizures in adulthood.

    I’d say that is a surprising finding. To my google educated mind, that tells me that may not necessarily have to encounter an immune response as the result of a ‘full blown infection’ in order to have long term effects. Shoot, all you really needed was a boost of tnf-alpha. And remembe, this is a cytokine shown again and again to be created at exaggerated levels in vitro by children with autism.

    When I look for something that tells me about our pediatric shots; especially the ones given at the earliest ages, and measures creation of things like tnf-alpha, I come up bare. It isn’t for lack of looking, but it could be for lack of skill. [I have found some other papers that measure this type of thing, one on HPV for example, but always on adults, and they have tended to show an increase in pro-inflammatory cytokines, as expected.] I do know that while I appreciate the paper you sent me above, it by no means provides the type of data that would speaks towards this study.

    While the paper I listed above is the most elegant in demonstrating the possibility of time dependent, inflammatory cytokine driven effects that has me (unnecessarily?) worried, you’ll find that there are about twenty papers with similar findings; i.e., an immune challenge during development can reprogram the immune system or HPA-axis in ways that we are only beginning to understand.

    This would be a worthwhile endeavor after you “detangle” the difference between correlation and causation as it applies to immune parameters in autistic children.

    I’ll let you know how it turns out!

    I would also welcome your discussion here of the potential etiologies of autism that you say you’d love to get into, but have unaccountably gotten sidetracked into pointing a finger at vaccines.

    OK!

    – pD

  251. #251 passionlessDrone
    September 4, 2010

    Hi ERV –

    … Um, do you all want me to do more immunology posts? Cause we actually learn about this stuff (when to vaccinate and why, vaccines and autoimmunity, how adjuvants work, etc) in school and seminars… I just prefer to write about viruses

    Those seminars sound pretty impressive. For example, I was looking at this paper: Early life activation of toll-like receptor 4 reprograms neural anti-inflammatory pathways that was published a few moonths ago and thought the findings were pretty neat:

    A single postnatal exposure to the bacterial endotoxin, lipopolysaccharide (LPS), reduces the neuroimmune response to a subsequent LPS exposure in the adult rat. The attenuated fever and proinflammatory response is caused by a paradoxical, amplified, early corticosterone response to LPS. Here we identify the mechanisms underlying the heightened corticosterone response to LPS in adults after early life exposure to LPS. In postnatal LPS-treated rats, hypothalamic corticotrophin-releasing hormone mRNA, pituitary proopiomelanocortin mRNA, and circulating adrenocorticotrophic hormone were all increased after adult exposure to LPS without significant modification to hippocampal or hypothalamic glucocorticoid receptor mRNA or protein or vagally mediated afferent signaling to the brain. Postnatal LPS administration did cause a persistent upregulation of the LPS Toll-like receptor-4 (TLR4) mRNA in liver and spleen, but not in brain, pituitary, or adrenal gland. In addition, cyclooxygenase-2 (COX-2), which is a prostaglandin biosynthetic enzyme and is normally undetectable in most peripheral tissue, was constitutively expressed in the liver. Adult immune activation of the upregulated TLR4 and COX-2 caused a rapid, amplified rise in circulating, but not brain, prostaglandin E(2) that induced an early, enhanced activation of the hypothalamic-pituitary-adrenal (HPA) axis. Thus, postnatal LPS reprograms the neuroimmune axis by priming peripheral tissues to create a novel, prostaglandin-mediated activation of the HPA axis brought about by increased constitutive expression of TLR4 and COX-2.

    Do you think it would be OK for you to post your lecture notes on the mechanisms of action of TLR mediated reprogramming of neural anti-inflammatory pathways as a result of early life challenge and how that intersects with our existing understanding of how adjuvants work, when and why we vaccinate, ect?

    I just hope pD isnt confusing their ignorance with ‘problems for the field’.

    I think my new signature might be, “less ignorant than a Creationist”.

    – pD

  252. #252 LW
    September 4, 2010

    “How many infants were naturally infected with Hep-b, influenza, rotavirus, diptheria, pertussis, tetanus, and hib on their sixtieth day from the womb?”

    This argument doesn’t make sense to me. Of that list of diseases, only influenza and rotavirus are available as live virus vaccines (as best I can tell from googling), and the influenza live virus vaccine is recommended ages two years and up, so it shouldn’t be given to a two-month-old. Hence, the only disease an infant might be infected with via vaccination is attenuated rotavirus, and apparently wild rotavirus is not uncommon in that age group, and is quite harmful. So the hand-wringing about infecting infants with numerous viruses by the sixtieth day of life is unjustified.

    As to confronting a child with the various antigens in the other viruses — I believe the point Dr. Offit was making in his frequently abused comment was that infants have historically been, and even now are, daily confronted with a huge array of antigens in the environment, all of which their immune systems will attack as best they can. The immune system does not and cannot know that this little molecule is part of a pertussis virus which might be deadly if the whole virus were present, which it isn’t, and the that little molecule is part of a dust mite, which is harmless. It just recognizes them all as not-self. The antigens themselves are not the diseases.

  253. #253 colmcq
    September 4, 2010

    hi Pd

    I’ve really admired your posts; very thoughtful and considerate.

    Q: if there was a predisposition towards certain kinds of adverse reactions following vaccination as you suggest, would this have been established via the epidemiological studies that have been carried out to date (fombonne madsen etc)?

    regards

    Col

  254. #254 Composer99
    September 4, 2010

    Nitpick, LW: pertussis bacterium.

    passionlessDrone: If memory serves, you can get up to two links. After that it has to get by the filter.

    ugh troll: ‘Critical thinking’. You keep using that phrase. You consistently demonstrate an inability to understand what critical thinking is all about, even as you cut and paste definitions of it from online dictionaries and/or Wikipedia. So I’m sure you’ll forgive me for taking your claims not at all seriously.

  255. #255 passionlessDrone
    September 4, 2010

    Hi lw –

    This argument doesn’t make sense to me. Of that list of diseases, only influenza and rotavirus are available as live virus vaccines (as best I can tell from googling), and the influenza live virus vaccine is recommended ages two years and up, so it shouldn’t be given to a two-month-old. Hence, the only disease an infant might be infected with via vaccination is attenuated rotavirus, and apparently wild rotavirus is not uncommon in that age group, and is quite harmful. So the hand-wringing about infecting infants with numerous viruses by the sixtieth day of life is unjustified.

    I must have done a poor job of explaining my position. The argument was made to me that wild type infection produces a longer lasting immunity than vaccine type. (I agree)

    You see, it is a well-known fact (and a mantra oft repeated by antivaxers) that even with the assistance of adjuvants, artificial vaccination-induced immunity is less robust and less durable than natural immunity.

    I believe the underlying argument here is that if my suggested mechanism of action is correct, a robust immune response (specifically, the initial inflammatory response), that therefore, regular infections would be much more problematic than vaccines. (Please forgive me, dt, if I have misunderstood your argument.)

    BUT. This analysis fails to take into consideration the possibility of a time dependent effects; i.e., can we or should we safely equate an infection (and associated inflammatory response) a child gets when they are four years old with an inflammatory response an infant gets when they are two months old?

    The official schedule for two month vaccinatiosn includes Hep-B, Hib, DTaP, Polio, rotavirus, and pneumococcal are included. My initial list, including influenza was wrong, but I had left out pneumococcal.

    I’m not “hand-wringing about infecting infants with numerous viruses by the sixtieth day of life “, I am merely making the point that from a developmental standpoint, we have precious little evidence to say that the response and corresponding effects of an infection at three, five, or ten years can safely be equated with one at two months. Infection with one of these diseases was very rare at this age; no doubt the repercussions were very dire, but on a percentage basis, very, very few infants actually got these diseases by sixty days. If our focus is not on pathogenic capacity of the microbes, but rather, potential effects of the corresponding immune response, our effort to bring vaccination rates up to 90%+ is a big, big change. The animal studies I have tried to present in posts 246 & 247 are examples of early life immune system activation, and nothing more, having long term, persistent effects.

    As to confronting a child with the various antigens in the other viruses — I believe the point Dr. Offit was making in his frequently abused comment was that infants have historically been, and even now are, daily confronted with a huge array of antigens in the environment, all of which their immune systems will attack as best they can.

    Technically true, but misses the point. You are confusing baseline exposure with exposre designed and delivered to initiate an immune response. For a common sense example of this, have you considered that fever is a known side effect about 1/4 of the time you get the DTAP, but your child fails to get a fever one in four days he is ‘confronted with a huge array of antiens’ on an everyday basis?

    From a clinical standpoint, look at this study:

    HPV-16 L1 VLP vaccine elicits a broad-spectrum of cytokine responses in whole blood.

    Here, we evaluated innate and adaptive immune system cytokine responses induced by HPV-16 L1 VLP in whole blood (WB) cultures from individuals receiving the vaccine (n=20) or placebo (n=4) before and after vaccination. 11 cytokines were measured: IL-1beta, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, IFN-gamma, TNF-alpha, and GM-CSF using multiplex bead arrays. Cytokine profiles from WB samples clearly discriminated between vaccine and placebo recipients and between pre and post-vaccination responses. Significant increases in Th1, Th2 and inflammatory cytokines were observed in WB assays following vaccination. Results from WB assays were compared against parallel PBMC-based assays in a subset of patients. Differences between whole blood assay and PBMC were observed, with the highest levels of induction found for WB for several cytokines. Our results indicate that multiplex assays for cytokine profiling in WB are an efficient tool for assessing broad spectrum, innate and adaptive immune responses to vaccines and identifying immunologic correlates of protection in efficacy studies.

    I would be curious in how you would reconcile this finding, significant increases in pro-inflammatory cytokines post vaccination in the non placebo group only? Both groups were exposed to the same bewildering array of antigens during daily exposure, yet only one group showed an increase in inflammatory cytokines. Mr. Offits back of the napkin calculations regarding T and B cell capacity are a nice way of destroying the over used canard of an ‘overwhelmed’ immune system, but in no way address the possibility of a persistently modified immune system. Once again, I would direct you to the studies I referenced in post 246 and 247 for examples of this.

    The immune system does not and cannot know that this little molecule is part of a pertussis virus which might be deadly if the whole virus were present, which it isn’t, and the that little molecule is part of a dust mite, which is harmless. It just recognizes them all as not-self. The antigens themselves are not the diseases.

    But I am not worried about the disease. I am worried about the resultant immune response, and you get one of those if the disease is real or not.

    – pD

  256. #256 Kristen
    September 4, 2010

    adelady,

    Someone might come up with an explanation for autism that tells parents that the mother’s pregnancy diet and home environment with the usual load of chemicals could be responsible if she herself absorbs them in a particular way. These might possibly be absorbed into her body and then through the placenta to affect the foetus.

    Too confronting.

    It’s much, much more reassuring to believe that malign outside forces caused such problems.

    I know I am not a “typical” autism mom, but I feel knowing would be more important than my guilt. I think most parents of autistic children already feel incredible guilt. Some deal with it by believing some evil entity (big pharma™, government, CDC, FDA etc…) intentionally caused their children to become autistic. It would be very hard for most of us to face facts if this conjectural “cause” were found, but if it would help to prevent problems in the future it would be worth it.

    I think many parents with autistic children have gotten over-zealous (stating the obvious, I know) but I can’t say I blame them for getting angry, just for staying ignorant. One year ago, when I found RI I was very angry and had wrong ideas, probably still do (look in the archives for my comments in 2009, not pretty). It is very difficult to refine ones understanding, but the facts are more important to furthering our understanding.

    That said, I don’t think there will ever be found a “cause” of autism, just risk factors (Genetic, perhaps. Environmental, perhaps. Both?) and possible preventative measures for those at risk.

    The biggest issue has to be caring for our children now, and developing the resources they need to meet their potential. The majority of autistics can learn to live in society and be happy and successful. Finding out how to teach them effectively and putting services in place to support them as adults. These are the things our children need. I think parents need to stop getting distracted looking for a “cure”, accept their children’s extraordinary needs and move foreword.

    PD does make well thought out comments. I think he should be treated with respect FWIW. I can’t say I agree with the direction of his argument, but he is being reasonable and deserves the same courtesy.

  257. #257 LW
    September 4, 2010

    passionlessDrone, I have no experience with children. My impression from reading, and from people around me who do have children, is that infants do occasionally have fevers. I find it difficult to believe (but I’m willing to be educated) that for all of human history, the average child never had a single episode of fever prior to the age of sixty days. I frankly find it difficult to believe that that is even true now in twenty-first century America, but again I am willing to be educated.

    My objection is to the term “infection” when speaking of vaccines that do not include live diseases. An infection gives rise to a race between the infecting organism, trying to be fruitful and multiply, and the defending immune system, trying to kill it off before it is well-established. If the immune system is slow off the mark, the patient may become very ill or even die. A vaccine that includes only antigens or deactivated viruses is simply there, giving the immune system a good look at the enemy. If the immune system doesn’t respond at all, the patient just goes on about his or her life but doesn’t have the desired immunity.

    Your argument is that immune system activation, not infection, is the issue, so I don’t think you should be asking “How many infants were naturally infected with Hep-b, influenza, rotavirus, diptheria, pertussis, tetanus, and hib on their sixtieth day from the womb?” since that isn’t anything like what is happening now. Using the word “infection” in this case strikes me as unnecessarily inflammatory, and it is a strawman.

    You continue to use it in your follow-up comment: “we have precious little evidence to say that the response and corresponding effects of an infection at three, five, or ten years can safely be equated with one at two months.” Since we’re still not talking about infection at two months, this is still inflammatory and a strawman.

  258. #258 Orac
    September 4, 2010

    Again, great thought. Please understand that neither Orac nor most of the other “scientists” here are interested in thoughtful discussion. Just speculative and vituperative narrative about possible toxins (vaccines, aluminum) rather than a reasoned debate about known toxins like PDBEs. The goal is getting others angry and generating traffic.

    Confirmation bias, Dr. Jay. You only seem ever to show up at my more “flame-throwing” posts. I can’t recall ever seeing you show up at my more thoughtful posts, like this:

    http://scienceblogs.com/insolence/2010/09/the_saga_of_avastin_and_breast_cancer.php

    Or this post, where I took Nancy Snyderman to task for going too far:

    http://scienceblogs.com/insolence/2010/07/dr_snyderman_please_be_more_careful.php

    Come to think of it, why are you making such a comment on this post, which basically agrees that the Fletchers should have been given the benefit of the doubt and compensated a lot sooner?

    I sense a new meme that Dr. Jay will be beating into the ground. It’s basically a variant of the “pharma shill” gambit. Unable, however, to connect me in any way with a pharmaceutical company, Dr. Jay has decided that I’m some sort of blog traffic whore who only does what he does for the money and fame that comes with more traffic and repeats that lie over and over again.

    Of course, Dr. Jay is well aware that I have another blog under my real name and that I receive zero compensation for doing that. I do it because I’m passionate about science-based medicine.. He is well aware that sometimes I even crosspost the very same post (with minor modifications) about vaccines over there. He is also aware that I have written posts very critical of him–yes, him–over at that other blog without crossposting that criticism here. Yet, oddly enough, Dr. Jay has never, ever shown up at that other blog to complain or criticize what I wrote over there. He would rather show up here, because here he can whine about how mean and nasty I supposedly am, what a self-indulgent traffic whore he seems to think me to be.

    Sorry, Dr. Jay. If you want to show me up, show up at my other blog in the posts about vaccines and I might start to take your whines a little more seriously. In the meantime, since you can’t answer the criticisms here, you’ve simply jumped onto the convenient (and false) claim that I’m in it for the money and notoriety.

  259. #259 passionlessDrone
    September 4, 2010

    Hi colmcg –

    Thank you for the kind words.

    Q: if there was a predisposition towards certain kinds of adverse reactions following vaccination as you suggest, would this have been established via the epidemiological studies that have been carried out to date (fombonne madsen etc)?

    Maybe. Unfortunately, the studies you refer to were all about the MMR, which generally is not given until at least a year of age, and up to eighteen months. These studies have no way to track the effect, if any, of shots given shortly after birth, or at two, four, and six months. Similarly, the thimerosal related studies, provides us information regarding the presence or absence of thimerosal, not the act of invoking an immune response. The animal studies I have been reading tend to be focussed on what would seemingly be an earlier stage of life, if applicable to humans; though the jump from rodent to human is fraught with unknowns.

    While the people who claim to have witnessed dramatic regressions in their child following MMR vaccination are definitely vocal; my concerns are more along the lines of subtle changes. The more we learn about things like exposures during development, it seems that our conclusions towards no effect are forced downwards as we learn apply finer filters.

    One recent study, Smith (2010) did perform an analysis of children from a thimerosal study and used thimerosal values as proxies for vaccine reception. I’m not convinced it was comprehensive enough to spot a subpopulation, and it was comprised of a selective population, but none the less, I must admit its findings do argue against my ideas.

    – pD

  260. #260 LW
    September 4, 2010

    Quoth Dr. Gordon,

    @LW I wonder just how much experience Dr. Gordon really has with vaccines. I know, I know, 31 years practicing, but I’ve been reading Respectful Insolence for years, and he’s always said that he vaccinates only rarely.

    I have a huge amount of experience with vaccines. I have been in private practice for only 31 years but involved in medicine and medical research since 1967.

    On the other hand::

    My vaccine schedule? Either none or just a DPT in the first 24 months of life. I think that there’s a greater risk vaccinating males under 24 months and would prefer not to unless there are special circumstances. I use very few other shots except the Varivax as a child approaches ten years because teen and adult pox are nasty and even a little dangerous especially during pregnancy. I give Hep B vaccines to nursing student/moms and dads, other medical moms and dads and higher risk teens and college kids.

    I know several doctors who have been in private practice since the mid-60s. All of them have more clinical experience than Dr. Gordon, and much more than Orac. All of them have a bit of experience with cancer (I expect any doctor sees cancer patients once in a while), but if I had a question about cancer, I’d rather ask Orac than one of them. His clinical experience is directly in oncology and theirs, while much more extensive, isn’t in oncology and isn’t worth much in this context.

    So Dr. Gordon has 31 years of clinical experience, and involvement of some kind with medicine and medical research for 43 years. That does not alter the fact that he gives minimal vaccines in his practice. He vaccinates none of his patients against rubella, not even young women who are not immune and may get pregnant, unless they have “very unusual travel plans”. He states that he does not regularly vaccinate against Hep-B (only in certain cases not including young children), and apparently he does not regularly vaccinate against influenza, Hib, polio, rotavirus, or pneumococcal disease, since he didn’t feel the need to mention any of them.

    I see no reason to believe that Dr. Gordon has much relevant and recent experience with vaccines.

  261. #261 colmcq
    September 4, 2010

    Thanks PD. A nice, reasoned response ;)

  262. #262 Dangerous Bacon
    September 4, 2010

    pD:“The study you linked to is primarily concerned with T and B cells, not the initial inflammatory response. I think I needed to bee even more concise with my thoughts. Sorry.”

    The study I linked to (as well as numerous others readily found with a simple PubMed search) measured cytokine response, the very aspect you complained was totally absent from research into pediatric vaccines. Your attempted shifting of the goalposts here does not even make sense.

