White Coat Underground

It has been alleged by Great Minds such as Jenny McCarthy (D.Goog.) that the US recommends far more vaccinations than other countries. Her precise statement was, “How come many other countries give their kids one-third as many shots as we do?” She put this into the context of wondering if our current vaccine schedule should be less rigid. The entire piece was filled with what could charitably called less-than-truthful assertions, but I’m not feeling that charitable: they are lies (or the rantings of an idiot, or the delusions of lunatic. There are probably other possibilities that I haven’t thought of).

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Oh, Jenny.

First, we need to parse out this “more shots than everyone else” statement. Dr. Jenny may think she understands what this means, but I doubt it. Some countries–Haiti, for example–give far fewer vaccines than we do because they are desperately poor and in a constant state of crisis. Because of this, they have very high rates of vaccine-preventable diseases. They want to vaccinate more, but can’t. Then there are countries who can afford to vaccinate. Let’s look at what three industrialized nations recommend before six years of age.

Vaccinations, by disease and country, 0-6 years of age

Vaccine	France	Germany	USA	Iceland
Hepatitis B	Yes	Yes	Yes	No
Rotavirus	No	No	Yes	No
Diphtheria, tetanus, and pertusis	Yes	Yes	Yes	Yes
Hib	Yes	Yes	Yes	Yes
Pneumococcus	Yes	Yes	Yes	No
Polio	Yes	Yes	Yes	Yes
Influenza	Not reported	Not reported	Yes	No
Meales, mumps, rubella	Yes	Yes	Yes	Yes
Varicella	No	Yes	Yes	No
Hepatitis A	No	No	Yes	No
BCG (disseminated TB)	Yes	No	No	No
Meningococcus	No	Yes	For some	Yes

If I understand Dr. McCarthy correctly, she is using the allegedly large difference in national vaccine recommendations to show that it is safe to vary vaccination schedules by some method or another. I would not disagree: vaccination schedules should not be immutable but should (and do) change based on available evidence. But changes should not be based on one or another person’s “feelings”, or on the observations of a cognitively impaired actress who serves as the spokesperson for an antivax cult (for example).

The other implication is that other countries, by having one-third fewer vaccinations (sic!), will have lower rates of autism. She bases her assertions about international vaccination rates and autism on a report self-published by her anti-vaccination group Generation Rescue. In this screed, which is tricked out to look like an actual scientific paper, they allege that the number of “mandatory vaccines” are much greater in the U.S.

The U.S. does not have “mandatory” vaccinations for the general population. Some schools, employers, and others may require vaccines as a condition of attendance/employment, but the general population is not forced to have vaccinations any more than they are forced to drink clean water. This inflammatory and mendacious language is pure agitprop.

It’s also not clear to me how they arrive at their numbers. Perhaps they count the total number of vaccinations given for each disease (i.e., each DPT counts as three vaccinations, given five times for “15 vaccinations). Using this method, by my count France “mandates” 35 vaccinations by year six (they report 17) and the U.S. has 36, as they reported. But this isn’t the counting method they say they used. In the footnotes they say that:

All vaccine schedules are as of 2006. Some countries use combination vaccines. All schedule counts have been normalized to compare to the US schedule. For example, if a country uses an MMR-Varicella combination vaccine, it counts as “2″ vaccines.

The report then goes on to try to link these supposedly vastly different vaccine schedules to supposedly vastly different autism rates in the EU vs. the U.S. (If you understand their “methods” better than I do, feel free to explain in the comments. To me, they seem frankly deceptive.)

European autism statistics are scarce, but high end estimates place them at up to 63/10,000, or 0.9/150, compared to a US estimate of 1/150. This isn’t much of a difference, and the report’s so-called multipliers are simply error multipliers, given the large range in prevalence estimates.

Jenny McCarthy’s senseless ramblings on health are based on more formal senseless ramblings from a special interest group whose “special interest” appears to be the promotion of infectious diseases.

