John Stone is listed as the UK Editor for Age of Autism, a daily web newspaper. He is author of numerous articles posted on Age of Autism as well as an active writer of comments, not only to Age of Autism articles; but to articles on other websites, including Every Child By Two’s blog, “Shot of Prevention.” I have written a number of commentaries on John Stone and his antivaccinationist views, but after seeing Stone’s article “Paul Offit’s 10,000 Vaccines and the Milgram Experiment,” now being posted for the fourth time, I just had to get out my pen and pad once more. In his article, Stone discusses four topics:
Using the Milgram Experiment as an explanation for why doctor’s vaccinate
Profits made on the manufacture and sale of vaccines
Paul Offit’s oft out-of-context quoted by antivaccinationists “10,000 vaccines”
The Cutter Incident
This paper will show that not one of his claims has any validity; but, rather, clearly display many of the flaws in Stone’s thinking as well as other antivaccinationists, including: poor scholarship, a deficient understanding of scientific thinking and methodology, deficient knowledge of immunology, microbiology, and epidemiology, deficient understanding of basic economics, the illogic of false analogies, as well as a lack of common sense, plus a blatant hypocrisy.
Stone’s knowledge of the Milgram Experiments appears to be based only on one article he found in a popular magazine and on a movie clip. Based on his writings on the Milgram Experiments, it does not appear that he even bothered to read the original articles, and isn’t aware that it wasn’t the Milgram experiment; but Experiments. If he had accessed the original articles, he would have found the study procedures and results to be quite different from the description in Psychology Today. Different enough to make him guilty of the False Analogy Fallacy, a logical fallacy that occurs when applying facts from one situation to a substantially different situation, precluding the ability to draw a logical conclusion (Rational Wiki. “False analogy”)
Stone repeats the antivaccinationists' trope of 10,000 vaccines, ignoring context and a clear display of lack of common sense. As an analogy, imagine a 15 - 20 minute lecture or 2,500 word article about research into potentially almost limitless energy. The last sentence states: “Our research indicates we could theoretically put 10,000 gallons of gasoline in your car tank.” The average gas tank holds probably up to 25 gallons. Given Stone’s lack of common sense, I assume he would take the 10,000 gallons literally. Most rational people would understand, even without context, that the 10,000 gallons did not refer to actual gallons of gasoline but to the energy/mileage equivalent. The physical impossibility of giving 10,000 vaccines at once to an infant or anyone together with the exponential leap from the current 17 vaccines, there not even being remotely so many microbes that vaccines would ever be developed for, says it all.
He continues to display faulty reasoning, actually a display of hypocrisy, when attacking the profit motive behind vaccines. He and other antivaccinationists seem to have NO problem with the purveyors of complementary and alternative medicines making profits, so it seems that the making of profits is only unacceptable when selling something Stone and other antivaccinationists disagree with. Of course doctors get paid for giving vaccinations. Should they give them for free? As a further display of his ignorance, Stone doesn’t seem to be aware that the profit margin for vaccines pales in comparison to other pharmaceuticals and that the amount doctors make on administering vaccines is, at best, marginal. In fact, some doctors take a loss on vaccinations.
Finally, Stone goes back 60 years in time to the Cutter Incident where approximately 200 people, mainly children, were paralyzed from an inadequately killed vaccine and thousands more exposed. Stone is either unaware of or intentionally ignores that this incident led to ever-increasing safety regulations and surveillance of vaccines. If one were to use Stone’s approach to medicine, since many beneficial medicines and interventions had problems years ago, much of modern medicine would be rejected. In fact, historically, one can find problems with much of modern technology. Is Stone’s approach even rational? And, again, Age of Autism chooses to repost Stone’s article as an example of “The Best of Age of Autism.”
And there you have John Stone and the Best of Age of Autism in a NUTshell!
Read Dr. Harrison's full article as a PDF version by clicking here.