    I do applaud your posting a detailed passage from another linked paper and attempting to explain why its findings concern you regarding vaccines (though you still seem to have the idea that infants exist in a pristine environment without any immune challenge unless someone vaccinates them, which is ridiculous). I hope you will continue to be specific in this manner instead of just posting long lists of papers which could be interpreted as a form of “Gish gallop”. This as you may know is a classic altie tactic of tossing out an extensive array of quotes and links meant to overwhelm opposition, but which on closer examination show minimal to no relevance to the subject, are taken out of context or represent outmoded and debunked views.

    I would also like to know which of your sources have equated immunization with infection in terms of potential negative effects on development, or claimed that infants would exist in a safe bubble without any form of antigenic challenge were it not for vaccination.

  263. #263 passionlessDrone
    September 4, 2010

    Hi Dangerous Bacon –

    The study I linked to (as well as numerous others readily found with a simple PubMed search) measured cytokine response, the very aspect you complained was totally absent from research into pediatric vaccines.

    The study measured cytokine response to subsequent challenge with measles, not whether or not the children experienced increases in inflammatory cytokines in vivo systemically as a result of the vaccination. Look at the HPV vaccination I posted above in 256 for an example; that’s a lot different than the study you posted. The adults in both groups in the study in 256 weren’t in a bubble, but only one group experienced an increase in pro-inflammatory cytokines. Why?

    I hope you will continue to be specific in this manner instead of just posting long lists of papers which could be interpreted as a form of “Gish gallop”.

    Very well. My style is already lengthy, and I was trying to keep from writing a manifesto.

    I would also like to know which of your sources have equated immunization with infection in terms of potential negative effects on development, or claimed that infants would exist in a safe bubble without any form of antigenic challenge were it not for vaccination.

    None of them. But again, evaluate the HPV vaccine study I referenced in 256; it isn’t about baseline exposure, it is about robust respose. An increase in pro-inflammatory cytokines is an increase in pro-inflammatory cytokines, there isn’t any escaping that. The mechanism of action, initiation of an immune response, is something that happens during vaccination.

    You aren’t going to argue that vaccination doesn’t result in a rise pro-inflammatory cytokines are you?

    – pD

  264. #264 Todd W.
    September 4, 2010

    @pD

    One thing that occurs to me regarding the study you posted at #256 (besides the rather small control group) is that they are looking at what happens after the introduction of non-self particles that have not already been recognized by the body vs. particles that most likely have (the placebo). How is this different than any other first-time exposure to a non-self particle, whether it be a vaccine or a bit of something that gets into a cut, is inhaled or is swallowed?

    Unfortunately, I don’t have access to the full text of that article to see what they actually did (or how they managed to get significant results with so few subjects in the control group). It just seems to me that it doesn’t exactly show what you seem to think it shows. Or at the very least, that the significance of what it shows doesn’t necessarily support the idea that vaccination at a specific point is either better or worse than exposure to some other intruding particles at the same point.

  265. #265 Jay Gordon
    September 4, 2010

    Orac, my apologies for taking the conversation in a completely unnecessary direction. Your post #259 is correct. In the heat of this discussion I believe I was rude and I am sorry. I am in the midst of reading your excellent post about our mutual hero Dr. Folkman.

    Have a nice weekend.

    Jay

  266. #266 Todd W.
    September 4, 2010

    @Dr. Jay

    I’m sorry that you’re tarring a well-informed, well read fellow poster like pD with the same brush you use for me.

    First off, Dr. Jay, pD is not being tarred with the same brush as you. Notice how people are actually giving his statements some serious thought and asking respectful, intelligent questions. They may not necessarily agree with him, but they aren’t scoffing at him.

    pD, on the other hand, supports his ideas with peer-reviewed research and a questioning point of view.

    And therein lies the reason pD is treated with far more respect than you, Dr. Jay. Notice how pD supports his assertions with evidence and science. Very unlike you. Notice, also, how pD actually answers the substantive questions posed to him, and quite promptly, I might add. Another trait that is quite at odds with your own behavior.

    For instance, we are now going on day 6 since these questions were first asked of you. Still, no answer:

    * You say that vaccine side-effect denialists (VSEDs) exist here at RI. Please provide a concrete example of VSED behavior, which you have defined as saying that there are no or virtually are no side effects.
    * What is your definition of “those at highest risk” (in the original context of the question – HiB)?
    * Am I correct that your recommendation is that except for people who meet that definition, everyone else should not bother with the [HiB] vaccine?

    It is for those reasons, Dr. Jay, that pD is treated tolerably well, while you, with all due respect, are seen as something of a joke. That may hurt your feelings, but really, you should know better by now, since you have been through the ringer so much here. You ought to know what kind of things you should be doing, such as actually answering questions and supporting your claims with something other than mere personal stories and tales.

  267. #267 Jay Gordon
    September 4, 2010

    Todd, I apologized to David for my rudeness and I’m also sorry I’ve offended you to the point that you relentlessly ask the same questions over and over. I’ll respect your questions as best I can by answering one more time:

    I am not willing to spend the time searching the archives to find a post denying all vaccine side effects. If you say there are none, I’ll accept the possibility that you have done that archive search and merely say that I must then accept that my only problem will be when and if VSEDs attribute most major vaccine side effects to coincidence. I take issue with that attribution. I will no longer dispute your claim that there has never been a single person here claiming that vaccines have no side effects.

    I cannot define the type of high risk patient who would benefit sufficiently from the HIB vaccine for me to recommend it with enthusiasm. Perhaps a family traveling to countries where there is still a large number of HIB cases would be one example. In most of the developed world herd immunity protects children and has nearly eradicated the invasive form of HIB. I am not recommending that we stop giving the vaccine. I do tell parents that the choice is theirs and that, because of the vaccine and herd immunity, their informed choice may be to decline the vaccine.

    No, I don’t recommend that “everyone else should not bother with the [HIB] vaccine. I recommend that parents inform themselves, trust their doctors’ opinions and make their decision based on the facts available.

    Those answers will have to suffice. I have no others.

    Have a nice holiday weekend, Todd.

    Jay

  268. #268 Dangerous Bacon
    September 5, 2010

    pD: “I’d love to see any study on a pediatric vaccine that detailed the level of the immune response in a metric other than antibody generation. Do you know of any?”

    (pD is informed that numerous vaccine studies look at both cell-mediated and humoral responses to immunity. The goal posts shift.)

    pD: “pD: “…what if I said, ‘proinflammatory cytokine generation’? What then? Can you point me to a pre / post vaccination study with pediatric vaccines that measures those?”

    (pD is given a link to a pediatric vaccine study that measures proinflammatory cytokine response following immunization and given directions to finding other similar papers. pD responds that, well, the linked study isn’t quite cytokine-y enough for him/her.)

    pD: “pD:”The study you linked to is primarily concerned with T and B cells, not the initial inflammatory response. I think I needed to bee even more concise with my thoughts. Sorry.””

    (pD is reminded that the study in question does in fact deal with this inflammatory response, the very issue of cytokine generation which pD implied had never been studied in vaccinated children. The goal posts are shifted again.)

    pD: “The study measured cytokine response to subsequent challenge with measles, not whether or not the children experienced increases in inflammatory cytokines in vivo systemically as a result of the vaccination.”

    This appears to be not just another goalpost shift but incorrect as well, as the linked study (as well as another in measles-immunized infants with a link on the same page as the study abstract) measured cytokine response in children (i.e., from baseline levels following immunization).

    No doubt pD will have another goalpost shift to present in response (pD is sort of the human equivalent of influenza, which drifts and shifts its genome frequently to complicate immunization efforts). These examples, however are sufficient to show the game being played.

    I agree with some other posters that pD is an improvement on other posters here – certainly a lot better than the antivax trolls and pseudomedical “authorities” that engage in denial about the seriousness of once-common infectious diseases and the success of immunization in vastly reducing or eliminating them, and personal nastiness (interspersed with complaints about how others are mean to them). Given pD‘s tactics of goalpost-shifting, his/her equating of vaccination with inducing “disease”, Gish galloping and assurance of being open to many theories of autism etiology while in actuality singlemindedly focusing on vaccines, I fear that we are seeing a person who, while less obvious and not as vituperative as his/her peers, is still deeply into antivax ideology.

    For the benefit of any who see vaccination as a hazardous interruption into the lives of infants and children who otherwise would be unexposed to DISEASE ORGANISMS and TOXINS, here’s an excerpt from an interesting paper about cytokines. It explains that such immune modulators are constantly acting even in the absence of overt disease:

    “Defining the role of cytokines in nonpathological states requires careful definition of what constitutes the pathological state. Bacteremia (i.e., viable bacteria in the bloodstream) is clearly an example of an extreme pathological condition. There is no question that cytokines are produced, circulate, and have profound influences on physiological function in sepsis. One might propose that the other extreme, namely absolutely no bacterial burden, would represent a purely physiological condition. But such a condition does not exist in nature. A small but steady influx of microorganisms and their toxins through the gastrointestinal mucosa and other epithelial barriers is constantly and effectively handled by resident macrophages and local lymphoid tissues. Therefore, we always exist in some relative state of infection.”

  269. #269 titmouse
    September 5, 2010

    One of the reasons Respectful Insolence rocks is because of people like Dangerous Bacon, who take the time to cite references and describe the points made within them. That’s a lot of work.

  270. #270 titmouse
    September 5, 2010

    Dr. Jay,

    As far as I can tell, your argument against the current recommended vaccine schedule boils down to, “Listen to me; I know what I’m talking about.”

    What happens if you are hit by a bus today? Won’t mankind suffer the loss of your evidence –something apparently so convincing that it trumps all the data aggregated by the CDC over several decades?

    Thankfully, humans invented something called “science,” which is a method of examining claims using tests of corroboration, falsification, logic, and parsimony. The corroboration bit frees us from the tyranny of people citing themselves as their own authority.

  271. #271 passionlessDrone
    September 5, 2010

    Hi Todd W –

    One thing that occurs to me regarding the study you posted at #256 (besides the rather small control group) is that they are looking at what happens after the introduction of non-self particles that have not already been recognized by the body vs. particles that most likely have (the placebo). How is this different than any other first-time exposure to a non-self particle, whether it be a vaccine or a bit of something that gets into a cut, is inhaled or is swallowed?

    Vaccines are achieving their end point, immunological memory of a pathogen in two primary ways; introduction of the bacterial or viral structures that our bodies have developed mechanisms to identify (i.e., via toll like receptors), and inclusion of adjuvants that insure an immune response is generated considering the relatively small amount of pathogen material included in the vaccine. The vaccine is designed to invoke an immune response; without one, you don’t get your desired endpoint, eventual presentation of the molecular structure of the pathogen to memory retaining cells of the immune system. A vaccine that doesn’t invoke an immune response is just a shot in the arm.

    Again, consider the frequency of minor adverse events as reported from the CDC, available here. Check out the DTAP, which causes a fever in about 25% of the cases. Do you think you’ve goten a fever 25% of the time after you ever got a cut?

    Similarly, the kernel of truth to the ‘bubble boy’ theory as presented to me here in several situations, is that our bodies are engulfed with antigens millions of times a day; every time you breath, drink from a glass, or eat a bite of food you ingest bacteria, yeast and other microbes. Also, don’t forget that the lungs, mucous, skin, and gastric acid are well developed systems for helping to insure that lots of these things are kept external to the body. Things that come out of needles bypass all of those. We must strive not to over simplify.

    A baby infant is exposed to ‘new’ things through many of the methods you describe from the second they are delivered. Do you think they suffer from adverse reactions such as fever at the rate of vaccination? When would it stop?

    It just seems to me that it doesn’t exactly show what you seem to think it shows.

    It shows exactly what I think it shows if the argument to be defeated is the notion that there is no difference immunologically between getting a shot and the multitudle of things we encounter on a daily basis.

    I’m going to attempt a rather lengthy response to Dangerous Bacon that hopefully will go into further detail towards why I think this study shows precisely what I think it does, and why the study he provided is a poor equivalent.

    – pD

  272. #272 sesli sohbet
    September 5, 2010

    Jay’s assumption that he is so much smarter than the Scientific Consensus is exactly like the climate change denialists. He is of course oblivious to the irony of calling us denialists.

  273. #273 dt
    September 5, 2010

    pD, I think you are in danger of generalising here.
    Fever correlates with certain immune responses, but is not invariable with infection, not specific for infection and is not a good surrogate for either the nature of the immunopathogenic reaction to infection or the aetiological trigger organism.

    Effective vaccination will usually reliably produce a specific immune response, yet despite effective vaccination, only a small minority of recipients will also get a febrile response. You quote a high 25% incidence with DTaP (which I assume is a correct quote, I haven’t had a chance to check your citation, but this is in excess of the usual incidence of fever following even pentavalent or hexavalent combination vaccines). If only a small fraction of vaccinees get fever, one should not presume fever and vaccination have immunopathological equivalence.

    It shows exactly what I think it shows if the argument to be defeated is the notion that there is no difference immunologically between getting a shot and the multitudle of things we encounter on a daily basis.

    No, I don’t recall anyone here impliing or stating that the multitude of antigenic challenges we encounter every day are directly equivalent to vaccination – that is a straw man.

    It has been proposed that the human infant’s immune system is potentially capable of responding to thousands of contemporaneous antigenic challenges – something I have no problem accepting. And I accept some challenges are different to others. However you seem to be saying that fever (which is a very common problem in infancy, and which does not even need to arise from invasive infection) is the key to the problems that concern you and that this is not something that will affect an infant until they are vaxed. That notion (if it is indeed what you are saying) is plainly wrong.

    The other thing you seem to forget is that fever may be beneficial, and not necessarily detrimental.

  274. #274 passionlessDrone
    September 5, 2010

    Hi Dangrous Bacon –

    You seem quite hung up on the idea that the study you provided somehow illustrates that I am changing my position; it would seem I need to provide additional detail on my thoughts, and as usual, this has been a useful learning experience for me regarding the need for clarity when defining my position. The balance between length of response that is overly technical is a difficult one, but I have apparently done a poor job deliniating where I think there might be a potential for problems from vaccination, and which types of studies I think would shed light on this problem. So more clarity it is.

    While Effects of Interleukin-12 and Interleukin-15 on Measles-Specific T-Cell Responses in Vaccinated Infants does technically measure one inflammatory cytokine as a result of vaccination, it only does so several months after the fact. This study, at the end of the day is about developing better ways for enhancing immunological memory, in stark contrast to attempting to evaluate the immediate pro-inflammatory response, which as I will attempt to detail below, is my focus.

    The animal studies I used to form my opinions, including the ones referenced above have all utilized a single exposure of an agent to invoke or mimic an inflammatory cytokine response, and in some instances, great care has been taken to insure that the inflammatory cytokine release was responsible for persistent resullts in the treatment group.

    So lets take a look at the methods section from, Postnatal Inflammation Increases Seizure Susceptibility in Adult Rats, a link to the full paper which I published above. For space considerations I am only posting parts of the methods, but the entire paper is freely available.

    Step 1: Animals were injected wiith LPS to ‘determine whether a single inflammatory event during development can influenze seizure susceptibility in later life’.

    Lipopolysaccharide injections. To determine whether a single inflammatory event during development can influence seizure susceptibility in later life, male rats were injected intraperitoneally on P14 with LPS (Escherichia coli, serotype O26:B6; 25, 100, or 250 µg/kg) or pyrogen-free saline. We previously established that 100 µg/kg LPS generates a mild inflammatory response in the host that lasts for 6–8 h (Heida et al., 2004; Ellis et al., 2006). Additional groups of rats were also injected on P14 with saline or LPS (100 µg/kg) to evaluate both the acute and chronic effects of LPS on cytokine and glial cell activity in the hippocampus (a seizure-vulnerable region). P14 is considered by some to be developmentally equivalent to a human infant of 1–2 years of age (Gottlieb et al., 1977; Avishai-Eliner et al., 2002). To determine whether there was a critical age at which LPS could cause long-term changes to seizure susceptibility, rats were also treated with saline or LPS (100 µg/kg) at P1, P7, or P20.

    Step 2: Several hours after infjection, brain tissue was evaluated for cytokine expression. This is an absolutely critical difference between what I am proposing and the study you provided. I’ll provide the pertinent snipets to make this point shortly.

    Cytokine assay and glial cell immunohistochemistry. To assess the acute effects of LPS on P14 rat microglia and cytokine (IL-1β and TNF) levels, we collected blood plasma at 2 h after injection, as well as hippocampal tissue 3 and 6 h after LPS (100 µg/kg) or saline injection (n = 4–6/group). Previous reports show that cytokine expression is increased within the adult hippocampus 6 h after peripheral LPS (Nguyen et al., 1998; Turrin et al., 2001; Oprica et al., 2006).

    Step 3: To validate that the changes being observed were, indeed, the result of an inflammatory response, the authors also performed direct injections of an inflammatory cytokine, TNF-alpha, as well as TNF-Alpha antibodies to discern if effects similar to LPS could be achieved.

    Intracerebroventricular injections. Cytokines are synthesized and released in the brain after a peripheral injection of LPS (Nguyen et al., 1998; Turrin et al., 2001). To evaluate the contribution of the central cytokine responses to peripheral LPS on the programming of the long-term effect on seizure susceptibility after peripheral LPS administration, P14 rats were given intracerebroventricular injections of the natural antagonist for IL-1, IL-1ra (Anakinra; 10 or 50 µg/5 µl), or the TNF neutralizing antibody (Infliximab; 50 µg/5 µl), concurrently with LPS (100 µg/kg, i.p.) or saline. We chose these dosages of IL-1ra because previous reports indicate that 4 µg intracerebroventricularly effectively antagonizes effects of peripheral pyrogens on rat behavior (Kent et al., 1992) and that 10 µg intracerebroventricularly significantly reduces the incidence of febrile seizures in rat pups (Heida and Pittman, 2005). In other P14 rats, rrTNF was administered intracerebroventricularly (bilaterally) at 1 µg/2.5 µl per side to determine the role of this cytokine in promoting long-term seizure susceptibility (n = 5–7/group). Dosages of TNF similar to this have been shown to influence neuronal transmission in the absence of negative side effects (Ignatowski et al., 1999; Reynolds et al., 2004). The surgical procedure, described in detail previously (Heida and Pittman, 2005), was performed under halothane anesthesia and required 10 min to conduct. Animals were returned to their dams, and seizure thresholds were examined 6–8 weeks later using the PTZ paradigm described above.

    To recap, some animals were injected with LPS, a known immune stimulant that triggers an inflammatory response via TLR4, some subjects were euthanized and assayed for brain cytokine expression within a few hours, and another set of animals were given injections of either tnf-alpha antibodies alongside LPS, or straight tnf-alpha in the absence of LPS. This is a study about the effect of the result of the immune response.

    Note:For space considerations, I am leaving out some of of the methods regarding the mechanisms by which the researchers went on to discern seizure susceptibility in the adult rats. I do not believe that they are necessarily salient for a discussion that involves the potential for an inflammatory cytokine response to have very difficult to predict consequences if present during critical developmental windows. But the entire paper is quite interesting.

    Now, lets compare this set of methods with the paper that you provided, Effects of Interleukin-12 and Interleukin-15 on Measles-Specific T-Cell Responses in Vaccinated Infants

    Subjects included 115 infants receiving well child care in Palo Alto, California, who received their primary measles vaccination at 6 (n = 33), 9 (n = 35), or 12 (n = 47) mo of age. Blood samples were taken before, 12 wk after monovalent measles vaccine given at 6 or 9 months of age, or 24 weeks after MMR administered to the 12-month-old infants.