Comments

#1 History Punk
March 24, 2010

It’s a real tragedy that American society has reached a point that people like PALMD are compelled to spend their time defending science against a woman whose entire career and celebrity is based on flashing her vagina in a porno mag over a decade ago.
#2 Rain L. Torts, Esq.
March 25, 2010

HP, the person in question expresses idiotic ideas galore. Is it really necessary to emphasize her professional career? Let’s stick to the foolish assertions…
#3 Terry Wilson
March 25, 2010

There’s also, of course, the identification of autism. I understand it varies with time (more are so identified as time goes by), definition (different methods of describing autism) and public awareness (the greater the news comments, the more the incidence).
#4 Mu
March 25, 2010

So, taking Jenny’s argument, it must be the dreaded rotavirus, varicella and Hep A vaccines (the ones we have on the schedule and France doesn’t) that make all the difference. Someone should tell her the goal posts have been moved to the 22 and a half yard line, please retarget accordingly.
#5 madder
March 25, 2010

So let me get this straight: in another country, MMR-Varicella combo counts as 2 vaccinations, but in this country MMR counts as 3?
#6 madder
March 25, 2010

Okay, I just had a look at their document. It’s a masterpiece of the correlation=causation fallacy. Their entire “argument” is that the US has lots of vaccination, lots of childhood mortality, and lots of autism; therefore vaccines cause autism. Or maybe it’s death. Or rather, “urgent additional study is required.”

But I can’t figure out how they came up with their data either. Following the euvac.net link they provide in the footnotes, I took France’s list as an example. The only way I can make the list add up to 17 vaccinations is by combining DT and aP into one, ignoring BCG, ignoring the birth dose of HepB, and also omitting PCV7. Accidentally, of course.

If that’s what they did, I like how their method footnote shows an example of expanding the number of vaccines in other countries, when it was (apparently) used here to reduce that number in at least France’s case.

Looking elsewhere… they say that the US had 10 mandated vaccines in 1983; their Table 1 shows 11.

I also note as you did, Pal, that their Table 1 lists “US mandated vaccines.” But they include 7 doses of influenza, and nobody can reasonably claim that it is “mandated.” My kids’ pediatrician recommends boosters of flu vaccine; so shouldn’t that number be even anyway? Are they counting the infant shot as a half-dose or something?

Wow. Just… wow.
#7 Vast Right Wing Conspiracy
March 25, 2010

We should be vaccinating with BCG too. Better (and cheaper) to prevent than later fight the multi-drug resistant strains.
#8 Lindy_lou
March 26, 2010

The child mortality stats were what I found most distasteful. More vaccines = higher under 5 mortality. Really? I suspect the the damning child mortality statistics of the USA are more to do with the yawning chasm between rich and poor and associated access to healthcare and nutrition, not to mention slack gun laws and any number of other tragic circumstances where a child could die or be accidently killed. As their numbers are not broken down into the various mortality categories, i.e. death from traffic accident, drowning, cancer, infectious disease etc, nor do we know which of the represented dead children are vaccinated, are they saying that vaccinating your child increases the risk of them say, being accidently shot by a neighbours child, using their parents firearm? If not, why have they not excluded such an instance? Oh wait, I know why. Disgusting piece of propaganda which is sadly thrown around by anti-vaccinationists as science. I’m glad a family tragedy of my own is not represented in those abused stats, I’d be very angry indeed.
#9 Sullivan
March 26, 2010

Okay, I just had a look at their document. It’s a masterpiece of the correlation=causation fallacy. Their entire “argument” is that the US has lots of vaccination, lots of childhood mortality, and lots of autism; therefore vaccines cause autism. Or maybe it’s death. Or rather, “urgent additional study is required.”

It isn’t even a real correlation.