Ad Hominem Attacks on Brian Deer: Antivaccinationists’ Poor Scholarship & Unethical Behavior
by Joel A. Harrison, PhD, MPH
Posted: December 6, 2016
In a series of articles in The London Sunday Times, investigative journalist Brian Deer uncovered numerous problems with the case series presented by Andrew Wakefield in a 1998 article published in the British medical journal The Lancet. Almost immediately antivaccinationists began an ongoing series of ad hominem attacks against Brian Deer. The purpose of this paper is to show that ad hominem arguments not only represent a false logic; but a desperate act by those incapable of logically and scientifically supporting their position. And not only are they a desperate act; but a clear display of unethical behavior, attacking the messenger rather than the message. In addition, this paper will show that even the ad hominem attacks resorted to were wrong and, thus, one more example of the poor scholarship displayed by antivaccinationists.
Don’t reject an argument just because you don’t like the arguer or you question his motives.
The ad hominem fallacy occurs when one mentions things about a person in an attempt to show that the person’s argument is flawed. An argument stands or falls on whether its premises adequately support its conclusion. . . Personal characteristics, associations, past history, motives, and the like of the one making the argument are irrelevant to whether premises support a conclusion.
No argument is refuted by showing that the arguer is flawed or biased. Good people with good intentions can argue fallaciously and bad people with evil motives can argue cogently.
In an article posted on Age of Autism by J.B. Handley entitled “Keeping Anderson Cooper Honest: Is Brian Deer The Fraud?”, I respond to Handley’s key claims about Brian Deer, showing that not only are they irrelevant to the validity of Deer’s reporting; but clear indications that Handley doesn’t know what he is talking about, that is, with no evidence he bothered to research his claims.
Since Handley refers to writings by Martin J Walker and Wakefield also refers to him in his book “Callous Disregard”, I thought it appropriate to include Walker in this paper, to show that Walker’s writings clearly display poor scholarship, poor understanding, and poor footnoting/referencing. In other words, Handley and Wakefield’s referring to Walker’s writings, rather than conducting independent research, is a clear example of the blind leading the blind.
Ad hominem attacks are one of several logical fallacies. If the source of any evidence is considered biased, this should lead to a more careful questioning/investigation, possible critique of the evidence. Even the most biased source can still have produced valid evidence. Unfortunately, antivaccinationists, in their zeal, when they cannot logically and/or scientifically refute evidence, resort all too often to personal attacks. These attacks include impugning people’s integrity, innuendo, hearsay, guilt by association, and several other approaches, which, in my opinion, says more about the accusers, especially their inability to reason, to logically and/or scientifically approach evidence as well as their own lack of integrity, decency, and civility. Antivaccinationist ad hominem attacks are acts of desperation by those who believe they have some absolute truth; but are incapable of supporting it through scholarship, science, logic and common sense.
Though it would have taken a much longer article to refute every single attack, this article clearly demonstrates that antivaccinationist attacks on investigative journalist Brian Deer are seriously flawed, basically totally wrong, demonstrating poor scholarship, simply cherry picking anything that confirms their rigid dogma with NO evidence of any effort to verify the validity of their attacks.
Years from now as more and more scientifically valid evidence contributes to our understanding of Autism Spectrum Disorders, hopefully, antivaccinationists will dwindle, mainly residing in the dustbins of history. I just hope the above occurs soon, given that resistance to vaccination is fueling the resurgence of several diseases that were on the verge of elimination. That more and more children suffer unnecessarily from vaccine-preventable diseases is a disgraceful result of the anti-vaccine movement.
Read Dr. Harrison's full article as a PDF version by clicking here.