    Ten children (aged 5-11 y) and 15 adults (aged 20-49 y) who had received two doses of MMR (the children according to the routine schedule of 12 mo and 5 y, and adults in childhood) were also evaluated with one blood sample. Not all assays were performed on all samples.

    Again, my presentation hasn’t been sufficiently clear to detail that my concerns involve the immediate rise in inflammatory cytokines following immune challenge, as was measured in Postnatal Inflammation Increases Seizure Susceptibility in Adult Rats, but I think that any intellectually honest reading of these methods will, at the very least, be forced to admit that there is a significant difference between evaluated for cytokine expression several hours after challenge, and measurements that were taken either twelve or twenty four weeks after challenge. Do you agree?

    More from your paper:

    Supernatants from PBMCs stimulated with measles antigen or uninfected cell control in the presence or absence of rhIL-12 (final concentration 5 U/mL) or rhIL-15 (final concentration 0.25 ng/mL and 2.5 ng/mL) each alone or in combination were collected from wells on days 5 and 7, and stored at -70°C. Preliminary studies showed peak production of IFN-γ between days 5 and 7 post-stimulation

    Here we can see that while an inflammatory cytokine, INF–γ was measured, it was only done as a result of subsequent stimulation with measles antigen. This is qualitatively different than the methods described in the study I linked to; and in fact, speaks very directly to the question I asked of you in post 238, but you neglected to to answer, nor include in your blockquote fest attempt to paint me as a goalpost shifter, namely:

    Considering I specifically mentioned that several studies showed attenuation of effects based on administration of anti-inflammatory agents, could you should me any studies on innate immune functioning that would be affected by similar agents with vaccination?

    Regarding Effects of Interleukin-12 and Interleukin-15 on Measles-Specific T-Cell Responses in Vaccinated Infants, the answer to this question is quite resoundingly, no.

    From a technical standpoint, I will admit, this study does evaluate for a pro-inflammatory cytokine following vaccination. Unfortunately, from a meaningful standpoint, it tells us nothing about the immediate inflammatory response following vaccination that is at the heart of my concerns.

    This appears to be not just another goalpost shift but incorrect as well, as the linked study (as well as another in measles-immunized infants with a link on the same page as the study abstract) measured cytokine response in children (i.e., from baseline levels following immunization).

    Would you be willing to post a PMID, title, or link to these studies?

    No doubt pD will have another goalpost shift to present in response (pD is sort of the human equivalent of influenza, which drifts and shifts its genome frequently to complicate immunization efforts). These examples, however are sufficient to show the game being played.

    If I wasn’t sure that I’d failed at properly defining my position, I would be a little offended at this point.

    I agree with some other posters that pD is an improvement on other posters here – certainly a lot better than the antivax trolls and pseudomedical “authorities” that engage in denial about the seriousness of once-common infectious diseases and the success of immunization in vastly reducing or eliminating them, and personal nastiness (interspersed with complaints about how others are mean to them). Given pD’s tactics of goalpost-shifting, his/her equating of vaccination with inducing “disease”, Gish galloping and assurance of being open to many theories of autism etiology while in actuality singlemindedly focusing on vaccines, I fear that we are seeing a person who, while less obvious and not as vituperative as his/her peers, is still deeply into antivax ideology.

    My posting history here is relatively sparse, though verbose when present. Anyone interested (I doubt that is few and far between), could see that my discussion at places like LBRB, or on my own blog are not confined to the vaccine space. Further insistence on this particular point seems to be less than useful. Google searches can provide anyone actually curious with the answer.

    At risk of being accused of a spammer as opposed to a “gish gallloper”, I’d like to specifically address the issue of ‘equating vaccniation with inducing “disease”‘ with more detail. The study I posted above shows with great elegance that tnf-alpha during development can permenantly modify susceptibility to seizures through several possible mechanisms. Here is a snipet from the discussion section of those papers.

    The most exciting finding of the present study is that a mild inflammatory response evoked by LPS during a critical period of development causes a long-lasting increase in hippocampal excitability in vitro, and enhanced seizure susceptibility to the convulsants LI-PILO, KA, and PTZ in vivo. The latter effect was observed over a range of mildly inflammatory doses of LPS and was only evident if administered during the second postnatal week (P7 and P14), and not before (P1) or after (P20) this time. Importantly, inactivation of the proinflammatory cytokine TNF with an intracerebroventricular TNF antibody blocked the long-term changes to seizure susceptibility induced by LPS, whereas intracerebroventricular administration of rrTNF alone mimicked the effect of LPS on seizure susceptibility. These novel results indicate that a single transient inflammatory episode during development can modify the brain through a TNF-dependant mechanism, making it more susceptible to generate seizures in adulthood.

    We showed that the LPS-precipitated changes to adult seizure susceptibility are linked to a critical developmental period (P7 and P14). This time window is similar to the period we previously observed for other physiological changes caused by postnatal LPS (Spencer et al., 2006b). Interestingly, this is also the time when long-term potentiation-induced plasticity first becomes apparent (e.g., P7) and shows maximum responsivity (e.g., P15) (Harris and Teyler, 1984). Thus, we may suspect that some permanent change has taken place during this relatively sensitive period of development in which the effects of LPS (and TNF) can modify synapses. Alternatively, TNF is known to be essential in the normal development of the hippocampus through regulation of neurotrophic factors such as nerve growth factor and brain-derived neurotrophic factor (Golan et al., 2004). The possibility exists that “optimal” levels of TNF may be perturbed after LPS-induced inflammation, even at potentially low doses (Fig. 2A). Future studies will be needed to address the potential mechanisms through which postnatal TNF permanently alters neuronal function to enhance excitability and seizure propensity.

    Clinically, CNS infections occur with some frequency in young children and may be associated with an increased risk for late unprovoked seizures (Rantakallio et al., 1986; Herman, 2002). In those patients surviving CNS infections, the risk for epilepsy was highest during the first 5 years after infection and remained elevated for the next 15 years (Annegers et al., 1988). Currently, there is limited clinical evidence to suggest that peripheral childhood infection contributes to the etiology of adult epilepsies. However, based on the novel data presented here, relatively mild early-life inflammation may be associated with permanent modifications in seizure susceptibility that persist well into adulthood. This may warrant additional patient history review to ascertain whether such a relationship exists. Our data raise the possibility that the known differences in adult seizure susceptibility to very similar insults may have their etiology in a common postnatal infection.

    There seems to be a lot of concern about my supposed confusing vaccination with disease state; but lets be clear about the mechanics of this study. None of the treatment aniimals were infected with any actual pathogen. None of them actually got sick. None of them had a disease or an infection. Even given that, the authors equating the immune challenge resulting from either LPS, or direct tnf-alpha injection, with ‘a common postnatal infection’.

    What should we make of this? Is it possible that the authors of this paper, the peer review staff at the journal that published it, and the people who funded the study, all are unable to discern that there is a difference between having a disease and having an immune challenge? Does this scenario really make sense to anyone?

    The reason is that that the actionable effect, the immune response, and in this case, specifically tnf-alpha, is created as a result of immune stimulation; and that pro-inflammatory cytokine response is absolutely the same if it is triggered by an actual pathogen, LPS, direct tnf-alpha injection, or dare I say, vaccination. If anyone has any doubt about this, again refer to the study on the HPV vaccine I posted in 256; one group and one group only developed a significant increase in pro-inflammatory cytokines, including tnf-alpha. We only have one innate immune system to trigger and vaccines trigger it. There isn’t any bypassing this simple fact.

    A common theme on this thread and in many others here seems to be asking someone a question, and then bashing them if they refuse to answer. So lets try. Dangerous Bacon:

    Does a vaccine initiate an immune response? Does this immune response include the creation of pro-inflammatory cytokines, such as tnf-alpha, IL-6 or Il-1beta? And finally, if the answer to those questions is yes, what is the functional difference between an pro-inflammatory cytokine release when the trigger is vaccination, versus infection with an actual pathogen?

    I have provided direct, clinical evidence in post #256 to answer the first two questions, but it is still possible, though unlikely, that Dangerous Bacon would like to dispute them.

    There are unknowns about the robustness of an LPS induced reaction as compared to a vaccine, but at the end of the day, LPS and the vaccines are recognized by toll like receptors and initiate the innate immune response. In other words, perhaps an actual infection creates a more vigorous immune response than a vaccination; I’d say this is certainly possible, but barring any studies, we cannot know for sure. The studies I mentioned regarding synergistic effects of stimulating multiple toll like receptors simultaneously makes this a difficult problem.

    But, that is why our studies on particular immunological functions within the autism realm can help us. Earlier I referenced, ,Differential monocyte responses to TLR ligands in children with autism spectrum disorders . Here is the abstract:

    Autism spectrum disorders (ASD) are characterized by impairment in social interactions, communication deficits, and restricted repetitive interests and behaviors. Recent evidence has suggested that impairments of innate immunity may play an important role in ASD. To test this hypothesis, we isolated peripheral blood monocytes from 17 children with ASD and 16 age-matched typically developing (TD) controls and stimulated these cell cultures in vitro with distinct toll-like receptors (TLR) ligands: TLR 2 (lipoteichoic acid; LTA), TLR 3 (poly I:C), TLR 4 (lipopolysaccharide; LPS), TLR 5 (flagellin), and TLR 9 (CpG-B). Supernatants were harvested from the cell cultures and pro-inflammatory cytokine responses for IL-1beta, IL-6, IL-8, TNFalpha, MCP-1, and GM-CSF were determined by multiplex Luminex analysis. After in vitro challenge with TLR ligands, differential cytokine responses were observed in monocyte cultures from children with ASD compared with TD control children. In particular, there was a marked increase in pro-inflammatory IL-1beta, IL-6, and TNFalpha responses following TLR 2, and IL-1beta response following TLR 4 stimulation in monocyte cultures from children with ASD (p<0.04). Conversely, following TLR 9 stimulation there was a decrease in IL-1beta, IL-6, GM-CSF, and TNFalpha responses in monocyte cell cultures from children with ASD compared with controls (p<0.05). These data indicate that, monocyte cultures from children with ASD are more responsive to signaling via select TLRs. As monocytes are key regulators of the immune response, dysfunction in the response of these cells could result in long-term immune alterations in children with ASD that may lead to the development of adverse neuroimmune interactions and could play a role in the pathophysiology observed in ASD.

    Given the same trigger, the immune response from children with autism included a marked increase in pro-inflammatory IL-1beta, IL-6 and TNFAlpha. Similar studies that have shown an exaggerated production of inflammatory cytokines in the autism realm would include Innate immunity associated with inflammatory responses and cytokine production against common dietary proteins in patients with autism spectrum disorder, or Preliminary evidence of the in vitro effects of BDE-47 on innate immune responses in children with autism spectrum disorders.

    Even if for most infants the immune response from a vaccination would be relatively weak, we cannot say the same thing for an infant who will go on to develop autism; they may be genetically, epigenetically, environmentally, or otherwise predisposed to react more vigorously to the same challenge. And the way they react, with increased levels of inflammatory cytokines, are the very same chemical messengers identified in the animal study above.

    Finally, I thought I’d spend my last hotlink to Macrophage Migration Inhibitory Factor and Autism Spectrum Disorders. On several occassions on this thread the problem with correlation and causation was brought up regarding immune abnormalities in autism; this is a problem, and we don’t have answers currently. That being said, I think that it is time to dispell the notion that the only people who believe such a relationship could be causal are internet cranks.

    Here is the abstract:

    Macrophage migration inhibitory factor (MIF) is an upstream regulator of innate immunity that promotes monocyte/macrophage-activation responses by increasing the expression of Toll-like receptors and inhibiting activation-induced apoptosis. On the basis of results of previous genetic linkage studies and reported altered innate immune response in autism spectrum disorder, we hypothesized that MIF could represent a candidate gene for autism spectrum disorder or its diagnostic components.

    Look at how gracefully this fits with the Enstrom study above; one finds genetic linkages and associated increased levels of a messenger known to promote monocyte/macrophage activation responses; and the other finds that when monocytes are stimulated, those from children with autism respond more vigorously. It is completely unsurprising.

    Despite the problems in understanding causation, one thing is certain, having autism isn’t causing children to be born with the MIF promoter allele.

    The following is from the Introduction:

    Given a complex model of the inheritance of ASD, possible etiopathic mechanism might involve an immunologic insult to the central nervous system (CNS) in individuals with a susceptible genetic background. We evaluated the genetic association between the innate mediator, macrophage migration inhibitory factor (MIF), and different behavioral components of ASD. MIF is encoded in a functionally polymorphic locus on chromosome 22q11.2 (Online Mendelian Inheritance in Man No. 153620, GenBank accession No. NM 002415) that has been associated with the incidence or severity of different autoimmune inflammatory conditions. Given its location in a previously identified locus of interest and its upstream action in immunity, MIF may represent acandidate gene for ASD or its components. Thus, the central hypothesis underlying this research was that a genetic predisposition to a particular level of MIF production may lead to a proinflammatory profile of cell activation that, if present during a neurodevelopmentally sensitive period, might contribute to the etiopathogenesis of autism.

    This was an expensive, and time consuming study to
    perform. It involved genotyping of hundreds of individuals, autism diagnosis on all children with autism, and measurement of blood levels of MIF for several hundred inviduals. The researchers involved with the study were from four continents, and it was partially funded by the National Institute of Health. It was published in Pediatrics. This is a real paper, and the underlying hypothesis was that a particular level of MIF production may lead to a proinflammatory profile of cell activation that, if present during a neurodevelopmentally sensitive period, might contribute to the etiopathogenesis of autism. The researchers undertaking this research were not doing so on a whim, but rather, on the basis of a wealth of underlying data implicating immunological dysfunction in autism.

    What were the findings of this paper?

    Collectively, these data identify MIF as a potential ASD susceptibility gene and support earlier suggestions of a role for innate immunity in the etiopathogenesis of this disease.

    Overall, the polymorphisms and plasma results provide suggestive evidence for neuroglial and innate immune activation in brain tissue and cerebrospinal fluid and increased expression of proinflammatory cytokines in the CNS or blood of patients with ASD. Persistent elevation of cytokines in the CNS may reflect an ongoing inflammatory process, microglial activation, or developmental arrest, because some cytokine levels increase during phases of neurodevelopment. Because MIF regulates the expression of innate cytokines, we hypothesize that a genetic predisposition at the MIF locus may lead to an inappropriate level of MIF production during a neurodevelopmentally sensitive period, contributing to the pathogenesis of ASD. Our data add to the evidence that some innate immunity genes may play an important role in the development of ASD.

    Does anyone reading this think that the authors of this study, the peer reviewers in Pediatrics, and the people who funded the study are confused by the concept of correlation versus causation? We do not know what causes the vast majority of autism. Very real and substantial attempts are being made to detagle if autism is immunologically mediated; to suggest otherwise is either intellectually dishonest, or alternatively, born out of a lack of understanding of a large body of evidence.

    With that, I will leave it to the individual reader to determine if this post is “gish gallosh” by someone “deeply into antivax ideology”, or the refinement of a ideas that have theoretical defense within the published literature.

    – pD

  275. #275 skeptiquette
    September 6, 2010

    One of the reasons Respectful Insolence rocks is because of people like Dangerous Bacon, who take the time to cite references and describe the points made within them. That’s a lot of work.

    Seriously?

    Let’s take a look at Dangerous Bacon’s post and cited references to see if his conclusions are accurate.

    pD: “I’d love to see any study on a pediatric vaccine that detailed the level of the immune response in a metric other than antibody generation. Do you know of any?”

    (pD is informed that numerous vaccine studies look at both cell-mediated and humoral responses to immunity. The goal posts shift.)

    The goal posts did not shift. Cell mediated and humoral refer to T-cells and B-cells, respectively, which make up the adaptive arm of the human immune system. pD is referring to the innate arm of the human immune system, which, when encountered by a pathogen, reacts immediately initiating a cascade of pro-inflammatory cytokines. These cytokines have many actions on our bodies other than just directing the adaptive immune response. One of these actions is to adjust behaviour patterns to better suit the host for the ensuing battle with the pathogen, generally referred to as “sickness behavior.” This phenomenon is largely modulated by pro-inflammatory cytokines (IL-1B, IL-6, TNF alpha).

    Cytokines are not considered humoral or cell mediated immune responses. Although cytokines can act on both of these types of immune responses they would be considered part of the innate immune response.

    pD: “pD: “…what if I said, ‘proinflammatory cytokine generation’? What then? Can you point me to a pre / post vaccination study with pediatric vaccines that measures those?”

    (pD is given a link to a pediatric vaccine study that measures proinflammatory cytokine response following immunization and given directions to finding other similar papers. pD responds that, well, the linked study isn’t quite cytokine-y enough for him/her.)

    Are you talking about the link in post 248 that you said you found on the first page of results in a pubmed search??

    I just perused it. The study was not designed to measure any sort of comprehensive pro-inflammatory response in the infants who were taking part.

    In a nutshell, the study was undertaken to evaluate the difference in T-cell and antibody (cell mediated and humoral) responses between adults and infants after measles vaccination, with the intent on trying to figure out why the adult response is more robust than that of an infant. Building on their previous work the authors (scientists) also wanted to look at the adaptive immune response in association with two cytokines, IL-12 and IL-15. Lastly, they wanted to evaluate the status of CD40L, a protein which stimulates B-cell proliferation. The primary goal of the study was not to comprehensively evaluate the innate immune response to measles vaccination. The goal was to gain an understanding into the differences in how and why the T-cell and B-Cell responses are diminished in infants under one year old; with the eventual goal of moving closer to a more effective pediatric vaccine in a more vulnerable cohort of infants (those under one year).

    The problem isn’t that the study is not cytokine-y enough (whatever that means, IMO just a good example of rhetoric), but more so that you either:

    a. Did not read the paper you cited.
    b. Did not understand what you read.
    c. Wanted so badly to refute one single point of pD’s argument you just tried to ram a square through a circle (figuratively)

    pD: “pD:”The study you linked to is primarily concerned with T and B cells, not the initial inflammatory response. I think I needed to bee even more concise with my thoughts. Sorry.””

    (pD is reminded that the study in question does in fact deal with this inflammatory response, the very issue of cytokine generation which pD implied had never been studied in vaccinated children. The goal posts are shifted again.)

    Nope, pD is spot on. You, on the other hand, are dead wrong. (for reasons discussed above)

    pD: “The study measured cytokine response to subsequent challenge with measles, not whether or not the children experienced increases in inflammatory cytokines in vivo systemically as a result of the vaccination.”

    This appears to be not just another goalpost shift but incorrect as well, as the linked study (as well as another in measles-immunized infants with a link on the same page as the study abstract) measured cytokine response in children (i.e., from baseline levels following immunization).

    Nope again.

    Once again, the scientists collected samples of whole blood from the subjects. Next, the removed the PBMC’s (peripheral blood mononuclear cells, basically, white blood cells) from the whole blood so that they could run tests on these cells. They put these cells in to 96 well microtiter plates so that they could add other components to the cells, run further tests on the supernatants from these wells and record the results.