First, childhood mortality is measured differently in the US. If GR wants to argue with that, they can take up with their hrero, Bernadine Healy
http://health.usnews.com/usnews/health/articles/060924/2healy.htm

Second, the compare autism rates from different birth cohorts. The French study they use is for children born between 1976 and 1985. GR compares this autism rate to that of US children born in 1994.

How can a group whose fundamental basis is that there is ab autism epidemic claim that is a valid comparison?

They can’t.
#10 madder
March 26, 2010

Sullivan–

Thanks for that. Someone else has coined the term “fractally wrong,” and this piece is a fine example.
#11 Sullivan
March 26, 2010

Madder,

JB Handley, founder of Generation Rescue and probably the author of this “study”, was on the TV show “The Doctors” about a year ago. That is where he first started talking about this “study”.

He threw the numbers out to bolster his arguments and to make it look like “The Doctors” didn’t read the science.

From what I can tell, he released his “study” *after* the show taped. So, there was no way for “The Doctors” to refute this obvious shell game of a faux-study.

Mr. Handley and the other guests refused to go on if “The Doctors” allowed any dissenting voices. Yep, the man who says he will debate anyone any where on this refused to allow an open debate.

This isn’t science. It is public relations and theater.
#12 madder
March 26, 2010

Sullivan–

This isn’t science. It is public relations and theater.

Absolutely. I know that they don’t “do” science. I know that they take every opportunity to misrepresent and fabricate evidence. The forbidden-debate game on The Doctors is no surprise given that guest and those hosts. But every now and then I am reminded anew of the number and scale of ways they find to be wrong about things, and it just takes my breath away.
#13 Sullivan
March 26, 2010

The Generation Rescue “study” is part of Mr. Handley’s campaign–which, in his own words is:

With less than a half-dozen full-time activists, annual budgets of six figures or less, and umpteen thousand courageous, undaunted, and selfless volunteer parents, our community, held together with duct tape and bailing wire, is in the early to middle stages of bringing the U.S. vaccine program to its knees.

He is working, and proud of it, to “bring the U.S. vaccine program to its knees”.

If Mr. Handley is successful, people will die. What more needs to be said?
#14 TheDissenter
March 27, 2010

“If Mr. Handley is successful, people will die. What more needs to be said?”

Just like all those people that didn’t get their swine flu shot. We’ll see how smug they all feel when millions are dying in the streets of swine flu.
#15 gaiainc
March 27, 2010

People did die of swine flu. That the swine flu didn’t end up being as virulent as initially thought is GOOD. I have not doubt that if the swine flu had been more virulent and more people had died then people like TheDissenter would be gnashing their teeth and wailing about how the guvmint didn’t protect us enough.

Getting angry and annoyed at people once again basically saying “damned if you do, damned if you don’t”. Gah!
#16 TheDissenter
March 28, 2010

“People did die of swine flu.”

People die of stuff all the time. So what? Last I heard 11,000 was the CDC estimate for American swine flu deaths, but I am going to guess that estimate is probably high to try and justify all the taxpayer money spent on it. The US gov’t spent $108,000,000 on unnecessary face masks for the swine flu alone. That’s almost $10k in face mask expenditures for every swine flu death?!? Any rational person has to conclude its really all about the money regardless of health outcomes.

“I have not doubt that if the swine flu had been more virulent and more people had died then people like TheDissenter would be gnashing their teeth and wailing about how the guvmint didn’t protect us enough.”

I wonder how many of the people that got the swine flu vaccine also got the swine flu. Funny how that statistic doesn’t seem to be kept for some reason, or at least I can’t find it. I wonder why? In 1976, more people died of the swine flu vaccine than died from the swine flu.
#17 Chris
March 28, 2010

I realize that you have a heart of stone, and do not care that number of pediatric deaths was much higher than in previous years. Actually, most normal people find the death of children to a tragedy.