Andrew Wakefield Has Never Been Exonerated: Justice Mitting’s Decision in the John Walker-Smith Case
by Joel A. Harrison, PhD, MPH
Posted: August 1, 2016
Andrew Wakefield Has Never Been
"Exonerated": Why Justice Mitting’s Decision
in the Professor John Walker-Smith Case
Does Not Apply to Wakefield
Andrew Wakefield is a prominent figure among those who fear that vaccines cause more harm than good. When the UK’s General Medical Council (GMC) revoked his medical license, as well as the license of Professor John Walker-Smith, a co-author on Wakefield’s 1998 paper, his supporters saw the decision as a political move to silence his criticism of vaccine safety and his claims that vaccines, the MMR in particular, played a causal role in the rise of autism and other childhood disabilities. Both Wakefield and Walker-Smith appealed the GMC decision; but Wakefield discontinued his appeal.
On March 7, 2012, Mr. Justice Mitting of the UK’s High Court of Justice published the Court’s decision in the Professor John Walker-Smith case, overturning the GMC decision. It did not take long for anti-vaccination websites to post articles referring to the Court’s decision, emphasizing that Walker-Smith and, by implication, Wakefield, had been exonerated.
This paper will show that Justice Mitting’s decision in no way exonerated Wakefield, that even with regard to John Walker-Smith, the decision was based on a procedural error, not factual innocence. In addition, despite what antivaccinationists have written, Justice Mitting’s decision also made clear that he considered the research showing no relationship between the MMR vaccine and autism to be established science.
In conclusion, it is clear that Andrew Wakefield has not, and given the overwhelming evidence, will NEVER BE EXONERATED.
Read Dr. Harrison's full article as a PDF version by clicking here.
Ignoring Context & Lack of Common Sense: Misusing “infant theoretical 10,000 vaccines at a time”
by Joel A. Harrison, PhD, MPH
Posted: March 18, 2016
Ignoring Context and a Lack
of Common Sense: Antivaccinationists
Absurdly Misusing Dr. Paul Offit’s
“each infant would have the theoretical
capacity to respond to about 10,000
vaccines at any one time”
A recurrent concern among parents is that the mounting number of vaccines now administered to babies is a major challenge to the infantile immune system. Leading advocate of childhood immunizations, Dr. Paul Offit, has sought on numerous occasions to reassure parents by emphasizing how robust and effective babies’ immune systems are at responding to the daily threats from the enormous number of bacteria and viruses they are exposed to. He has illustrated this by showing how - in theory - a baby's immune system could cope with the number of epitopes (parts of a microbe recognized by our immune system) represented by 10,000 vaccines at one time. While 10,000 seems like a lot, as Dr. Offit explains, even this number is small compared to the capacity of our immune system and, yet, it is exponentially greater than the epitopes represented by all the vaccines given to children.
Well-organized, well-funded groups have sprung up trying to persuade parents of the alleged dangers of vaccines. Their arguments are mistaken, confused, lacking in scientific rationale and logical cohesion. There is one claim, based on one statement/sentence made by Dr. Paul Offit, repeated umpteen times all over the blogosphere, that I think encapsulates their flawed thinking. This claim takes one sentence out of context, ignoring the entire lead in to it. However, even without the context, antivaccinationist’s use of it contradicts common sense. Rather than doing their homework, they amplify each other in a near hermetically sealed self-reinforcing closed circle.
I believe that there is not a single book or paper that I couldn’t find one or two sentences that I could take out of context in order to prove any point I wish to. The purpose of this paper is to once again explain how our immune systems work, how vaccinations fit in the picture, and to show just how flawed antivaccinationist thinking is.