    The first order of business was to challenge the subject cells with measles vaccine antigen. Next they added recombinant IL-12 and IL-15 both individually and together to the stimulated PBMCs. They looked at what happened to T-cell proliferation and Interferon gamma production in the presence and absence of these two cytokines.

    Dangerous Bacon, can you explain, using actual references to the study design, how this study measured the pro-inflammatory response of a pediatric population to the measles vaccine?

  276. #276 Jay Gordon
    September 6, 2010

    “No, I don’t recall anyone here impliing or stating that the multitude of antigenic challenges we encounter every day are directly equivalent to vaccination – that is a straw man.

    I love that one.

    In fact, that argument can be found scattered all throughout the past days, weeks, months, years. Here and elsewhere. And, no Todd, I won’t go through the archives to cite chapter and verse.

    Dave, nice “Adams” post at SBM. I’ve never heard of Mike Adams but I share your ambivalence about Dr. Oz.

    Best,

    Jay

  277. #277 dt
    September 6, 2010

    Dr Jay, I see you are indulging in your usual MO of drive-by sniping at cherry-picked, out of context quotes from people, while all the time ignoring the primary discussion that is going on and ignoring any meaningful response to the issues or the questions that have been asked of you. And you wonder why we laugh at you?

    I, and not Todd, said the bit about antigenic challenge. Let’s put it into context, shall we?
    Antivaxers claim the immune system is overwhelmed by the challenge of a few dozen antigens given during the recommended infant vax schedule. This claim is countered by pointing out that:
    (a) The immune system is perfectly capable of responding to numerous simultaneous challenges, and that this is quite fortunate, because
    (b) We are all exposed to numerous antigenic challenges from the moment of birth.

    The straw man, which you have grasped so firmly that your little fists are full of splinters, is to claim that we regard every antigenic challenge as equivalent to a vaccine antigen challenge. Patently they are not, and I would not equate the encountering of say ingested dog salivary proteins as tantamount to an MMR shot. But we do still get numerous challenges that are equivalent- exposures to certain infections for example, which may be frequent throughout childhood, and which can all induce significant systemic immunological host responses.

    There is nothing to see here Jay, move along now. You can leave the discussion to people who know what they are talking about and who engage in proper debate.

  278. #278 passionessDrone
    September 6, 2010

    Hi Dangerous Bacon –

    [Note: The original version of this response landed in the spam filter, so I have removed one of the links, and resubmitted. Orac: Feel free to terminate / ignore the entry in the spam filter. Thanks]

    You seem quite hung up on the idea that the study you provided somehow illustrates that I am changing my position; it would seem I need to provide additional detail on my thoughts, and as usual, this has been a useful learning experience for me regarding the need for clarity when defining my position. The balance between length of response that is overly technical is a difficult one, but I have apparently done a poor job deliniating where I think there might be a potential for problems from vaccination, and which types of studies I think would shed light on this problem. So more clarity it is.

    While Effects of Interleukin-12 and Interleukin-15 on Measles-Specific T-Cell Responses in Vaccinated Infants does technically measure one inflammatory cytokine as a result of vaccination, it only does so several months after the fact. This study, at the end of the day is about developing better ways for enhancing immunological memory, in stark contrast to attempting to evaluate the immediate pro-inflammatory response, which as I will attempt to detail below, is my focus.

    The animal studies I used to form my opinions, including the ones referenced above have all utilized a single exposure of an agent to invoke or mimic an inflammatory cytokine response, and in some instances, great care has been taken to insure that the inflammatory cytokine release was responsible for persistent resullts in the treatment group.

    So lets take a look at the methods section from, Postnatal Inflammation Increases Seizure Susceptibility in Adult Rats, a link to the full paper which I published above. For space considerations I am only posting parts of the methods, but the entire paper is freely available.

    Step 1: Animals were injected wiith LPS to ‘determine whether a single inflammatory event during development can influenze seizure susceptibility in later life’.

    Lipopolysaccharide injections. To determine whether a single inflammatory event during development can influence seizure susceptibility in later life, male rats were injected intraperitoneally on P14 with LPS (Escherichia coli, serotype O26:B6; 25, 100, or 250 µg/kg) or pyrogen-free saline. We previously established that 100 µg/kg LPS generates a mild inflammatory response in the host that lasts for 6–8 h (Heida et al., 2004; Ellis et al., 2006). Additional groups of rats were also injected on P14 with saline or LPS (100 µg/kg) to evaluate both the acute and chronic effects of LPS on cytokine and glial cell activity in the hippocampus (a seizure-vulnerable region). P14 is considered by some to be developmentally equivalent to a human infant of 1–2 years of age (Gottlieb et al., 1977; Avishai-Eliner et al., 2002). To determine whether there was a critical age at which LPS could cause long-term changes to seizure susceptibility, rats were also treated with saline or LPS (100 µg/kg) at P1, P7, or P20.

    Step 2: Several hours after infjection, brain tissue was evaluated for cytokine expression. This is an absolutely critical difference between what I am proposing and the study you provided. I’ll provide the pertinent snipets to make this point shortly.

    Cytokine assay and glial cell immunohistochemistry. To assess the acute effects of LPS on P14 rat microglia and cytokine (IL-1β and TNF) levels, we collected blood plasma at 2 h after injection, as well as hippocampal tissue 3 and 6 h after LPS (100 µg/kg) or saline injection (n = 4–6/group). Previous reports show that cytokine expression is increased within the adult hippocampus 6 h after peripheral LPS (Nguyen et al., 1998; Turrin et al., 2001; Oprica et al., 2006).

    Step 3: To validate that the changes being observed were, indeed, the result of an inflammatory response, the authors also performed direct injections of an inflammatory cytokine, TNF-alpha, as well as TNF-Alpha antibodies to discern if effects similar to LPS could be achieved.

    Intracerebroventricular injections. Cytokines are synthesized and released in the brain after a peripheral injection of LPS (Nguyen et al., 1998; Turrin et al., 2001). To evaluate the contribution of the central cytokine responses to peripheral LPS on the programming of the long-term effect on seizure susceptibility after peripheral LPS administration, P14 rats were given intracerebroventricular injections of the natural antagonist for IL-1, IL-1ra (Anakinra; 10 or 50 µg/5 µl), or the TNF neutralizing antibody (Infliximab; 50 µg/5 µl), concurrently with LPS (100 µg/kg, i.p.) or saline. We chose these dosages of IL-1ra because previous reports indicate that 4 µg intracerebroventricularly effectively antagonizes effects of peripheral pyrogens on rat behavior (Kent et al., 1992) and that 10 µg intracerebroventricularly significantly reduces the incidence of febrile seizures in rat pups (Heida and Pittman, 2005). In other P14 rats, rrTNF was administered intracerebroventricularly (bilaterally) at 1 µg/2.5 µl per side to determine the role of this cytokine in promoting long-term seizure susceptibility (n = 5–7/group). Dosages of TNF similar to this have been shown to influence neuronal transmission in the absence of negative side effects (Ignatowski et al., 1999; Reynolds et al., 2004). The surgical procedure, described in detail previously (Heida and Pittman, 2005), was performed under halothane anesthesia and required 10 min to conduct. Animals were returned to their dams, and seizure thresholds were examined 6–8 weeks later using the PTZ paradigm described above.

    To recap, some animals were injected with LPS, a known immune stimulant that triggers an inflammatory response via TLR4, some subjects were euthanized and assayed for brain cytokine expression within a few hours, and another set of animals were given injections of either tnf-alpha antibodies alongside LPS, or straight tnf-alpha in the absence of LPS. This is a study about the effect of the result of the immune response.

    Note:For space considerations, I am leaving out some of of the methods regarding the mechanisms by which the researchers went on to discern seizure susceptibility in the adult rats. I do not believe that they are necessarily salient for a discussion that involves the potential for an inflammatory cytokine response to have very difficult to predict consequences if present during critical developmental windows. But the entire paper is quite interesting.

    Now, lets compare this set of methods with the paper that you provided, Effects of Interleukin-12 and Interleukin-15 on Measles-Specific T-Cell Responses in Vaccinated Infants

    Subjects included 115 infants receiving well child care in Palo Alto, California, who received their primary measles vaccination at 6 (n = 33), 9 (n = 35), or 12 (n = 47) mo of age. Blood samples were taken before, 12 wk after monovalent measles vaccine given at 6 or 9 months of age, or 24 weeks after MMR administered to the 12-month-old infants.

    Ten children (aged 5-11 y) and 15 adults (aged 20-49 y) who had received two doses of MMR (the children according to the routine schedule of 12 mo and 5 y, and adults in childhood) were also evaluated with one blood sample. Not all assays were performed on all samples.

    Again, my presentation hasn’t been sufficiently clear to detail that my concerns involve the immediate rise in inflammatory cytokines following immune challenge, as was measured in Postnatal Inflammation Increases Seizure Susceptibility in Adult Rats, but I think that any intellectually honest reading of these methods will, at the very least, be forced to admit that there is a significant difference between evaluated for cytokine expression several hours after challenge, and measurements that were taken either twelve or twenty four weeks after challenge. Do you agree?

    More from your paper:

    Supernatants from PBMCs stimulated with measles antigen or uninfected cell control in the presence or absence of rhIL-12 (final concentration 5 U/mL) or rhIL-15 (final concentration 0.25 ng/mL and 2.5 ng/mL) each alone or in combination were collected from wells on days 5 and 7, and stored at -70°C. Preliminary studies showed peak production of IFN-γ between days 5 and 7 post-stimulation

    Here we can see that while an inflammatory cytokine, INF–γ was measured, it was only done as a result of subsequent stimulation with measles antigen. This is qualitatively different than the methods described in the study I linked to; and in fact, speaks very directly to the question I asked of you in post 238, but you neglected to to answer, nor include in your blockquote fest attempt to paint me as a goalpost shifter, namely:

    Considering I specifically mentioned that several studies showed attenuation of effects based on administration of anti-inflammatory agents, could you should me any studies on innate immune functioning that would be affected by similar agents with vaccination?

    Regarding Effects of Interleukin-12 and Interleukin-15 on Measles-Specific T-Cell Responses in Vaccinated Infants, the answer to this question is quite resoundingly, no.

    From a technical standpoint, I will admit, this study does evaluate for a pro-inflammatory cytokine following vaccination. Unfortunately, from a meaningful standpoint, it tells us nothing about the immediate inflammatory response following vaccination that is at the heart of my concerns.

    This appears to be not just another goalpost shift but incorrect as well, as the linked study (as well as another in measles-immunized infants with a link on the same page as the study abstract) measured cytokine response in children (i.e., from baseline levels following immunization).

    Would you be willing to post a PMID, title, or link to these studies?

    No doubt pD will have another goalpost shift to present in response (pD is sort of the human equivalent of influenza, which drifts and shifts its genome frequently to complicate immunization efforts). These examples, however are sufficient to show the game being played.

    If I wasn’t sure that I’d failed at properly defining my position, I would be a little offended at this point.

    I agree with some other posters that pD is an improvement on other posters here – certainly a lot better than the antivax trolls and pseudomedical “authorities” that engage in denial about the seriousness of once-common infectious diseases and the success of immunization in vastly reducing or eliminating them, and personal nastiness (interspersed with complaints about how others are mean to them). Given pD’s tactics of goalpost-shifting, his/her equating of vaccination with inducing “disease”, Gish galloping and assurance of being open to many theories of autism etiology while in actuality singlemindedly focusing on vaccines, I fear that we are seeing a person who, while less obvious and not as vituperative as his/her peers, is still deeply into antivax ideology.

    My posting history here is relatively sparse, though verbose when present. Anyone interested (I doubt that is few and far between), could see that my discussion at places like LBRB, or on my own blog are not confined to the vaccine space. Further insistence on this particular point seems to be less than useful. Google searches can provide anyone actually curious with the answer.

    At risk of being accused of a spammer as opposed to a “gish gallloper”, I’d like to specifically address the issue of ‘equating vaccniation with inducing “disease”‘ with more detail. The study I posted above shows with great elegance that tnf-alpha during development can permenantly modify susceptibility to seizures through several possible mechanisms. Here is a snipet from the discussion section of those papers.

    The most exciting finding of the present study is that a mild inflammatory response evoked by LPS during a critical period of development causes a long-lasting increase in hippocampal excitability in vitro, and enhanced seizure susceptibility to the convulsants LI-PILO, KA, and PTZ in vivo. The latter effect was observed over a range of mildly inflammatory doses of LPS and was only evident if administered during the second postnatal week (P7 and P14), and not before (P1) or after (P20) this time. Importantly, inactivation of the proinflammatory cytokine TNF with an intracerebroventricular TNF antibody blocked the long-term changes to seizure susceptibility induced by LPS, whereas intracerebroventricular administration of rrTNF alone mimicked the effect of LPS on seizure susceptibility. These novel results indicate that a single transient inflammatory episode during development can modify the brain through a TNF-dependant mechanism, making it more susceptible to generate seizures in adulthood.

    We showed that the LPS-precipitated changes to adult seizure susceptibility are linked to a critical developmental period (P7 and P14). This time window is similar to the period we previously observed for other physiological changes caused by postnatal LPS (Spencer et al., 2006b). Interestingly, this is also the time when long-term potentiation-induced plasticity first becomes apparent (e.g., P7) and shows maximum responsivity (e.g., P15) (Harris and Teyler, 1984). Thus, we may suspect that some permanent change has taken place during this relatively sensitive period of development in which the effects of LPS (and TNF) can modify synapses. Alternatively, TNF is known to be essential in the normal development of the hippocampus through regulation of neurotrophic factors such as nerve growth factor and brain-derived neurotrophic factor (Golan et al., 2004). The possibility exists that “optimal” levels of TNF may be perturbed after LPS-induced inflammation, even at potentially low doses (Fig. 2A). Future studies will be needed to address the potential mechanisms through which postnatal TNF permanently alters neuronal function to enhance excitability and seizure propensity.

    Clinically, CNS infections occur with some frequency in young children and may be associated with an increased risk for late unprovoked seizures (Rantakallio et al., 1986; Herman, 2002). In those patients surviving CNS infections, the risk for epilepsy was highest during the first 5 years after infection and remained elevated for the next 15 years (Annegers et al., 1988). Currently, there is limited clinical evidence to suggest that peripheral childhood infection contributes to the etiology of adult epilepsies. However, based on the novel data presented here, relatively mild early-life inflammation may be associated with permanent modifications in seizure susceptibility that persist well into adulthood. This may warrant additional patient history review to ascertain whether such a relationship exists. Our data raise the possibility that the known differences in adult seizure susceptibility to very similar insults may have their etiology in a common postnatal infection.

    There seems to be a lot of concern about my supposed confusing vaccination with disease state; but lets be clear about the mechanics of this study. None of the treatment aniimals were infected with any actual pathogen. None of them actually got sick. None of them had a disease or an infection. Even given that, the authors equating the immune challenge resulting from either LPS, or direct tnf-alpha injection, with ‘a common postnatal infection’.

    What should we make of this? Is it possible that the authors of this paper, the peer review staff at the journal that published it, and the people who funded the study, all are unable to discern that there is a difference between having a disease and having an immune challenge? Does this scenario really make sense to anyone?

    The reason is that that the actionable effect, the immune response, and in this case, specifically tnf-alpha, is created as a result of immune stimulation; and that pro-inflammatory cytokine response is absolutely the same if it is triggered by an actual pathogen, LPS, direct tnf-alpha injection, or dare I say, vaccination. If anyone has any doubt about this, again refer to the study on the HPV vaccine I posted in 256; one group and one group only developed a significant increase in pro-inflammatory cytokines, including tnf-alpha. We only have one innate immune system to trigger and vaccines trigger it. There isn’t any bypassing this simple fact.

    A common theme on this thread and in many others here seems to be asking someone a question, and then bashing them if they refuse to answer. So lets try. Dangerous Bacon:

    Does a vaccine initiate an immune response? Does this immune response include the creation of pro-inflammatory cytokines, such as tnf-alpha, IL-6 or Il-1beta? And finally, if the answer to those questions is yes, what is the functional difference between an pro-inflammatory cytokine release when the trigger is vaccination, versus infection with an actual pathogen?

    I have provided direct, clinical evidence in post #256 to answer the first two questions, but it is still possible, though unlikely, that Dangerous Bacon would like to dispute them.

    There are unknowns about the robustness of an LPS induced reaction as compared to a vaccine, but at the end of the day, LPS and the vaccines are recognized by toll like receptors and initiate the innate immune response. In other words, perhaps an actual infection creates a more vigorous immune response than a vaccination; I’d say this is certainly possible, but barring any studies, we cannot know for sure. The studies I mentioned regarding synergistic effects of stimulating multiple toll like receptors simultaneously makes this a difficult problem.

    But, that is why our studies on particular immunological functions within the autism realm can help us. Earlier I referenced, Differential monocyte responses to TLR ligands in children with autism spectrum disorders . Here is the abstract:

    Autism spectrum disorders (ASD) are characterized by impairment in social interactions, communication deficits, and restricted repetitive interests and behaviors. Recent evidence has suggested that impairments of innate immunity may play an important role in ASD. To test this hypothesis, we isolated peripheral blood monocytes from 17 children with ASD and 16 age-matched typically developing (TD) controls and stimulated these cell cultures in vitro with distinct toll-like receptors (TLR) ligands: TLR 2 (lipoteichoic acid; LTA), TLR 3 (poly I:C), TLR 4 (lipopolysaccharide; LPS), TLR 5 (flagellin), and TLR 9 (CpG-B). Supernatants were harvested from the cell cultures and pro-inflammatory cytokine responses for IL-1beta, IL-6, IL-8, TNFalpha, MCP-1, and GM-CSF were determined by multiplex Luminex analysis. After in vitro challenge with TLR ligands, differential cytokine responses were observed in monocyte cultures from children with ASD compared with TD control children. In particular, there was a marked increase in pro-inflammatory IL-1beta, IL-6, and TNFalpha responses following TLR 2, and IL-1beta response following TLR 4 stimulation in monocyte cultures from children with ASD (p<0.04). Conversely, following TLR 9 stimulation there was a decrease in IL-1beta, IL-6, GM-CSF, and TNFalpha responses in monocyte cell cultures from children with ASD compared with controls (p<0.05). These data indicate that, monocyte cultures from children with ASD are more responsive to signaling via select TLRs. As monocytes are key regulators of the immune response, dysfunction in the response of these cells could result in long-term immune alterations in children with ASD that may lead to the development of adverse neuroimmune interactions and could play a role in the pathophysiology observed in ASD.

    Given the same trigger, the immune response from children with autism included a marked increase in pro-inflammatory IL-1beta, IL-6 and TNFAlpha. Similar studies that have shown an exaggerated production of inflammatory cytokines in the autism realm would include Innate immunity associated with inflammatory responses and cytokine production against common dietary proteins in patients with autism spectrum disorder, or Preliminary evidence of the in vitro effects of BDE-47 on innate immune responses in children with autism spectrum disorders.

    Even if for most infants the immune response from a vaccination would be relatively weak, we cannot say the same thing for an infant who will go on to develop autism; they may be genetically, epigenetically, environmentally, or otherwise predisposed to react more vigorously to the same challenge. And the way they react, with increased levels of inflammatory cytokines, are the very same chemical messengers identified in the animal study above.