Just as most normal people condemn the vaccine tests done on disabled children at Willowbrook.
#18 Vicki
March 29, 2010

You don’t calculate the value of an intervention by the lives it doesn’t save. If you were wondering how much anti-lock brakes are worth, you would try to find out how many people died every year in car crashes before they were introduced, and how many die now. The difference is (or includes) the lives saved. If you were serious, you would also look up rates of non-fatal accidents–reducing concussions and neck injuries is worth something too.

And yes, “people die of stuff all the time.” But on that basis you could dismiss absolutely anything that helps people. And I could respond “people waste money all the time, so why not spend X amount on Y idea without worrying about whether it works?” Would you be convinced by that? Or would you point out that there’s no evidence for, say, spending money to paint purple polka dots on the fast lanes of interstate highways.
#19 TheDissenter
March 29, 2010

“If you were wondering how much anti-lock brakes are worth, you would try to find out how many people died every year in car crashes before they were introduced, and how many die now.”

Its not that simple. Antilock brakes were seen as the cause of many accidents before people knew how to use them properly. Many people would hit the brakes hard and the pumping of the pedal made them release the brake by accident and crash.

You have though, unwittingly pointed out a great example of bad science relying on poor data and misinterpreted statistics. Just because there may be fewer fatal accidents after the introduction of antilock brakes doesn’t mean the antilock brakes reduce fatal accidents, and similarly, just because one vaccine is safe and effective doesn’t mean they all are which is what the vax cult members think for some inscrutable reason. You will never hear a vax cult member speak badly of any vaccine, even the 1976 swine flu vaccine that killed more people than the swine flu did. The indoctrination runs that deep.
#20 The Gregarious Misanthrope
March 30, 2010

So what is this “vax cult” you speak of? Cults tend to adhere rigidly to their orthodoxy and react badly to outsiders and are notoriously averse to new information. Which pretty much makes Age of Autism a cult. No one is deleting your comments here.

Presumably you’ve heard of RotaShield? It appeared to be causing a bowel obstruction in 1 per 12,000 vaccinated infants, so it was pulled from the market. Hey, new information! Let’s re-evaluate our position.

There is some question as to whether Gardasil has caused a rapid-onset ALS in several young women. The frequency of this seems to be too low to have been found in the initial trials which is why new vaccines are closely monitored. So the issue is being investigated. The “cult” isn’t suppressing any of this. It’s how science works. It’s not a perfect process, but it tends to self-correct.

The AoA reaction to new information is to rip the goalposts out of the ground and move them to a new part of the field and shout “Here! Here is where the problem is!”

You are right about the 1976 flu. One guy died of the flu and about 25 died from GBS complications. It looked like the strain that caused the 1918 pandemic so they launched a major effort to vaccinate everyone and got about 25% of the country before the combined side effects and lack of virulence ended the program. But look, here I am talking about it. How un-cultish of me.

Just like this past year, no one can tell how virulent the strain will be. Scientists are trying to figure it out. Pandemics can happen fast so you have to make decisions fast and sometimes you don’t have all the info you’d like to.

So when the next pandemic rolls through and 5-10% of the population dies because the vaccines were delayed while waiting for all the facts, you’ll be OK with that? Would you be OK with it while your child died in your arms? At that point you’d probably give anything for a vaccine, even one that was 50% effective and 1% deadly.

Did you ever consider that it’s more than just the numbers of dead? The latest H1N1 had real potential to cause grave economic harm on top of the deep recession we already have. We were lucky. Lost work and wages, high medical costs and jammed hospitals, people afraid to go out or spend. We could have easily ended up in a depression. Severe economic crises can kill people through lack of medical care, nutrition, housing, heat, etc.

If you’d rather sit on your hands, that’s fine for you. But I won’t.
#21 Anonymous
April 11, 2010

so you’re saying that 20,000 kids getting autism is just the ramblings of someone who knows nothing about health?
#22 madder
April 13, 2010

@Anonymous:

What is your point? No reputable health professional will deny that autism exists.