For those who actually either read Dr. Offit’s article or listened to his talk, it should have been obvious that his “10,000” or “100,000” vaccines, when taken in context, was clearly referring to the number of antigens (the small part of a microbe that the immune system recognizes) that our immune systems can deal with at one time. In fact, the actual quote in his article: “then each infant would have the theoretical capacity to respond to about 10,000 vaccines at any one time (obtained by dividing 107 B cells per mL by 103 epitopes per vaccine),” makes it quite clear by including B cells and epitopes per vaccine. If this wasn’t obvious, then for both those who read the article and/or listened to the talk and those who solely read quotes of only the out-of-context sentences, common sense should have made it obvious. First, just using ones imagination should have made it quite clear that one could NOT give 10,000 or 100,000 vaccines to an infant at one time. It would be impossible, whether one gave it as separate injections for each vaccine or even packed 20 vaccines per injection, impossible except for antivaccinationists such as Linda. Secondly, there are only 17 vaccines mandated or recommended for infants and even their administration is staggered. Not even in ones wildest imagination could we jump from 17 to 1,000 or 10,000 or 100,000.
Research in vaccine development focuses on the microbes that pose the greatest risk. In fact, there are only 27 currently approved vaccines against distinct pathogens and 19 in development (other vaccines are in early stages of development, various different formulations for the same microbe, or for treatment of cancers). These numbers include vaccines for microbes that don’t exist in the US or UK, only given when traveling abroad, or are not a risk for infants. So, Dr. Offit’s cited 10,000 or 100,000 vaccines doesn’t pass the common sense muster. Reasonably intelligent people would ask what he is talking about? Unfortunately, antivaccinationists, in their fervor to attack anyone who promotes vaccines, in their lack of logic, in their lack of rationality, in their deficient understanding of immunology, microbiology, infectious diseases, historically and currently in the world, in their deficient understanding of epidemiology and in their LACK OF COMMON SENSE, jump at whatever seems to confirm their rigid ideology, display incredibly poor scholarship by not taking even the least time to investigating further. Why should they given that they know they are right.
Stone, a major contributor to Age of Autism, believes that the more antigens per shot the greater the risk. However, besides the fact that even the antigens from 20 microbes would be far below what our immune system is capable of, he is NOT aware that multivalent vaccines reduce the pain from multiple shots and usually the amount of additional ingredients such as stabilizers and adjuvants. In other words, exactly the opposite of his fears.
Monitoring antivaccination websites, it becomes obvious that they represent a near hermetically-sealed self-reinforcing circle. Someone cited Dr. Offits “10,000” vaccines and, without thinking, the antivaccinationists have been repeating it ever since. One example of just how absurd their thinking is.
I welcome parents questioning. Not only do they have the right to; but they should. However, when they do this, they should listen, their questions should not be rhetorical ones, and they should do the research, take the time to learn some of the basics, starting with, perhaps, Sompayrac’s excellent little book, “How the Immune System Works”, not relying on articles found on websites such as Age of Autism, articles deficient in so many ways.
Read Dr. Harrison's full article as a PDF version by clicking here.
Debunking Antivaccinationist John Stone & the CDC “Whistleblower”: Review of “DeStefano Rides Again”
by Joel A. Harrison, PhD, MPH
Posted: December 5, 2015
Debunking Antivaccinationist John Stone
and the CDC "Whistleblower": A Review of
John Stone’s “DeStefano
Rides Again: GSK Rotavirus Vaccine
Study Loses 80% Of Cases And 18
Deaths”(Age of Autism, August 25, 2015,
reposted October 27, 2015)
I’ve written several articles for Every Child By Two. Each of them shows clearly the poor scholarship, deficient science, and often lack of common sense contained in articles written by antivaccinationists. The bottom line is they don’t know what they are talking about. If people are to decide on whether to vaccinate their children or not, it should be based on scholarly, well-grounded science, and reflect basic common sense, not claims made by people who are deficient in these.
John Stone is the UK editor for the online blog, Age of Autism. In a recent article, Stone writes:
Frank DeStefano, the CDC's Director of Immunization Safety and the lead author at the center of CDC whistleblower William Thompson’s allegations about destroying MMR/autism data, is involved in another case of apparently hiding data, this time involving intussusception and death, in a newly published paper concerning the safety of GSK’s rotavirus vaccine, Rotarix.