    Finally, I thought I’d spend my last hotlink to Macrophage Migration Inhibitory Factor and Autism Spectrum Disorders. On several occassions on this thread the problem with correlation and causation was brought up regarding immune abnormalities in autism; this is a problem, and we don’t have answers currently. That being said, I think that it is time to dispell the notion that the only people who believe such a relationship could be causal are internet cranks.

    Here is the abstract:

    Macrophage migration inhibitory factor (MIF) is an upstream regulator of innate immunity that promotes monocyte/macrophage-activation responses by increasing the expression of Toll-like receptors and inhibiting activation-induced apoptosis. On the basis of results of previous genetic linkage studies and reported altered innate immune response in autism spectrum disorder, we hypothesized that MIF could represent a candidate gene for autism spectrum disorder or its diagnostic components.

    Look at how gracefully this fits with the Enstrom study above; one finds genetic linkages and associated increased levels of a messenger known to promote monocyte/macrophage activation responses; and the other finds that when monocytes are stimulated, those from children with autism respond more vigorously. It is completely unsurprising.

    Despite the problems in understanding causation, one thing is certain, having autism isn’t causing children to be born with the MIF promoter allele.

    The following is from the Introduction:

    Given a complex model of the inheritance of ASD, possible etiopathic mechanism might involve an immunologic insult to the central nervous system (CNS) in individuals with a susceptible genetic background. We evaluated the genetic association between the innate mediator, macrophage migration inhibitory factor (MIF), and different behavioral components of ASD. MIF is encoded in a functionally polymorphic locus on chromosome 22q11.2 (Online Mendelian Inheritance in Man No. 153620, GenBank accession No. NM 002415) that has been associated with the incidence or severity of different autoimmune inflammatory conditions. Given its location in a previously identified locus of interest and its upstream action in immunity, MIF may represent acandidate gene for ASD or its components. Thus, the central hypothesis underlying this research was that a genetic predisposition to a particular level of MIF production may lead to a proinflammatory profile of cell activation that, if present during a neurodevelopmentally sensitive period, might contribute to the etiopathogenesis of autism.

    This was an expensive, and time consuming study to
    perform. It involved genotyping of hundreds of individuals, autism diagnosis on all children with autism, and measurement of blood levels of MIF for several hundred inviduals. The researchers involved with the study were from four continents, and it was partially funded by the National Institute of Health. It was published in Pediatrics. This is a real paper, and the underlying hypothesis was that a particular level of MIF production may lead to a proinflammatory profile of cell activation that, if present during a neurodevelopmentally sensitive period, might contribute to the etiopathogenesis of autism. The researchers undertaking this research were not doing so on a whim, but rather, on the basis of a wealth of underlying data implicating immunological dysfunction in autism.

    What were the findings of this paper?

    Collectively, these data identify MIF as a potential ASD susceptibility gene and support earlier suggestions of a role for innate immunity in the etiopathogenesis of this disease.

    Overall, the polymorphisms and plasma results provide suggestive evidence for neuroglial and innate immune activation in brain tissue and cerebrospinal fluid and increased expression of proinflammatory cytokines in the CNS or blood of patients with ASD. Persistent elevation of cytokines in the CNS may reflect an ongoing inflammatory process, microglial activation, or developmental arrest, because some cytokine levels increase during phases of neurodevelopment. Because MIF regulates the expression of innate cytokines, we hypothesize that a genetic predisposition at the MIF locus may lead to an inappropriate level of MIF production during a neurodevelopmentally sensitive period, contributing to the pathogenesis of ASD. Our data add to the evidence that some innate immunity genes may play an important role in the development of ASD.

    Does anyone reading this think that the authors of this study, the peer reviewers in Pediatrics, and the people who funded the study are confused by the concept of correlation versus causation? We do not know what causes the vast majority of autism. Very real and substantial attempts are being made to detagle if autism is immunologically mediated; to suggest otherwise is either intellectually dishonest, or alternatively, born out of a lack of understanding of a large body of evidence.

    With that, I will leave it to the individual reader to determine if this post is “gish gallosh” by someone “deeply into antivax ideology”, or the refinement of a ideas that have theoretical defense within the published literature.

    – pD

  279. #279 passionlessDrone
    September 6, 2010

    Hi dt –

    Effective vaccination will usually reliably produce a specific immune response, yet despite effective vaccination, only a small minority of recipients will also get a febrile response. You quote a high 25% incidence with DTaP (which I assume is a correct quote, I haven’t had a chance to check your citation, but this is in excess of the usual incidence of fever following even pentavalent or hexavalent combination vaccines). If only a small fraction of vaccinees get fever, one should not presume fever and vaccination have immunopathological equivalence.

    I asked Bacon this question, which he neglected to address. Maybe you will respond:

    We know that vaccines often times cause mild reactions; i.e., fevers, and this is likely due to induction of the immune response and associated creation of inflammatory and pyrogenic cytokines. This would seem to be straightforward with how we think vaccines are actually marshalling an immune response. Can we agree on that?

    My concern is with the immediate, inflamatory cytokine response. I am asserting that vaccination causes a rise in pro-inflammatory cytokines that is significant over everyday exposure. It may, or may not, be equivalent when compared to actual infection, but that is lagely besides the point. Why do you believe the mechanism of action was in the study I posted in 256, if not the designed intention of vaccines, the generation of an immune response? You just don’t get from point A to point B without toggling the innate immune response. You don’t. The frequency with which this results in fever is only applicable if you can describe a mechanism by which vaccines can achieve their result without initiating an innate immune response. Can you do this?

    Antivaxers claim the immune system is overwhelmed by the challenge of a few dozen antigens given during the recommended infant vax schedule. This claim is countered by pointing out that:
    (a) The immune system is perfectly capable of responding to numerous simultaneous challenges, and that this is quite fortunate, because
    (b) We are all exposed to numerous antigenic challenges from the moment of birth.

    Unfortunately, this is a common cannard proposed by “anti-vaxxers”. It is an easy target to dismantle. It is also a gross over simpliciation. What we really need to be discussing is the ability for vaccines to persistently modify the immune system in ways we may not understand.

    This isn’t controversial, after all, the immunological memory created is such an example; we are not immune to a pathogen, and then we are immune. So clearly, at the adaptive level, immunization can modify the immune system.

    But what about the innate immune arm of the immune system? Can that be modified by vaccination? I’d recommend you give some good thought towards this question. What reasons would you give if you had to defend the notion that only the adaptive arm of the immune system is modified through vaccination?

    As evidence that such changes are possible, why not take a look at this study, which I referenced above: Early life activation of toll-like receptor 4 reprograms neural anti-inflammatory pathways

    Here is the abstract:

    A single postnatal exposure to the bacterial endotoxin, lipopolysaccharide (LPS), reduces the neuroimmune response to a subsequent LPS exposure in the adult rat. The attenuated fever and proinflammatory response is caused by a paradoxical, amplified, early corticosterone response to LPS. Here we identify the mechanisms underlying the heightened corticosterone response to LPS in adults after early life exposure to LPS. In postnatal LPS-treated rats, hypothalamic corticotrophin-releasing hormone mRNA, pituitary proopiomelanocortin mRNA, and circulating adrenocorticotrophic hormone were all increased after adult exposure to LPS without significant modification to hippocampal or hypothalamic glucocorticoid receptor mRNA or protein or vagally mediated afferent signaling to the brain. Postnatal LPS administration did cause a persistent upregulation of the LPS Toll-like receptor-4 (TLR4) mRNA in liver and spleen, but not in brain, pituitary, or adrenal gland. In addition, cyclooxygenase-2 (COX-2), which is a prostaglandin biosynthetic enzyme and is normally undetectable in most peripheral tissue, was constitutively expressed in the liver. Adult immune activation of the upregulated TLR4 and COX-2 caused a rapid, amplified rise in circulating, but not brain, prostaglandin E(2) that induced an early, enhanced activation of the hypothalamic-pituitary-adrenal (HPA) axis. Thus, postnatal LPS reprograms the neuroimmune axis by priming peripheral tissues to create a novel, prostaglandin-mediated activation of the HPA axis brought about by increased constitutive expression of TLR4 and COX-2.

    Permenant changes to the HPA axis and neuro-immune responses to subsequent challenges as a result of a single activation of TLR4 in early life. We can quibble about the lack of data one way or another regarding the robustness of an inflammatory response from vaccination, but make no mistake, TLR4 does get activated at the two, four, and six month visits.

    But we do still get numerous challenges that are equivalent- exposures to certain infections for example, which may be frequent throughout childhood, and which can all induce significant systemic immunological host responses.

    Yes but are the frequent throughout infancy? That is where we must focus our attention, the very first few months of life. The vaccine schedule, for good reason, is top heavy at the earliest ages of life; two, four, and six month appointments in the US. Do you honestly think that pre-vaccination 90%+ of infants experienced one of the equivalent events you describe at two, four, and six months of age? Again, developmental status is critical, we cannot allow ourselves to confuse infancy with ‘childhood'; broad assumptions that ignore the complexity of development are the kiss of death for reaching sound conclusions.

    – pD

  280. #280 dt
    September 6, 2010

    @ pD
    I admit I haven’t been able to give the LPS study a thorough reading as yet. But why do you think LPS exposure in postnatal rats provides an equivalent example of human vaccination with quite different antigens, such as DTaP?

    1. I know of no human vaccine that uses LPS as an antigen.
    2. Endotoxin provokes a fairly unique immune response, involving cytokines more often linked into the severe sepsis cytokine cascade.
    3. LPS responses markedly differ between rodents and humans (who are interestingly enough much more sensiive and responsive to it’s stimulus)
    4. Human infants get exposed to endotoxin too, and quite naturally. So one would expect your extrapolations to apply to all these human infants. In fact, seeing as how humans are exquisitely sensitive to endotoxin, if your rat study holds any weight at all, then just about ALL human infants would be having epileptic seizures.

    I really don’t see where you are trying to go with all of this.

  281. #281 Enkidu
    September 6, 2010

    Dr Jay says: ” In most of the developed world herd immunity protects children and has nearly eradicated the invasive form of HIB. I am not recommending that we stop giving the vaccine. I do tell parents that the choice is theirs and that, because of the vaccine and herd immunity, their informed choice may be to decline the vaccine.”

    Dr. Jay as the voice of “informed choice.” I love how you use herd immunity as a reason not to vaccinate, thereby setting up to destroy herd immunity in the future.

  282. #282 Militant Agnostic
    September 6, 2010

    Dr Jay says: ” In most of the developed world herd immunity protects children and has nearly eradicated the invasive form of HIB. I am not recommending that we stop giving the vaccine. I do tell parents that the choice is theirs and that, because of the vaccine and herd immunity, their informed choice may be to decline the vaccine.”

    In other words, Dr. “I’m not anti-vaccine but” Jay encourages parents to be sociopathic parasites.

  283. #283 passionlessDrone
    September 6, 2010

    Hi dt –

    But why do you think LPS exposure in postnatal rats provides an equivalent example of human vaccination with quite different antigens, such as DTaP?

    You need to move up one level, to understanding the Toll Like Receptors; very specialized sensing mechanisms of our immune system that detect foreign particles as the first step of an immune response. We’ve got a lot of different types of them, and they are designed to understand different classifications of pathogens as a result of some very fine level molecular structure that pathogens share as broad classes.

    So, for example, TLR4 has evolved to detect molecular patterns that are common to gram negative bacteria. LPS is a major component of the cell wall for gram negative bacteria, which is why it is so useful as to simulate a pathogen invasion. This is also why, for example, the authors are using LPS and consequent TLR4 activation as a mechanism for learning about common infections. TLR2 detects a variety of pathogen types, including gram positive bacteria. TLR3 is a viral detector. There are many more, and very likely some overlap and crosstalk between them.

    We have different adaptive memories for specific antigens, i.e., diptheria, pertussis, or measles; but the first line of defense, the innate immune response, understands invaders at a far, far more generalized level.

    But the classification system of TLRs is very important if you want to understand why our shot schedule that combines viruses and a variety of bacterial pathogens at the same time. Why? Because of the articles I posted in #211 tell us that in some instances, if you stimulate several different TLRs simultaenously, the resultant inflammatory cytokine response is syngeristic.

    In other words, if you body detects that it is under attach from a gram positive bacteria, a gram negative bacteria, and a virus all at the same time, the response is not additive. From a survival standpoint, this makes sense; better to risk an increased inflammatory response with the benifit of surviving a multipronged attack. However, it significantly complicates matters if our goal is to try to understand the inflammatory response from getting vaccinated against nine or ten pathogens simulatenously; especially barring any clinical evidence.

    Regarding the DTaP, for example, the pertussis bacteria is gram negative; it is detected by TLR4, the same gatekeeper that detects LPS. From that point on, the resultant chemical messages, inflammatory cytokines, are no different in function between LPS and pertussis. Tnf-alpha is tnf-alpha, regardless of the triggering agent.

    . I know of no human vaccine that uses LPS as an antigen.

    But do you know of any vaccines that use gram negative bacteria as an antigen?

    2. Endotoxin provokes a fairly unique immune response, involving cytokines more often linked into the severe sepsis cytokine cascade.

    3. LPS responses markedly differ between rodents and humans (who are interestingly enough much more sensiive and responsive to it’s stimulus)

    While cross species problems are present, they are still triggering the same top level system, the TLR. Use of LPS to initiate an immune response is an exceedingly common tool; it isn’t because we want to learn more about rats. Do you believe that the authors, peer reviewers, and funders from the LPS / seizure study I referenced all fail to understand this problem?

    4. Human infants get exposed to endotoxin too, and quite naturally. So one would expect your extrapolations to apply to all these human infants. In fact, seeing as how humans are exquisitely sensitive to endotoxin, if your rat study holds any weight at all, then just about ALL human infants would be having epileptic seizures.

    You seem to be crossing your own wires here; does this natural exposure to endotoxin lead to sepsis and cytokine cascade all the time? Following your logic, ‘just about ALL human infants’ would have had a bout with sepsis. It is more complicated than that.

    And again, please take a look at how common it is to use LPS to induce an immune response; it happens all the time; you can’t color my study as not having any weight without also painting thousands, or tens of thousands of other studies with the same brush.

    And remember, we have plenty of experimental evidence that the same trigger will result in different inflammatory cytokine production in the autism pouplation. Take a look at the study I published above, Differential monocyte responses to TLR ligands in children with autism spectrum disorders which describes a highly exaggerated inflammatory response after stimulation of TLR2 and TLR4. For some reasons why this might be the case, read the Macrophage Migration Inhibitory Factor and Autism Spectrum Disorders study I also referenced, which found increased levels of a known TLR upregulator in the autism cohort.

    – pD

  284. #284 dt
    September 6, 2010

    “It is more complicated than that”

    Quite. Picking and choosing the bits you think support your hypothesis is disingenuous, to say the least.

    You quite erroneously assume that a vaccine prepared from a GNB (like pertussis) must contain LPS/endotoxin.

    For example, acellular pertussis vaccines consist of 5 antigenic components. None of them is LPS.
    (but whole cell pertussis on the other hand……?)

    The acellular pertussis vaccine component of Daptacel® contains 5 acellular pertussis antigens isolated from B. pertussis grown in modified Stainer-Scholte liquid media. The fimbriae types 2 and 3 are extracted from the bacterial cells and the pertussis toxin (PT), filamentous hemagglutinin (FHA), and pertactin (PRN) are prepared from the supernatant. The pertussis antigens are then purified using sequential filtration, salt-precipitation, ultrafiltration and chromatography. Pertussis toxin is detoxified with glutaraldehyde and FHA is treated with formaldehyde.

    http://www.medscape.com/druginfo/monograph?cid=med&drugid=149818&drugname=Diph%2CPertus(Acel)%2CTet+Ped+(PF)+IM&monotype=monograph&secid=7

    Pertussis toxin is a 105 kDa protein composed of six subunits: S1, S2, S3, (2)S4, and S5. The toxin is both secreted into the extracellular fluid and cell bound. Some components of the cell-bound toxin (S2 and S3) function as adhesins, and appear to bind the bacteria to host cells. S2 and S3 utilize different receptors on host cells. S2 binds specifically to a glycolipid called lactosylceramide, which is found primarily on the ciliated epithelial cells. S3 binds to a glycoprotein found mainly on phagocytic cells.

    The S1 subunit of pertussis toxin is the A component with ADP ribosylating activity, and the function of S2 and S3 is presumed to be involved in binding the intact (extracellular) toxin to its target cell surface. Antibodies against PTx components prevent colonization of ciliated cells by the bacteria and provide effective protection against infection.

    http://www.textbookofbacteriology.net/pertussis.html

    The clue to “LPS” is in the name – lipo-polysaccharide. It contains a portion of Lipid-A joined to a core oligosaccharide and a polysaccharide O antigen. Previous attempts to vaccinate with LPS to protect mammals against endotoxic shock have ended in failure.

    No current vaccines of GNB use LPS as an antigen.

    You talk a good talk pD, but there are gaping holes in your concept. I am reminded of the attempts by Mohamed Al Bayati to demonstrate that Eliza-Jane Scovill died of an allergic reaction to amoxicillin rather than PCP/AIDS. He quoted extensive literature demonstrating the feasibility of the sequence of events as he wished to presume. A clinician would take one look and cry “utter crap!” but to a semi-informed audience who were not well versed in clinical medicine it all sounds so plausible and sciency, with apparently valid scientific references to boot.

    I fear your immunological treatise here, with its talk of pyrogenic cytokines, TLRs and signalling pathways, may be in the same vein. An immunologist (and I am not one) would likely see the glaring errors and logical disconnects sticking out like sore thumbs, seeing how even someone like me can see obvious problems.

  285. #285 dt
    September 6, 2010

    ETA I see pD that you (cleverly?) don’t specifically say vaccines like pertussis contain LPS, you just strongly imply it (eg. “they are gram negative bacilli”) and state that any vaccine based on a GNB will signal through TLR4.

    But the ligand for TL4 is lipopolysaccharide. (Other suspected ligands include some heatshock proteins from C. pneumoniae, some RSV components and extracellular matrix components)

  286. #286 sid offit
    September 6, 2010

    pD vs dt = chess vs. checkers

  287. #287 sid offit
    September 6, 2010

    pD vs dt = Brock Lesner vs. Barney Fife

  288. #288 sid offit
    September 6, 2010

    pD vs dt = Godzilla vs. Bambi

  289. #289 augustine
    September 7, 2010

    Pd really is taking it to you guys. But it doesn’t really matter. In the end ideology rules the day in this blog. There is a new king in town. The neo-atheists. “We are science. And there’s nothing you can do about it.”

  290. #290 augustine
    September 7, 2010

    For those of you, who last time, confused neo-atheism with paleo-atheism, here is an excerpt from the internet encyclopedia of philosophy:

    http://www.iep.utm.edu/n-atheis/

    “A standard observation is that New Atheist authors exhibit an unusually high level of confidence in their views. Reviewers have noted that these authors tend to be motivated by a sense of moral concern and even outrage about the effects of religious beliefs on the global scene.”

    “Regarding the metaphysical component, the New Atheist authors share the central belief that there is no supernatural or divine reality of any kind. The epistemological component is their common claim that religious belief is irrational. The moral component is the assumption that there is a universal and objective secular moral standard.”

    “The New Atheists make substantial use of the natural sciences in both their criticisms of theistic belief and in their proposed explanations of its origin and evolution. They draw on science for recommended alternatives to religion. They believe empirical science is the only (or at least the best) basis for genuine knowledge of the world, and they insist that a belief can be epistemically justified only if it is based on adequate evidence. Their conclusion is that science fails to show that there is a God and even supports the claim that such a being probably does not exist.”

    The new atheist = critical thinking, skepticism, with a “mixture” of science.

  291. #291 Chris
    September 7, 2010

    dt is winning.

  292. #292 colmcq
    September 7, 2010

    fascinating. Do continue.

  293. #293 titmouse
    September 7, 2010

    Hey hey hey, people. Polarized debates are like drinking a six-pack. The buzz can be satisfying and a little addictive. But “my team gud! ur team bad!” is as embarassing to watch as the lampshade-on-head dance.

    Everyone wins when the truth wins. Including the bad people too stupid to realize this.

    I like pD, but I’m not following his major point. Is he/she worried that vaccination correlates with autism incidence? Cuz that horse has ceased-to-be.

    At best, one might argue that an association exists but is too subtle for our epidemiologists to detect currently.

    When you have a broad hypothesis, it’s not too difficult to weave an appearance of support from details in the scientific literature. That’s why we want more than, “Hey look at this biochemistry which might result in symptoms X,Y, and Z.”

    It’s possible to write computer code using genetic algorithms involving random mutation and natural selection. However, such code is impossible for programmers to later debug. Random shit in the code that seems to do nothing actually makes a difference in how the code runs on a particular machine. Remember that as we struggle to decode human physiology.

    Regarding the autism-vaccine hypothesis, the first evidential hurdle is a real correlation between vaccination and autism. Until that’s present, the biochemical details are pretty moot.

  294. #294 Todd W.
    September 7, 2010

    @Dr. Jay

    Todd, I apologized to David for my rudeness and I’m also sorry I’ve offended you to the point that you relentlessly ask the same questions over and over.

    I’m not offended at all. The reason that I asked my questions over and over is because you have this tendency to make claims and then completely ignore requests for clarification or substantiation. The only way, it seems, to get even a vague answer from you is to hector you until you finally respond. It’s like pulling teeth.

    I am not willing to spend the time searching the archives to find a post denying all vaccine side effects. If you say there are none, I’ll accept the possibility that you have done that archive search and merely say that I must then accept that my only problem will be when and if VSEDs attribute most major vaccine side effects to coincidence. I take issue with that attribution. I will no longer dispute your claim that there has never been a single person here claiming that vaccines have no side effects.

    I made no claim, Dr. Jay, though nice try to turn that around. I merely asked for you to back up your claim with evidence. But, you can’t be bothered to do so. Got it. You’ll simply argue by assertion and leave it at that.

    I cannot define the type of high risk patient who would benefit sufficiently from the HIB vaccine for me to recommend it with enthusiasm.

    I didn’t ask what the definition would be to recommend it “with enthusiasm”, but rather what exactly your definition of “highest risk” was, since you pretty clearly stated that such individuals would be the only ones to whom you would give the HiB vaccine.

    Also, if you cannot define who you would consider at “highest risk”, then how do you decide who to give it to?

    I am not recommending that we stop giving the vaccine…No, I don’t recommend that “everyone else should not bother with the [HIB] vaccine. I recommend that parents inform themselves, trust their doctors’ opinions and make their decision based on the facts available.

    First off, I didn’t ask if your recommendation was to stop using the HiB vaccine altogether, so I’m not sure why you’re stating that you wouldn’t recommend stopping it.

    Your reply to my final question doesn’t really make much sense, in light of your opinion of the HiB vaccine. Do you just not make any recommendations at all? Do you lack conviction in your beliefs? If you think that the HiB is only useful in those at “highest risk”, then why avoid making the recommendation that anyone who is not at high risk needn’t bother with the vaccine? Seems pretty simple to me: If you are in the high risk group (whatever that is), then get the vaccine. If you are not in the high risk group, you can get it if you want, but you don’t need it.

    Let’s recap:

    * What is your definition of a “vaccine side effect denialist” (VSED)?

    Dr. Jay: VSED is saying that there are no side effects or virtually are no side effects from vaccines.

    * You say that VSEDs exist here at RI. Please provide a concrete example of VSED behavior.

    Dr. Jay: I cannot or am unwilling to offer any concrete examples.

    * What is your definition of “those at highest risk” [for HiB]?

    Dr. Jay: I have no definition by which I operate. The closest I can come is to suggest that those traveling to regions with high rates of HiB are at “high risk”.

    * Am I correct that your recommendation is that except for people who meet that definition [of high risk for HiB], everyone else should not bother with the [HiB] vaccine?

    Dr. Jay: I will make no solid recommendation one way or the other, even though I believe that only those at high risk for HiB would benefit from the vaccine. Patients should listen to their doctors [how does one listen to their doctor if their doctor won't make a recommendation, one wonders] and inform themselves.

    Do those summaries sound about right, Dr. Jay? I do not want to misconstrue your words.

    Man. It took about one and a half week just to get those vague, noncommittal answers?

  295. #295 Todd W.
    September 7, 2010

    @pD

    [The study linked to in post #256] shows exactly what I think it shows if the argument to be defeated is the notion that there is no difference immunologically between getting a shot and the multitudle of things we encounter on a daily basis.

    But that’s not the question that the study is addressing. It is looking at the effect of a novel non-self assault. You had said in post 256:

    I would be curious in how you would reconcile this finding, significant increases in pro-inflammatory cytokines post vaccination in the non placebo group only? Both groups were exposed to the same bewildering array of antigens during daily exposure, yet only one group showed an increase in inflammatory cytokines.

    This study, since it was examining HPV vaccine, presumably used adults (or, at the very youngest, teens). One can fairly safely assume that by that age, all of the “bewildering array of antigens during daily exposure” is old hat to the immune system. It already recognizes all that stuff. So, the study is not comparing the vaccine vs. other novel non-self particles. It is comparing novel non-self particles to absence of non-self particles.

    Therefore, the study cannot be used to show that there is a difference between getting a vaccine and being exposed to the variety of new particles (bacterial, viral, chemical) one encounters in the first hours, days, months or years of life. The best we can conclude from the study at 256 is that the HPV vaccine triggers “increases in Th1, Th2 and inflammatory cytokines”. It says nothing about what a non-vaccine novel invading non-self particle would do. Also, due to the probably ages of the subjects, it says nothing about how an infant immune system would respond.

    So I stand by my original thought, that the study at 256 does not say what you think it says.

  296. #296 Antaeus Feldspar
    September 7, 2010

    Augie:(or should I say Auger, since you’re so good at boring)

    Oh, I like this one. I almost never bother responding to Augie except when exposing his Goofus moves, but when I do, it’ll be Auger from now on.

  297. #297 whiplash injury
    September 8, 2010

    A recent study published in PLoS One, the online journal of the Public Library of Science concluded that there is no link between MMR and autism. The study tested the proposition that the vaccine’s weakened muscle virus somehow lodged in and inflamed intestines, allowing wasted products to escape and reach the central nervous system. The research team had two questions: Does measles virus really persist in children with both disorders (autism and gastrointestinal complaints), and did vaccination precede the GI complaints which in turn preceded autism? Studying 25 children with both autism and GI disorders, the researchers found no relationship with vaccine timing as 5 of the children had MMR vaccines preceeding GI complaints which in turn preceeded autism symptoms, and only one child had traces of measles genetic material in his bowels.

  298. #298 passionlessDrone
    September 8, 2010

    Hi dt –

    Do you have some reason to believe that the inflammatory cytokine tnf-alpha is functionally different when LPS is the triggering agent? I only ask because you seem extremely caught up with this particular facet of the study design, for reasons I’m not really clear on.

    First and foremost, don’t forget that the animals in Postnatal Inflammation Increases Seizure Susceptibility in Adult Rats also found the following:

    1) Direct injection of tnf-alpha resulted in synaptic excitability differences.
    2) Administration of LPS concurrently with tnf-alpha blockers had the same effect as saline.

    Alternatively, we could look to a very similar study by the same group of researchers, Viral-like brain inflammation during development causes increased seizure susceptibility in adult rats

    Here is the abstract:

    Viral infections of the CNS and their accompanying inflammation can cause long-term neurological effects, including increased risk for seizures. To examine the effects of CNS inflammation, we infused polyinosinic:polycytidylic acid, intracerebroventricularly to mimic a viral CNS infection in 14 day-old rats. This caused fever and an increase in the pro-inflammatory cytokine, interleukin (IL)-1β in the brain. As young adults, these animals were more susceptible to lithium-pilocarpine and pentylenetetrazol-induced seizures and showed memory deficits in fear conditioning. Whereas there was no alteration in adult hippocampal cytokine levels, we found a marked increase in NMDA (NR2A and C) and AMPA (GluR1) glutamate receptor subunit mRNA expression. The increase in seizure susceptibility, glutamate receptor subunits, and hippocampal IL-1β levels were suppressed by neonatal systemic minocycline. Thus, a novel model of viral CNS inflammation reveals pathophysiological relationships between brain cytokines, glutamate receptors, behaviour and seizures, which can be attenuated by anti-inflammatory agents like minocycline .

    Please note the similarities with our previous study; an inflammatory response during development leads to increased seizure susceptibility. But more importantly for your fascination with LPS, notice also that the triggering agent, Poly:IC is different than LPS, and that a different anti-inflammatory agent, minocycline, was able to suppress the effect.

    The mechanism of action isn’t about LPS or Poly:IC; it is about whether there is an inflammatory response, or there isn’t an inflammatory response. I don’t know how to be more clear on this, unfortnately.

    Regarding the meaningfullness of whether or not the DTaP actually triggers TLR4 for creation of inflammatory cytokines, we could look to Developmental biology of the innate immune response: implications for neonatal and infant vaccine development. [PMID: 19918215], published in May of 2009, which states in part:

    It is increasingly appreciated that an important determinant of vaccine efficacy is the ability of a given vaccine to activate the innate immune system to enhance APC function and Th1-polarizing adaptive responses (52). Currently, the two vaccines that are regularly given at birth in humans are the bacillus Calmette-Guerin (BCG) vaccine and the hepatitis B (HepB) vaccine (Table 1). BCG is capable of inducing a strong Th1-type immune responses in human neonatal cells in vitro (53) and in vivo (54), which is in part due its ability to activate multiple TLRs expressed by APCs (55).

    Haemophilus influenzae type b (Hib) conjugate vaccines are initially administered at 6 to 8 weeks of age. Hib activates transfected HEK293 cells in a TLR2- and TLR4-dependent manner, likely reflecting expression of bacterial lipopeptides (TLR2) and lipopolysaccharide (TLR4) (63) (64) (Table 1). Indeed, the outer membrane protein complex (OMPC) found within the Hib-OMPC glycoconjugate vaccine is TLR2 and MyD88-dependant, and in the absence of TLR2, the immunogenicity of the Hib-OMPC vaccine is significantly reduced (64).

    I suppose, the informed reader could argue that we have evidence that some pediatric vaccines might achieve the entirity of their immunostimulatory effects through interferrence with processes downstream of the TLRs (though we still really do not understand how alm adjuvants work), and because we also do not understand precisely how or where an exaggerated immune response is being generated by TLR stimulation in the autism subgroup, it is possible that the mechanisms of action are separate and distinct. It is an example of logical acrobatics that hinges on our lack of knowledge, which has always been my largest concern, but it is an argument my ideas are potentially susceptible to.

    At the end of the day, unfortunately, what we have is a lack of evidence. No studies on autism that study the effect of early life immune stimulation unless they involve the presence or absence of thimerosal. No studies on the release of pro-inflammatory cytokines as a result of vaccination in the pediatric shot schedule. No clear understanding of how alum actually achieves its immunostimulatory effects and a nascent understanding of the neonatal immune response. This is in stark contrast to the over riding narrative of this site, and indeed, the media hype.

    – pD

  299. #299 titmouse
    September 8, 2010

    This is just a test to see if I’m still in the spam trap.

  300. #300 titmouse
    September 8, 2010

    The tufted titmouse is now free of the filter!

    Woohoo!

    If anyone can explain to me why I’ve been filtered out of ScienceBlogs for nearly a year, I would be most appreciative.

  301. #301 passionlessDrone
    September 8, 2010

    Hi Todd W –

    It is looking at the effect of a novel non-self assault.

    You keep on dancing around the elephant in the room, vaccines are designed to invoke an immune response. If we were talking about something whose intention was other than to insure an immune response was generated you might have a point.

    This study, since it was examining HPV vaccine, presumably used adults (or, at the very youngest, teens). One can fairly safely assume that by that age, all of the “bewildering array of antigens during daily exposure” is old hat to the immune system. It already recognizes all that stuff. So, the study is not comparing the vaccine vs. other novel non-self particles. It is comparing novel non-self particles to absence of non-self particles.

    Please forgive me if I misunderstand your underlying argument, but doesn’t your logic follow that we ought to see an increasing trend in inflammatory cytokines, baseline, as a child is younger? In other words, the day a child is born, he is exposed to a million antigens (or whatever), an immunolgoical response is created, the next day, he is exposed to a million, but he already encountered a hundred of them, and they are considered ‘non novel’ at this point; consequently leading to a less robust immunological response. As age increases, the number of new novel non self particle dwindles. Is that correct?

    I found this, which somewhat speaks towards this line of thought Age-specific analysis of normal cytokine levels in healthy infants [PMID:14580162]

    While pathophysiology of elevated cytokines is well delineated, reference values for children are unknown, although they may vary physiologically with age and differ from those of adults. Between June and November 2001, interleukin (IL)-6, IL-10 and tumor necrosis factor-α (TNF-α) concentrations from blood samples of 79 healthy children in six different age groups (group I: 03 months; group II: 4-12 months; group III: 13-24 months; group IV: 25-36 months; group V: 37-48 months; group VI: 49-60 months) were measured with ELISA. TNF-α was within 2.2-3.5 pg/ml in all groups with a trend toward higher values in groups II and III (p = ns). IL-6 was significantly lower in group III than in groups IV (p = 0.0165) and VI (p = 0.0147). IL-10 was within 3.35.5 pg/ml in all groups (p = ns). In regression analysis no correlation between age and cytokine concentrations was found. Although not statistically significant, IL-6 was lower and TNF-α higher than the adult reference values provided by the kit manufacturer. Although reference cytokine levels seem not agerelated during early infancy, IL-6 is significantly lower during the second year of life than later. In infants aged 5 years or younger, reference levels of IL-6 should be chosen lower, and those of TNF-α higher, than the adult reference values.

    So between the age of zero months and five years, the authors could detect no change in baseline cytokine values; though paradoxical trending of inflammatory cytokines were observed. Presumably a child of five has encountered significantly more antigens than a child of three months, at yet baseline values do not seem to be different. Despite all those environmental antigens, baseline values of cytokines did not fluctuate. Does this have any impact on your thoughts regarding novel non self particle exposures?

    Therefore, the study cannot be used to show that there is a difference between getting a vaccine and being exposed to the variety of new particles (bacterial, viral, chemical) one encounters in the first hours, days, months or years of life.

    But what if we goto basic research on vaccines? For example, what if we look at this paper, Alum induces innate immune responses through macrophage and mast cell sensors, but these are not required for alum to act as an adjuvant for specific immunity [PMID: 2912728]

    Here is the most pertinent snipet in regards to our discussion:

    Our results show that many proinflammatory cytokines and chemokines are rapidly produced in vivo after exposure to alum.

    Or, we could look here at Mechanism of action of licensed vaccine adjuvants, also published in 2009 that states in part:

    However, recent work on alum and on the squalene-based emulsion MF59, has demonstrated that besides antigen delivery functions, these classes of adjuvants can also activate innate immunity pathways in vivo, generating an immunocompetent environment at injection site. Interestingly, it has been demonstrated that alum adjuvanticity depends on the activation of a protein complex called NLPR3/inflammasome, which is required for the correct processing of a number of pro-inflammatory cytokines, including IL1β.

    This is a forum where you expected to do more than shoot holes in studies, but instead, to provide evidence to support claims; especially if those claims run counter to a variety of evidence.

    If you would like to claim that vaccines do not invoke an inflammatory immune response, or perhaps do not do so in infants, you need to bring more to the table than the utter lack of studies in the infant population and claim maybe it is the case. You don’t like the fact that I used an HPV study and adults, fine. Find a study that discerns the inflammatory response in infants; especially one that shows a lack of inflammatory cytokines. This task should be exceedingly simple if the studies are actually available.

    Also, due to the probably ages of the subjects, it says nothing about how an infant immune system would respond.

    We do have some evidence that at the neonatal stage, right after birth, there are significant differences in the immune response; which is one reason we generally wait until a few months to start it up (except Hep-B or some others in other countries, I believe). [See Developmental biology of the innate immune response: implications for neonatal and infant vaccine development which I referenced above for some of what is known in this regard.]

    During the course of looking at this it occurred to me that this is a very curious evolutionary development, when the infant is absolutely at its most vulnerable, it has different immune response profile. We might consider that opposed to being a problem to overcome in order to vaccinate neonates even earlier, it might be a sign of evoluationarily selection; maybe nature is trying to tell us something.

    – pD

  302. #302 Todd W.
    September 8, 2010

    @pD

    I’m not making any claims, one way or the other. I am merely addressing one particular point you made and the evidence you presented in support of that claim.

    Your claim (paraphrased): Vaccines induce production of inflammatory cytokines, but the normal background exposure to antigens and other agents do not (or do, but at significantly lower levels).

    Your supporting evidence: A study in, presumably, adults examining administration of HPV VLPs vs. placebo and the resulting immune response.

    The study you presented does not support your argument. It shows that vaccines lead to increased production of inflammatory cytokines in adults vs. placebo. It does not show that vaccines lead to increased production of inflammatory cytokines in individuals (specifically, children) vs. background antigen exposure.

    That is all that I am saying. My reasoning is that, probably, by the time individuals reach the age of the subjects in the HPV study, they have been exposed to and their immune systems react differently to the everyday background antigens they encounter as compared to children.

    Your follow-up citation, “Age-specific analysis of normal cytokine levels in healthy infants” [PMID:14580162] suggests that the immune response in adults vs. children may not differ that greatly, at least in regard to IL-6, IL-10 and TNF-α. However, that still says nothing about the immune response to daily antigen exposures vs. vaccine exposure.

    Your citation on alum is not really surprising, in that we know alum incites a stronger immune response, but it only has significance if we are discussing vaccines that use alum as an adjuvant. Yes, we know that alum induces an immune response. That says nothing about the immune response to other antigenic exposure from daily life in infancy. And I got the impression that you were speaking of the immune response to vaccines in general, not specifically those containing an adjuvant.

    This is a forum where you expected to do more than shoot holes in studies, but instead, to provide evidence to support claims; especially if those claims run counter to a variety of evidence.

    The only claim I am making is that the study you provided does not appear to support your claim.

    If you would like to claim that vaccines do not invoke an inflammatory immune response, or perhaps do not do so in infants, you need to bring more to the table than the utter lack of studies in the infant population and claim maybe it is the case.

    Again, I am not making any such claim. Since I am not making a claim, other than what I’ve already stated just above, the onus is not on me to produce supporting evidence for a straw man you’ve created.

    You don’t like the fact that I used an HPV study and adults, fine. Find a study that discerns the inflammatory response in infants; especially one that shows a lack of inflammatory cytokines.