Last month Representative Posey revealed to Congress that Thompson told Dr. Brian Hooker in a taped telephone conversation regarding the DeStefano MMR paper that:
Sometime soon after the meeting, we decided to exclude reporting any race effects, the co-authors scheduled a meeting to destroy documents related to the study. The remaining four coauthors all met and brought a big garbage can into the meeting room and reviewed and went through all the hard copy documents that we had thought we should discard and put them in a huge garbage can.
The new CDC based study of GSK’s Rotarix vaccine by Haber et al., of which DeStefano is senior author and therefore responsible for research integrity, admits a small association with the serious condition of intussusception (an intestinal obstruction secondary to the inversion of one portion of the intestine within another). The paper states that from February 2008 to December 2014 the Vaccine Adverse Event Reporting System (VAERS) “received 108 confirmed insusceptible reports after RV1” (Rotarix). However, a careful review of the database reveals no less than 565 cases for the period. The paper claims to have excluded only 4 reports as unconfirmed (making a total of only 112). (Stone, 2015a; reposted 2015b)
In an Addendum posted a day after the reposting of his article, Stone writes:
I took this article down for 24 hours to consider the points made by "n davis" and "n davis is correct". I had overlooked the fact that the paper selects US cases only - that there are only a trickle of cases from the US against a relative flood from abroad - and this is basis of massive selection bias, particularly in relation to deaths. It also shows that the US reporting system while always vastly inadequate is wilting. Pharmaceutical companies are required by law to forward reports from abroad where they come to their attention: there is nothing in n davis's claim that these reports were unavailable to DeStefano - anyone interested in the safety of the vaccine to US children or any other would have considered all of the reports. (Stone 2015c)
Stone claims that a recent article by Haber et al. (2015) omitted a large number of cases of intussusception and some deaths. Stone writes: “a careful review of the database reveals no less than 565 cases for the period. The paper claims to have excluded only 4 reports as unconfirmed (making a total of only 112).” Stone’s article attacks the integrity of CDC researchers.
Stone repeats the claims made by Thompson, the so-called CDC whistleblower, that the CDC destroyed data from an earlier study (DeStefano, 2004) and withheld a finding associating MMR vaccine and African American males under 36 months of age.
Stone subsequently admitted he was wrong about Haber et al. omitting cases of intussusception; but, in a lame attempt to justify himself, he writes: “that I had overlooked the fact that the paper selects US cases only - that there are only a trickle of cases from the US against a relative flood from abroad - and this is basis of massive selection bias, particularly in relation to deaths. It also shows that the US reporting system while always vastly inadequate is wilting. Pharmaceutical companies are required by law to forward reports from abroad where they come to their attention. . . anyone interested in the safety of the vaccine to US children or any other would have considered all of the reports. (Stone, 2015c)
Stone failed to note that the Haber et al. study included verifying the reported cases from the medical records, something that would be near impossible for foreign cases. Stone also fails to understand that deaths reflect levels of medical care which can be less effective than in the US. He also fails to understand that diagnoses vary in accuracy, the reason for Haber et al. conducting chart audits. Stone also fails to understand that the denominator, that is, the population of the US vs. the non-US population influences the incidence of cases. Quite simply, the larger number of cases from outside the US could reflect a much larger population and, thus, not a higher incidence of cases.
By analogy, using US crime data, most Americans would be interested in how safe it is in the US, NOT how many Americans are killed abroad.
Stone claims, without any justification, that pharmaceutical companies would proportionately receive more reports abroad of vaccine-related adverse events and would be more law abiding in reporting them than in the US.
While Stone states: “anyone interested in the safety of the vaccine to US children or any other would have considered all of the reports;” he and other antivaccinationists, when critiquing the effectiveness of vaccines, exclude international data on vaccine-preventable disease morbidity and mortality. In other words, if international data supports their position, great, if it doesn’t, ignore it.