    You were the one trying to show that the immune response to vaccines is significantly different than the immune response to daily antigen exposure (in childhood). It is therefore your responsibility to produce the evidence to support that assertion.

    To recap, I do not deny that there is an inflammatory response to vaccines. You have provided ample evidence that that can and does occur in a variety of different manners and degrees. What you have not done, however, is support the rest of your argument: that daily antigen exposure in infancy produces marked differences in immune response vs. vaccines (e.g., that daily novel antigen exposure does not result in production of proinflammatory cytokines).

  303. #303 dt
    September 8, 2010

    So, in essence this is pD’s argument…….

    Vaccines induce immune responses, acting to produce specific protective immune responses against specific antigens, but also via a common final pathway they generate proinflammatory cytokines, which may have adverse consequenses. (So far, so “good”:- there is reasonable evidence to suggest this may happen).

    pD’s extrapolation: Vaccines induce these responses whereas other antigenic exposures do not. His evidence for this? ……..Nothing.

    It is dependent upon you pD to show that the human infant does not respond in this fashion to antigenic challenges. Many of the thousands of challenges infants face may be minor, true, and provoke muted responses which are not typically associated with significant proinflammatory cytokine production, but quite clearly many other challenges are not minor. They provoke significant systemic responses on exposure to numerous posssible pathogens (the list of candidates that infants are exposed to is considerable). The added challenge of vaccines would appear to be pretty insignificant in the grand scheme of things.

  304. #304 passionlessDrone
    September 8, 2010

    Hi dt –

    You are close to my argument, but for some reason you left out the part about our evidence that children with autism seem to create more pro-inflamatory cytokines than their undiagnosed peers, however. And while I haven’t detailed it on this thread, for the sake of brevity, we also have several studies that tell us that as the proposensity for an inflammatory state increases, so too, does the severity of the autistic behaviors.

    For example, in Macrophage migration inhibitory factor and autism spectrum disorders

    There were genetic associations between known functional polymorphisms in the promoter for MIF and autism spectrum disorder-related behaviors. Also, probands with autism spectrum disorder exhibited higher circulating MIF levels than did their unaffected siblings, and plasma MIF concentrations correlated with the severity of multiple autism spectrum disorder symptoms

    Or, we could look at Increased serum levels of high mobility group box 1 protein in patients with autistic disorder

    BACKGROUND: High mobility group box 1 (HMGB1) is a highly conserved, ubiquitous protein that functions as an activator for inducing the immune response and can be released from neurons after glutamate excitotoxicity. The objective of the present study was to measure serum levels of HMGB1 in patients with autistic disorder and to study their relationship with clinical characteristics.

    METHODS: We enrolled 22 adult patients with autistic disorder (mean age: 28.1+/-7.7 years) and 28 age- and gender-matched healthy controls (mean age: 28.7+/-8.1 years). Serum levels of HMGB1 were measured by enzyme-linked immunosorbent assay (ELISA).

    RESULTS: Compared with healthy subjects, serum levels of HMGB1 were significantly higher in patients with autistic disorder (10.8+/-2.6 ng/mL versus 5.6+/-2.5 ng/mL, respectively, P<0.001). After adjustment for potential confounders, serum HMGB1 levels were independently associated with their domain A scores in the Autism Diagnostic Interview-Revised, which reflects their impairments in social interaction.

    Or, we could look at Elevated plasma cytokines in autism spectrum disorders provide evidence of immune dysfunction and are associated with impaired behavioral outcome

    Autism spectrum disorders (ASD) are characterized by impairment in social interactions, communication deficits, and restricted repetitive interests and behaviors. A potential role for immune dysfunction has been suggested in ASD. To test this hypothesis, we investigated evidence of differential cytokine release in plasma samples obtained from 2 to 5year-old children with ASD compared with age-matched typically developing (TD) children and children with developmental disabilities other than autism (DD). Participants were recruited as part of the population based case-control CHARGE (Childhood Autism Risks from Genetics and Environment) study and included: 97 participants with a confirmed diagnosis of ASD using standard assessments (DSM IV criteria and ADOS, ADI-R), 87 confirmed TD controls, and 39 confirmed DD controls. Plasma was isolated and cytokine production was assessed by multiplex Luminex analysis. Observations indicate significant increases in plasma levels of a number of cytokines, including IL-1beta, IL-6, IL-8 and IL-12p40 in the ASD group compared with TD controls (p<0.04). Moreover, when the ASD group was separated based on the onset of symptoms, it was noted that the increased cytokine levels were predominantly in ASD children who had a regressive form of ASD. In addition, increasing cytokine levels were associated with more impaired communication and aberrant behaviors. In conclusion, using larger number of participants than previous studies, we report significantly shifted cytokine profiles in ASD. These findings suggest that ongoing inflammatory responses may be linked to disturbances in behavior and require confirmation in larger replication studies. The characterization of immunological parameters in ASD has important implications for diagnosis, and should be considered when designing therapeutic strategies to treat core symptoms and behavioral impairments of ASD.

    If you are going to summarize my argument, please do not leave out its most important component; that if our parameter of interest is an immune response, the autism population has evidence suggestive of a susceptible population. This is an important point that despite my best efforts, seems to have eluded you; is there a particular reason you have decided not to include this in your summarization?

    pD’s extrapolation: Vaccines induce these responses whereas other antigenic exposures do not. His evidence for this? ……..Nothing.

    Please read my resonse to Bacon in post #238 where I said:

    I called it a faux infection, and our functional end point, generation of an inflammatory response, is the same from vaccination or wild infection.

    Infections generate an immune response. So do vaccinations. If you looked at the study I posted on 302, you will see that no detectable changes were found in children aged 3 to 60 months concerning baseline cytokine levels for why we have reason to believe that everyday exposure isn’t causing the same type of inflamamtory response that an infection, or a vaccine does.

    For the record, I’d clearly state that if my theory is to hold water, infections early in life would have the same propensity for harm. I have no problems with admitting this.

    In fact, we have some evidence for this, though it is conflicting. For example, we might use Infection in the first 2 years of life and autism spectrum disorders. which found:

    Children with subsequent diagnoses of autism do not have more overall infections in the first 2 years of life than children without autism. Data suggest that children with autism may have modestly elevated rates of infection in the first 30 days and that, during the first 2 years, children with autism may be at higher risk for certain types of infections and lower risk for others. Additional studies that explore the associations between prenatal and early childhood infections and autism may help clarify the role of infection and the immune system in the etiology of autism spectrum disorder.

    Or, we could look to Association of hospitalization for infection in childhood with diagnosis of autism spectrum disorders: a Danish cohort study which reports:

    A total of 7379 children were diagnosed as having ASDs. Children admitted to the hospital for any infectious disease displayed an increased rate of ASD diagnoses (HR, 1.38 [95% confidence interval, 1.31-1.45]). This association was found to be similar for infectious diseases of bacterial and viral origin. Furthermore, children admitted to the hospital for noninfectious disease also displayed an increased rate of ASD diagnoses (HR, 1.76 [95% confidence interval, 1.68-1.86]), and admissions for infection increased the rate of mental retardation (2.18 [2.06-2.31]).

    I believe there are other studies that show no relationship.

    It is dependent upon you pD to show that the human infant does not respond in this fashion to antigenic challenges. Many of the thousands of challenges infants face may be minor, true, and provoke muted responses which are not typically associated with significant proinflammatory cytokine production, but quite clearly many other challenges are not minor.

    Again, you’ll have to define ‘antigenic challenge’ in this regard for me. You’ve identified the biggest problem with your argument here, but don’t realize it when you say, ‘clearly many other challenges are not minor’. While this is technically true, to equate to our ~90% vaccination rate, “many other” needs to read in the range of four million children a year. Nearly every child is being vaccinated on their 60, 120, and 180 day from the womb (and a great many on their 2 or 3). Do you think you could provide evidence that such a similar profile exists for infections? Sure it happened to some infants in the past, but do you think it happened to 90% of them? This is a big change from how our ancestors evolved.

    The added challenge of vaccines would appear to be pretty insignificant in the grand scheme of things.

    And so, after all of this, lacking evidence, we are left with the assumption of no harm.

    – pD

  305. #305 Calli Arcale
    September 8, 2010

    I suppose the most trivial example would be colonization of the infant gut. That happens almost immediately after birth, and the gut flora changes completely several times in the first year as the child encounters new bacteria and the gut ecology gradually settles out. Given the massive immune system presence in the gut, I would think this to be significant, even if it’s not identical to a subcutaneous injection. It happens to 100% of babies. (Remember, it doesn’t need to be a massive and visually obvious infection to trigger an immune response.)

    And so, after all of this, lacking evidence, we are left with the assumption of no harm.

    Not exactly. We are left with no evidence of harm.

    Out of curiosity, if autistic children do, as you say, produce more pro-inflamatory cytokines than their normal peers, wouldn’t we expect to see a disproportionate rate of severe illness among the autistic population, and probably also of autoimmune disorders? I’ve heard it claimed that there is an increased rate, but have not seen any convincing evidence; mostly, I’ve heard anecdotes: “my child is autistic and has allergies!” which of course is useless, because lots of children have allergies anyway.

  306. #306 dt
    September 9, 2010

    @pD
    “If you are going to summarize my argument, please do not leave out its most important component; that if our parameter of interest is an immune response, the autism population has evidence suggestive of a susceptible population. This is an important point that despite my best efforts, seems to have eluded you; is there a particular reason you have decided not to include this in your summarization?”

    I have never mentioned autism, i have only dealt with the vaccination and immune challenge issue so far.

    All I am saying is that you have provided no evidence that vaccination provides a greater immune challenge in infants that the background incidence of natural infection, and the “antivax” argument is that vaccines are to blame.

    You say autistics have a higher rate of immune activation/proinflammatory cytokines, and the inference is this is somehow causal in the autism. I am not tackling that argument, merely asking for an important link in the evidential chain to be clarified – namely that this is something which disproportionately affects vaccinated infants (which seems to be where you are coming from). I see that rather than dealing solely with vaccination, you are approaching the problem now from the perspective of “immunoactivation causes autism, whether it be vaccination or infection” which is somewhat different from the argument I thought you were taking initially, what with your previous focus on the vaccine aspect.

    Your own cited evidence points to the fact that autistic kids do get infections, and indeed may get more infections that kids without autism. This might support the idea that immunoactivation is linked with autism, but says nothing about the role of vaccines. (It also doesn’t really support your idea that a fraction of the population is hypersusceptible, and this is why they get autism – that might be the case if you showed autistic kids had equivalent rates of infections to other kids – but you have shown they get more infections, which indicates a cumulative “load” effect rather than a hypersensitivity).

    I would argue that since the immune response to vaccines is far narrower and often less robust than the challenge of a natural infection, that vaccination could reduce cases of autism, as overall it would lessen the immune burden.

    Taking this where I know you will go next, you will say that the challenges from vaccines occur at an earlier age than the natural challenges, so this must be bad. Yet I have indicated that the challenges to the infant immune system are frequent and significant, even in early infancy. (And don’t forget that the bete noir vaccine wrt autism, the one which is meant to make kids regress/change withing hours of recieving it, is the MMR which is not given in the first year)

    Let’s take RSV for example. This is only one of literally dozens of viruses that an infant will get during its first year of life. Not only can the infant catch it once, but several times, as little immunity is engendered. Two thirds of infants get this in their first year, and it is one in which virtually all the harm caused is by virtue of the host immune response, which is varied and complex.

    This review is quite enlightening:
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2258918/pdf/1625-07.pdf

    Now if kids are getting frequent “significant” antigenic challenges such as this throughout their infancy, I can see no logic in ascribing the added small immune burden of vaccination (which might actually help lessen the overall burden by reducing the risk of natural infection) as being significant enough to induce autism.

    Your concept, that infection-induced immunoactivation is the trigger for autism, would if taken to its logical conclusion, lead to a “bubble” mentality of isolating all infants from others for the first year of life to reduce chances of getting any infections, and promote the search and use of vaccines for RSV, rotavirus, ECHO viruses, corona viruses, coxsackie viruses, flu and paraflu, rhinoviruses… (thats hundreds and counting).

    I hardly think that as a strategy to reduce the incidence of autism that this would find favour, particularly among the type of mothers that both hate vaccines and espouse the hygeine hypothesis.

  307. #307 dt
    September 9, 2010

    Clarification on RSV: “Not only can the infant catch it once, but several times, as little immunity is engendered.”

    By this I mean little long lasting protective immunity. The initial acute immune response is very active and significant, as I indicate.

  308. #308 passionlessDrone
    September 9, 2010

    Hi Callie Arcade –

    Out of curiosity, if autistic children do, as you say, produce more pro-inflamatory cytokines than their normal peers, wouldn’t we expect to see a disproportionate rate of severe illness among the autistic population, and probably also of autoimmune disorders?

    It is not as I say, it was as the data says. I have provided some references in post #275 on this. Further

    As far as severe illness in the autism population, there are a few studies on this that I believe are negative; i.e., no differences were found. There was the paper in 305 I linked to that showed an increase in hospitilization in the ASD group, though I’m not sure if that fits the classification of severe illness or not. (?)

    Regarding auto immune disorders, there is one negative study, Atopic features in early childhood autism. [PMID: 18272414] that I know of. It does not seem to have been studied too well.(?) The linkage to parental autoimmune disorders seems strong; see my post at 199 for some studies that fit this criteria.

    – pD

  309. #309 Calli Arcale
    September 9, 2010

    Sorry, I didn’t mean to imply anything ugly; just trying to be clear that I was referencing you. I was too lazy to go up and do another blockquote for what was more a case of curiosity than anything else. (It was late; I was tired. I sorta turn into a pumpkin after 10PM.)

    I guess my real question is whether, if there isn’t increased rate of other illnesses, whether the pro-inflammatory cytokines in autistic children in that data is actually meaningful. Just because something is more doesn’t mean it’s doing anything. *shrugs* I’m out of my depth on that question.

  310. #310 passionlessdrone
    September 9, 2010

    Hi dt –

    I have never mentioned autism, i have only dealt with the vaccination and immune challenge issue so far.

    It was my hope that by this point you will have noticed that the overwhelming majority of my links have been related to autism.

    All I am saying is that you have provided no evidence that vaccination provides a greater immune challenge in infants that the background incidence of natural infection, and the “antivax” argument is that vaccines are to blame.

    Why is it that the complete and seemingly undisputed lack of studies on the innate immune response in regard to vaccination is my problem? This is the heart of my concern; we don’t have quality data on this. I cannot provide links to studies that do not exist; and in the line of my arguement, as you seem to sense later on in your response, ‘greater’ is only part of the potential problem; timing is also important.

    Regarding ‘the “antivax” argument’, I have stated with some clarity that I have no problems with a myriad of other causes.

    I have absolutely no problem with a bazillion other mechanism of action; pure genetics, the environmental ubiquity of endorcrine disruptors, pesticides, and other chemicals, the fattening of the populace, actually getting a viral or bacterial infection, difficulties in birthing and/or gestation, epigenetic alterations from any combination of the above, whatever. My worldview is far, far away from a place where vaccines are the only potential problem.

    (Post 231)

    You say autistics have a higher rate of immune activation/proinflammatory cytokines,

    That isn’t what “I say”; it was what the data says.

    and the inference is this is somehow causal in the autism.

    I am saying this is possible. Big difference. See my post in 229 for more on this.

    I am not tackling that argument, merely asking for an important link in the evidential chain to be clarified – namely that this is something which disproportionately affects vaccinated infants (which seems to be where you are coming from). I see that rather than dealing solely with vaccination, you are approaching the problem now from the perspective of “immunoactivation causes autism, whether it be vaccination or infection” which is somewhat different from the argument I thought you were taking initially, what with your previous focus on the vaccine aspect.

    You are over simplifying my position. I am saying that immunoactivation may lead to autism. Please find a single place where I have made the causation claim. As evidence of a nuanced position on my end, regarding both causation and infections, I could quote myself from this thread:

    I cannot make the claim to prove that immune dysfunction in autism is causal. Similarly, I cannot prove that vaccination can cause autism.

    (Post 229)

    I am worried about the resultant immune response, and you get one of those if the disease is real or not.

    (Post 256)

    In other words, perhaps an actual infection creates a more vigorous immune response than a vaccination;
    I’d say this is certainly possible, but barring any studies, we cannot know for sure. The studies I mentioned regarding synergistic effects of stimulating multiple toll like receptors simultaneously makes this a difficult problem.

    (Post 275)

    Do you have some particular reason that despite all of this, you continue to pigeonhole my position as advocating causation can be proven and ignoring infection?

    I would argue that since the immune response to vaccines is far narrower and often less robust than the challenge of a natural infection, that vaccination could reduce cases of autism, as overall it would lessen the immune burden.

    The extended immune response, sure; but if I were to ask you, or anyone, to post something that details the inflammatory cytokine response from vaccination, no one has seen fit or able to do so. You are making an assumption without data; that’s a bad way to handle systems as complicated as this.

    Taking this where I know you will go next, you will say that the challenges from vaccines occur at an earlier age than the natural challenges, so this must be bad. Yet I have indicated that the challenges to the infant immune system are frequent and significant, even in early infancy. (And don’t forget that the bete noir vaccine wrt autism, the one which is meant to make kids regress/change withing hours of recieving it, is the MMR which is not given in the first year)

    I am saying that we have evidence that time can have a sigificant effect; but I do like how you’ve picked up on that component of my thoughts. Regarding the MMR, please refer to my post 260 where I said:

    While the people who claim to have witnessed dramatic regressions in their child following MMR vaccination are definitely vocal; my concerns are more along the lines of subtle changes. The more we learn about things like exposures during development, it seems that our conclusions towards no effect are forced downwards as we learn apply finer filters.

    Let’s take RSV for example. This is only one of literally dozens of viruses that an infant will get during its first year of life.

    This is a ridiculous statement. I don’t know if you’ve ever had children, but I have, and they do not get sick ‘dozens’ of time in the first year of life! Lets say each viral infection lasted two days; at two dozen infections, that would be forty eight sick days in the first year of life alone; one seventh of the infants first year of life! Does anyone out there have a baby? Have they been sick anywhere close to one day a week?

    What if we were to see what the oft quoted Paul Offit says about the frequency of infection in Vaccines and Autism: A Tale of Shifting Hypotheses?

    Further, vaccines represent a minute fraction of what a child’s immune system routinely navigates; the average child is infected with 4–6 viruses per year [32].

    The figure you have provided, “dozens of viruses” is, conservatively, several orders of magnitude greater than what Mr. Offit claims! Could you please provide any evidence at all that infants are infected with “literally dozes of viruses during its first year of life”? I’d hate to think you pulled this number from nowhere in an attempt to try to minimize the frequency of vaccinations, so why not just let everyone know from where you got this astoundingly high figure. As I’ve stated repeatedly, this is a forum where you are expected to substantiate your claims, and this one is a whopper of a claim. This thread has been an absolute exercise in people making claims and then refusing to back them up with data. Not this time. Where on Earth did you get this idea?

    Not only can the infant catch it once, but several times, as little immunity is engendered. Two thirds of infants get this in their first year, and it is one in which virtually all the harm caused is by virtue of the host immune response, which is varied and complex.