Stone and other antivaccinationists imply that since they had not heard of rotavirus prior to the introduction of the rotavirus vaccine that it is a disease manufactured to sell a vaccine. Rotavirus was first discovered in 1973, and was quickly recognized to be the major cause of childhood diarrhea, long before development of a vaccine had been contemplated. Stone apparently is unaware that approximately 80% of serious cases of diarrhea in infants resulting in hospitalization had unknown causes prior to the 1970s when rotavirus was discovered and long before the first vaccine was approved the medical literature contained an ever-increasing number of studies of rotavirus. Fascinating how Stone twists his ignorance into a justification for attacking the vaccine.
Despite Thompson’s repeated claims that the CDC destroyed data, parroted by Stone and other antivaccinationists, the data is not only available in electronic form for re-analysis as posted on the CDC website; but Brian Hooker actually obtained the data and used them for his now-retracted article.
Despite Thompson’s repeated claims that the DeStefano article omitted analyses on African American boys, they did include this in their paper. However, the article by Hooker was retracted because he used an analysis of a cohort design for data collected for a case-control study and based his conclusion on changing the age range so he could get a minimum of 5 kids in one cell of the analysis. Stone and other antivaccinationists not only ignore this; but fail to understand some of the basics of epidemiological design and statistical significance testing.
If this were simply a debate on Piltdown Man, it would be partly sad because of the fraud involved and, perhaps, intellectually amusing. However, antivaccinationists are undermining one of the most important tools we have to prevent suffering, morbidity and mortality, one of the main contributors to increases in life-expectancy. Parents, in deciding on whether to vaccinate their children or not, should be wary of claims made by people so deficient in just about everything. Do NOT allow the lie told most often to become the truth!
Read Dr. Harrison's full article as a PDF version by clicking here.
Deficient Science, Hypocrisy & Bogus Arguments: Two Articles by Age of Autism’s Anne Dachel
by Joel A. Harrison, PhD, MPH
Posted: September 30, 2015
“Dachel Media Update: Willingham
Wanders Into Waldo” Age of Autism
August 10, 2015
“Dachel Media Update: Forbes’ Emily
Willingham Has Made Up Your Mind” Age of Autism
August 11, 2015
Over the past several decades, a number of bloggers and organizations have claimed that vaccines and/or their ingredients cause a number of disorders, foremost among these is autism. The results of their efforts have been a decline in vaccine coverage and a rise in previously rare childhood diseases resulting in unnecessary suffering, hospitalizations, long-term disabilities, and even death.
Anne Dachel is a regular contributor and Media Editor for Age of Autism. In two recent articles (Dachel, 2015ab), Dachel criticizes several articles by Emily Willingham, a science writer at Forbes (2015ab). As this paper will show, from Dachel’s own articles it is clear:
Dachel literally doesn’t understand epidemiology and causal inference.
Dachel displays poor scholarship in claiming that vaccine supporters rely solely on epidemiological studies, missing the numerous references to animal and other research types.
Dachel is hypocritical in criticizing epidemiological studies while promoting/advocating for an epidemiological study comparing never vaccinated to vaccinated.
Dachel resorts to a typical logical fallacy, ad hominem attacks.
Dachel is hypocritical to imply, with NO credible evidence, that Emily Willingham is a “pharma shill“ by stating “Emily Willingtoworkforpharmaaham's version is below.” while she proudly refers to her own for-profit sponsor.
Dachel’s approach is great propaganda for the uninformed; but not a valid scholarly approach. In neither of her articles does Dachel actually address what Willingham writes. Dachel could have directly critiqued each of the points Willingham made, including specific information from the writings she mentions; but she didn’t. Instead, Dachel refers to writings that Willingham may or may not have read. Using Dachel’s approach one could critique just about any article by throwing in a reference to another article or book without giving any details.
Dachel, like many antivaccinationists, takes the approach that people are guilty until proven innocent or, perhaps, guilty with no possibility of proving innocence. However, it is a basic American principle to be considered innocent until proven guilty.