    I think RSV is a great example of exactly the type of potential problem I am proposing; immune disturbances early in life having difficult to predict consequences!

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2258918/pdf/1625-07.pdf

    This is a pretty neat paper. Unfortunately, your assertion that ‘virtually all of the harm is caused by the virtue of the host response’ seems to be at odds with the conclusions of the paper, however.

    The relative contribution of viral versus various host factorsto RSV pathogenesis remains controversial.

    In most cases, however, there may not be a single predominantfactor. Instead, there may be different relative contributions from the various interacting viral and host factors that will depend on the speed and magnitude of viral replication,
    the effectiveness of the host response, underlying predispositions toward aberrant, exaggerated, or deficient aspects of the host response, maturational state, and other factors.

    Now if kids are getting frequent “significant” antigenic challenges such as this throughout their infancy, I can see no logic in ascribing the added small immune burden of vaccination (which might actually help lessen the overall burden by reducing the risk of natural infection) as being significant enough to induce autism.

    Define ‘frequent’ and “significant”. Also, please provide evidence that such “significant” antigenic challenges are “frequent”. And finally, provide some evidence that demonstrates the robustness of the inflammatory cytokine response of pediatric vaccines. Until you can start backing your assertions up, I don’t see how to proceed. My biggest concern is over a lack of data, and you seem to think that just telling me things without backing them up is sufficient. It isn’t good enough, especially when it seems that your own references seem to disagree with your conclusions, or your claims are several times the value of other claims made by others.

    Your concept, that infection-induced immunoactivation is the trigger for autism, would if taken to its logical conclusion, lead to a “bubble” mentality of isolating all infants from others for the first year of life to reduce chances of getting any infections, and promote the search and use of vaccines for RSV, rotavirus, ECHO viruses, corona viruses, coxsackie viruses, flu and paraflu, rhinoviruses… (thats hundreds and counting).

    Please replace “is the trigger for autism”, with “could be one of many triggers for autism”. I’m not advocating anything except an intellectually honest conversation about what we know, and what we don’t. If you can start providing evidence regarding the magnitude of the immune response after vaccination, that would be a good start. There are things we can meaningful control (the rate, and schedule of vaccination), and things we cannot meaningfully control (exposure to the world). I’m saying we should evaluate looking at things we can control, not that we try to change things for which we have no control.

    I hardly think that as a strategy to reduce the incidence of autism that this would find favour, particularly among the type of mothers that both hate vaccines and espouse the hygeine hypothesis.

    I do not hate vaccines, and I think the hygeine hypothesis has some intriguing possibilities.

    – pD

  311. #311 Dangerous Bacon
    September 9, 2010

    titmouse: “Regarding the autism-vaccine hypothesis, the first evidential hurdle is a real correlation between vaccination and autism. Until that’s present, the biochemical details are pretty moot.”

    This reminds me of the homeopathy advocate Orac sometimes lampoons, the eminent Dr. Lionel Milgrom. This guy publishes journal articles containing fabulous equations and models showing how homeopathy might produce its wonderful healing effects. All of this mumbo-jumbo is predicated on the conviction that homeopathy actually works beyond placebo effect, but is a waste of time and electrons considering that such evidence of effectiveness is lacking.

    Similarly, one can weave a jargon-filled connect-the-dots narrative about how the immune response to vaccines (unlike the immune response to “natural” infectious assaults on the body occurring on a daily basis) imperils children and makes an autism-vaccine link rational; lost in all of this is the ample evidence that vaccines do not cause autism. So having a pretty collection of irrelevant cytokine anecdotes does not make for a convincing argument.

  312. #312 Sid Offit
    September 9, 2010

    The repeated use of Paul Offit’s canard, “we’re challenged by billions of bacteria everyday” as a way to excuse the possible adverse effects of vaccination is beyond ridiculous. It’s like saying eating a cup of Activa is the equivalent of receiving a MMR injection.

  313. #313 dt
    September 9, 2010

    pD:

    “It isn’t good enough, especially when it seems that your own references seem to disagree with your conclusions, or your claims are several times the value of other claims made by others.

    My own statement regarding RSV was that “Two thirds of infants get this in their first year, and it is one in which virtually all the harm caused is by virtue of the host immune response, which is varied and complex.”
    You dispute that the paper indicates that the host immune response causes most of the damage. Perhaps I was wrong to suggest “virtually all” the damage was through immunopathogenesis. I was trying to emphasise to you that RSV does provoke a very brisk immune response (like many other viruses do) The review does admittedly present evidence for direct viral cytopathogenesis, but also significant evidence for immunopathogenesis, eg:

    Several observations suggest a substantial contribution of host immunity to RSV disease. For example, clinical observations (as noted above) and in vitro studies (described later)showed that RSV is not highly cytopathic or invasive.///When cotton rats with an established
    RSV infection were administered a neutralizing antibody that reduced pulmonary virus replication more than 1,000-fold, there was little effect on pulmonary pathology; the
    addition of anti-inflammatory glucocorticoid therapy was necessary to reduce pathology (122). A similar lack of clinical improvement was observed for intubated children with an established infection, for whom antibody therapy reduced viral shedding 30-fold compared to controls (97). The inability to block disease progression by sharply reducing virus replication is suggestive of immunopathology rather than direct viral cytopathology. Finally, genetic polymorphisms that increase expression of the IL-4, IL-8, and (tentatively) CCR5 genes were associated with an increased frequency of severe pediatric RSV disease, suggesting that these host factors can contribute
    to pathogenesis

    and

    Excessive T-lymphocyte cytotoxicity is one potential mechanism
    of immune-mediated pathogenesis…..depletion of CD4 or CD8 T cells reduced disease, and depletion of both resulted in long-term infection without illness…. T-cell reconstitution dramatically reduced viral shedding but also resulted in a dramatic increase in pulmonary disease …..A role for Th2-biased responses in RSV pathogenesis was
    suggested by (i) the Th2-mediated disease associated with FIRSV discussed above, (ii) the Th2 bias of the young infant
    (discussed later), in whom severe disease is more frequent, and (iii) the association of Th2 responses with asthma, which involves small airway constriction, mucus plugging, and wheezing similar to patterns seen with RSV disease.

    But enough quibbling over that particular split hair…..

    pD:

    “It isn’t good enough, especially when it seems that your own references seem to disagree with your conclusions, or your claims are several times the value of other claims made by others.

    This is a reference to Paul Offit’s remark that “the average child is infected with 4–6 viruses per year” and your dislike that I said infants are infected with dozens of viruses.

    Would that you so readily believed everything that came out of Offit’s mouth….. ;)

    I think that his estimate is an underestimate. Apart from RSV (already covered) we have:
    Rhinovirus
    Human metapneumovirus
    Influenza
    Parainfluenza A/B
    CMV
    Herpes viruses – types 1, 3, 4, 5, 6, 7.
    Rotavirus
    Adenovirus
    Coxsackie (several subtypes)
    ECHO (several subtypes)
    Coronavirus
    and the rest

    Admittedly I cannot instantly lay my hands on a source giving the exact incidence of each of these these in infancy, suffice to say that they do occur and chances are most infants will be exposed to and infected with many or most of these, and a few others I haven’t mentioned to boot.
    That time your kid was a bit grizzly and hot for a couple of hours? Could have been an ECHO virus.
    That time your kid just seemed off colour, and din’t even have a fever? Could have been adenovirus.

    We are not talking about severe clinical disease/hospitalisation here, just an infection sufficient to engender an immune response. Not every infection provokes a bad clinical response. And most viral infections in infancy are asymptomatic/subclinical.

  314. #314 Todd W.
    September 9, 2010

    @Sid

    Straw man. No one is saying that the daily antigenic challenges are the same as vaccination or that it excuses vaccine AEs.

    However, if someone is going to claim that vaccines “overwhelm” the immune system, or that they have some other major deleterious effect on the immune system, then they need to show a) that such effects do not occur from normal exposure to environmental challenges or b) that such effects occur with greater severity and/or regularity than environmental challenges.

  315. #315 dt
    September 9, 2010

    Apols – HHV-5 is CMV. Didn’t mean to list it twice.

  316. #316 dt
    September 9, 2010

    @Sidtroll:

    “The repeated use of Paul Offit’s canard, “we’re challenged by billions of bacteria everyday” as a way to excuse the possible adverse effects of vaccination is beyond ridiculous.”

    Nice to see you are paying such close attention to the actual discussion Sid. Now be a good boy and go play with some matches near another strawman, will you?

  317. #317 Sid Offit
    September 9, 2010

    I would argue that since the immune response to vaccines is far narrower and often less robust than the challenge of a natural infection, that vaccination could reducecases of autism, as overall it would lessen the immune burden.

    You’re expending considerable effort to not see this but

    “far narrower and often less robust” i.e. different may very well be the problem. As you must know, the immune system is quite complex and has evolved to behave in a specific and synergistic way. Different, less robust or not, may therefore lead to deleterious consequences.

  318. #318 Calli Arcale
    September 9, 2010

    But *does* it? That’s the question. I’m not inclined to get terribly worried about something until there’s data. I appreciate PD’s point about “if nobody does the studies, we won’t know”, but I’m still not going to live my life in fear of all the things we don’t know yet. Maybe having an aquarium is bad for your health in some way which hasn’t yet been studied; I’m still not going to get rid of my guppy/pleco collection.

  319. #319 passionlessDrone
    September 9, 2010

    Hi dt –

    Perhaps I was wrong to suggest “virtually all” the damage was through immunopathogenesis. I was trying to emphasise to you that RSV does provoke a very brisk immune response (like many other viruses do)

    OK. But the details in this discussion are important, had I decided not to respond anyone reading might have taken your words as accurate, when clearly, they are still a point of some contention. It isn’t that I care about RSV in particular, I care that it seems to be a recurrent theme; making statements that subsequently cannot be substantiated, or for which we have evidence that is the opposite.

    I’m in general agreement that the immune response to RSV is brisk, and available evidence says that the immune response is responsible for future outcomes.

    your dislike that I said infants are infected with dozens of viruses.

    I dislike that you seem to have the propensity to say things that you cannot substantiate with evidence and how elbematic this is for the entire vaccine / autism discussion. Again, had I not asked you to substantiate this value, what is to keep a future reader from actually believing that an infant gets ‘dozens’ of viral infections their first year? The fact that there are other infectious disease experts (who appear not to know much about autism), that claim staggeringly lower values isn’t something to sneeze at, to use a pun.

    Here is an example; lets say I were to claim that kids got ‘literally dozens’ of vaccines at their check ups, I’d get crucified with ridicule; yet you make the claim that kids get dozens of viral infections in their first year and it’s no big deal, something I ‘dislike’. Is accuracy important or not? Is the ability to substantiate a statement important or not? I thought I’d wandered into someplace where that was important; maybe I was wrong.

    I further dislike that you consistently misrepresent my position, though I cannot tell if that is intentional or not.

    I think that his estimate is an underestimate.

    Well, OK. For the sake of argument, I could just as easily say that his estimate is an overestimate and we’d both be in the same place; without anything to back it up. If you can find something, anything that approaches two viral infections a month, please push up a link.

    We are not talking about severe clinical disease/hospitalisation here, just an infection sufficient to engender an immune response.

    Can you tell me if this fits as “significant” in your model above (Post 307), or not? That would be a big help.

    Tragically, we are back to the same place we’ve been for a long time; your inability to demonstrate that we understand the strength of an immune response from vaccination. Without that, attempting to make equivalencies between asymptomatic presentation, and everyday exposure are at best, educated guesses. I think that is a problem, but I guess others don’t. I’m not sure how we move on from that. (?)

    – pD

  320. #320 passionlessDrone
    September 9, 2010

    Hi Calle Arcade –

    I appreciate PD’s point about “if nobody does the studies, we won’t know”, but I’m still not going to live my life in fear of all the things we don’t know yet.

    I am quite pleased that someone has, apparently, received at least one of my messages. I’d also add that I’ve always very much appreciated your writing style and usually find your posts quite thoughtfull.

    – pD

  321. #321 Calli Arcale
    September 9, 2010

    *blushes* That’s very kind of you to say, pD. I find you very articulate and thoughtful, and I often learn something from your posts. You’re also a warm-hearted person, and that’s always a good thing to find on the Web, where anonymity tends to encourage harsher expressions of opinion.

  322. #322 dt
    September 10, 2010

    pD, I rather feel this discussion is inexorably descending into a “tit for tat” exchange of nitpicking. I hope not and will try and prevent it from becoming one.

    “Here is an example; lets say I were to claim that kids got ‘literally dozens’ of vaccines at their check ups, I’d get crucified with ridicule; yet you make the claim that kids get dozens of viral infections in their first year and it’s no big deal”.

    There is a difference. Firstly, antivaxers do say this about vaccines, and the important thing to note is that they keep saying it even when corrected. The claim is one that is easily verified and quantified.

    My claim that infants get dozens of viral infections is an estimation based upon knowledge of the existing medical literature, personal and professional experience (and I am open to the possibility that this may be an overestimate). It is unlikely to be able to be definitively proved without a rather comprehensive prospective (and invasive) microbiological surveillance study being carried out on infants, which would be difficult to justify.

    But let me say why I think there is supporting evidence that infants get frequent infections in infancy, of which most will be viral.

    Firstly you have quoted one study yourself (Infection in the First 2 Years of Life and Autism Spectrum Disorders)which indicates the frequency of infections in infants, comparing this to those with and without autism. The methodology indicates that infections are only recorded if they were serious enough to result in “inpatient, outpatient, emergency,and referral visits” (ie they will miss less serious infection episodes, which common sense will tell you will greatly outnumber the episodes for which medical care is sought). The mean number of infections in the first 2 years of life were 8.7 and 8.9 for cases and controls respectively.

    Another prospective study, entitled “Serial viral infections in infants with recurrent respiratory illnesses” looked for viral infections in infants up to 1 year who had a parent/both parents with asthma. If it was thought that the child had a respiratory infection, this was assessed and all episodes which were deemed moderate or greater severity (MSI) were then clinically assessed, and nasal sampling carried out for viruses. Also routine nasal washings were carried out in some children in the study, regardless of symptoms.
    Results show that these kids had a median of 2 “moderate to severe” respiratory illnesses in the first year, and the analysis goes on to focus on the subset of infants who had recurrent illnesses.

    “Viral detection rate increased with the severity of illness: 29 (45%) out of 65 in asymptomatic infants, 14 (67%) out of 21 in infants with mild illness and 136 (91%) out of 150 in infants with MSI”

    Now I’d like to drill down into this sampling of “asymptomatic” kids for a moment. The study did sampling of kids and grouped them according to the frequency of Moderate to severe illnessess in the year (MSIs). Overall, there were 193 samples done on asymptomatic kids. 63 were positive for one virus (32%), and some were positive for more than one virus.
    http://erj.ersjournals.com/content/32/2/314/T1.expansion.html (see near bottom of the table)

    I mention this to show that viruses are detected quite frequently in infants, and that even asymptomatic infants when randomly sampled, show evidence of a respiratory viral infection nearly a third of the time. Now when one considers the limitations that this study had in detecting viruses (they did not sample for Human bocavirus, CoV HKU1 and respiratory polyomaviruses), the conclusion must be that respiratory viral infection is quite frequent/prevalent in infants if random/sporadic sampling can reveal evidence of same in a minimum of a third of apparently well children.

    These studies give some indication of the frequency of infections in early childhood. The bulk of infections may be due to respiratory or gastrointestinal viruses, but other nonspecific viral illnesses also occur. A check on the epidemiology and clinical data on the dozens of potential individual virus infections reveals that these viruses are commoner than one would believe at first sight. For example, have any of you heard of Sapovirus or Astrovirus? They both can cause diarrhoea, and a survey looking for them in non-hospitalised infants with gastrointestinal upset found them in 4.7% of cases (Epidemiology and molecular characterization of sapovirus and astrovirus in Japan, 2008-2009.)

    I mention this last study to demonstrate that viruses we have never even heard of can be found in kids, but only if one is able to look for them using sophisticated molecular diagnostics. Claiming, as I do, that infants can be infected with “dozens” of viruses hardly seems far fetched, indeed it seems highly probable. Unless every infant is screened for every known virus it is unlikely that we will be able to accurately determine the incidence of infection. Certainly some better known respiratory viruses seem pretty prevalent, being found in a third of well infants.

    I cannot find other prospective studies at the moment which demonstrate the incidence of infant viral infections – my googlefu is weak today. I am happy to try and hunt more down next week (I am pretty busy this w/e).

    How does one rate infection significance? That depends. Most infections have a spectrum of clinical presentations, from subclinical to severe, but the immune response to the infection does not necessarily correlate with clinical severity. Any and every exposure to an infectious agent will result in an immune response, and if this is very effective, then the infection may not even be noticed by the child’s parent or person infected.

    So immunologically significant (but clinically insignificant) infections may be occuring all the time in all of us. This is something else you need to consider in your model.

  323. #323 passionlessDrone
    September 11, 2010

    Hi dt –

    pD, I rather feel this discussion is inexorably descending into a “tit for tat” exchange of nitpicking. I hope not and will try and prevent it from becoming one.

    OK.

    I cannot find other prospective studies at the moment which demonstrate the incidence of infant viral infections – my googlefu is weak today. I am happy to try and hunt more down next week (I am pretty busy this w/e).

    I’m super busy too and have already let my tenaciousness get the better of me on this thread. I do have some thoughts on what you have presented, but want to do some more reading, and some more real life in before I get fired up again. I’ll check back in a few days.

    – pD

  324. #324 Drivebyposter
    September 11, 2010

    The repeated use of Paul Offit’s canard, “we’re challenged by billions of bacteria everyday” as a way to excuse the possible adverse effects of vaccination is beyond ridiculous. It’s like saying eating a cup of Activa is the equivalent of receiving a MMR injection.

    How exactly do you come to that conclusion?
    It’s more like…
    “Saying a quote means something other than what it actually means makes you an ass”

    I’m fairly sure you know this, but the immune system deals with a lot of challenges on an average day. A vaccine wont doesn’t add that many more than it’s used to. If you’re used to running 15 miles a day, running an extra 200 feet probably won’t matter.

  325. #325 skeptique
    October 4, 2010

    DT’s argument:

    The immune responses from natural sources is at least greater than or equal to the immune responses from vaccination, and therefore, an immune response elicited by vaccines is unlikely to contribute in anyway to behavioural or neurodevelopmental changes.

    I see a problem with this argument.

    Basically, how can we understand if the immune response elicited by vaccines is contributing to behavioural or neurodevelopmental changes by arguing that the natural exposure to viral and bacterial antigens elicits a far greater response than vaccines?

    you can’t

    I can see using this type of logic to determine the relative risk of an increased immune response via vaccination vs. the increased immune response from natural infection on the outcome of neurodevelopmental disorders consistent with autism.

    But first wouldn’t we have to study the relationship between vaccination and various parameters of immune response(both adaptive and innate) and how these values correlate with behavioral changes or neurodevelopmental changes?

    sorry to bring this back from the dead, but seemed like a decent conversation was taking place, and I had some thoughts.

    BTW, in reference to some earlier posts regarding TLR stimulation. the pertussis toxoid used in childhood vaccines is an agonist of the TLR4/tlr2 pathway (just like LPS) interesting!

The site is currently under maintenance and will be back shortly. New comments have been disabled during this time, please check back soon.