In my articles published by Every Child By Two (Available here ), I have reviewed and critiqued several articles posted on Age of Autism and SafeMinds, one of Age of Autism’s sponsors. Each of my reviews has clearly highlighted the poor scholarship, deficient science, and, often, lack of common sense used by the authors of those articles that render their opinion void of any credibility This article, which reviews some of Anne Dachel’s articles on Emily Willingham is yet another example that adds hypocrisy to the growing list of antivaccinationist flaws.
If people, especially parents are to decide on whether or not to vaccinate themselves and their children such decisions should be based on science and logic (critical thinking) and not belief systems deficient in both.
Read Dr. Harrison's full article as a PDF version by clicking here.
“A Dose of Reality” Does Not Support Abolishing VICP
by Dorit Rubinstein Reiss, Professor of Law
UC Hastings College of Law
Posted: August 7, 2015
In a recent article published in the Pennsylvania Law Review, Prof. Nora Freeman Engstrom suggested that the arguments for moving medical malpractice from the regular tort system to health courts are flawed, because we have reason to doubt whether health courts will fulfill the expectations of their proponents. She drew on the experience of the National Vaccine Injury Compensation Program (VICP) to demonstrate the point, suggesting the program has “stumbled” and did not meet expectations.
The article is thorough, thoughtful, and informative. It’s a valuable, important read for those considering whether to support health courts as an alternative to liability via the tort system. That said, I would like to point out some limitations and problems in Engstrom’s discussion of VICP, and suggest that the claim that the program “stumbled” is problematic.
I would like to emphasize three points.
First, note that this post is not a comprehensive response to Engstrom, nor is it on the subject of whether or not the US should adopt health courts. Engstrom raises many important points pertinent to health courts which I do not address in this post.
Second, I want to emphasize that for those interested in VICP, Engstrom provides a thorough, well supported, and accessible introduction to the structure and functioning of VICP. There is much to learn from it.
Third, I disagree with the implied interpretation suggested by anti-vaccine activists that flaws make the program a failure. For that reason, I would avoid saying that the VICP “stumbled”. Though Engstrom says the VICP has stumbled, Engstrom never says that the VICP is a flat-out failure. In fact, the last pages of her article point out several of the VICP’s strengths and pointing out the program’s many advantages is critically important. While it’s possible the VICP is imperfect, there’s little evidence it’s failed altogether. Imperfect is not failing. But the term “stumbled” is – and will be – used by anti-vaccine activists to claim otherwise. Likewise, the Press Release by Stanford is unhelpful since it uses language that supports that view.
Those who object to vaccination are already making inappropriate use of Engstrom’s analysis. The anti-vaccine movement has been deeply opposed to the VICP for some time. They have called for the abolishment of the program and for returning adjudication of vaccine injuries to state courts. That, in my view, would be a real error because sending vaccine injuries to the courts would be more difficult for those with valid claims as well as for our overall health by endangering the vaccine supply.
The National Vaccine Injury Compensation Program is an administrative program created by Congress in the 1980s to solve two problems. One was the supply problem. Pharmaceutical companies were being crippled by liability litigation and were abandoning the vaccine manufacturing industry entirely. The program was an attempt to retain vaccine manufacturers and reduce the number of companies that were opting out of the industry by offering them limited liability protection. The second was to assist citizens who may have been harmed by vaccines in getting fair and timely compensation. (I addressed the technical details of how the VICP is substantially easier on plaintiffs, also known as petitioners, in another post here.
In her article, Engstrom raises three central problems with VICP, and then highlights four issues that lead, in her view, to the problems. This post proceeds in three part: examining the problems Engstrom raises, examining her explanations for them, and then in closing, explaining why VICP is still a better option for those claiming vaccine injuries than the courts of justice.
Professor Dorit Rubinstein Reiss is a Professor of Law at UC Hastings College of Law. Her undergraduate degree in Law and Political Science (1999, Magna cum Laude) is from the Faculty of Law in the Hebrew University of Jerusalem where she served as Editor in Chief of the Law Review. Following graduation from law school, Professor Reiss clerked for a year and a half in the Israeli Ministry of Justice’s Department of Public Law, working on a variety of constitutional and administrative law issues.
She received her Ph.D. from the Jurisprudence and Social Policy program in UC Berkeley, writing her dissertation on accountability in the liberalized telecommunications and electricity sectors in England, France and Sweden. During her studies in Berkeley she worked as a teaching assistant in ten courses, winning the Outstanding Graduate Student Instructor Award.
Professor Reiss’ research examined accountability of agencies at the state, national and international level, with agencies studied including the CPUC, the FAA, and other agencies in the United States and Europe. Increasingly, however, her research and activities are focused on legal issues related to vaccines, including exemption laws and tort liability related to non-vaccination.
Professor Reiss lives in the South Bay with her husband, Frederick, and their young son. She enjoys reading, hiking, biking and dancing.
Wrong About Measles, Cancer & Autism: Dan Olmsted’s “Measles, Cancer, Autoimmunity, Autism”
by Joel A. Harrison, PhD, MPH
Posted: May 28, 2015
Wrong About Measles, Cancer &
Autism: A Review of Dan Olmsted's
Article "Weekly Wrap: Measles, Cancer
(Age of Autism, May 17, 2014)
A number of organizations as well as bloggers have arisen over the past several decades claiming that vaccines and/or their ingredients cause a number of disorders, foremost among these is autism. The results of their efforts have been a decline in vaccine coverage and a rise in previously rare childhood diseases, resulting in unnecessary suffering, hospitalizations, long-term disabilities, and even death. The following paper will demonstrate, using as an example an article by Dan Olmsted, founder, owner, and chief editor of Age of Autism, the poor scholarship and science displayed by many antivaccinationists. If people are to decide on whether to vaccinate their children or not, it should be based on scholarly, well-grounded science, and reflect basic common sense, not claims made by people who are deficient in these..
Olmsted’s recent post on Age of Autism, “Weekly Wrap: Measles, Cancer, Autoimmunity, Autism” should raise a number of red flags regarding his scholarship, basic understanding of science, and even common sense. Olmsted’s article claims that a recent study treated multiple myeloma with a measles vaccine. Olmsted then goes on to speculate that measles may have had a preventative effect on cancer and that vaccinations led to increasing rates of cancer.
The conclusions of this paper are:
Dan Olmsted, founder, owner, and chief executive of Age of Autism, posted an article, “Weekly Wrap: Measles, Cancer, Autoimmunity, Autism” claiming a recent study, Russell SJ et al. (July 2014) “Remission of Disseminated Cancer After Systemic Oncolytic Virotherapy” used a measles vaccine to treat multiple myeloma. Olmsted then goes on to speculate that “wild-type measles . . . performs some unsuspected function in preventing the occurrence of cancer.” Olmsted based his entire article on two newspaper accounts of the research with no indication he either read the easily available actual research article and/or understood it. A measles vaccine was not used. Instead it was a genetically engineered measles virus strain that was designed to specifically target cancer cells. In fact, if Olmsted had even read the two newspaper articles carefully, they both mentioned that the measles virus had been so modified.
Though wrong about the use of a measles vaccine, this paper looks at the remainder of Olmsted’s paper to show that even if he had been right about the use of a vaccine, he was still wrong about the inferences from it, thus showing his poor scholarship, poor understanding of science, and overall poor knowledge of the history and current status of vaccine-preventable infectious diseases.
Olmsted traced “the anonymous Case 3 in the first medical paper on autism, from 1943” [Kanner, “Autistic Disturbances of Affective Contact”][and found] “his death certificate from July 8, 2011, the cause was listed: multiple myeloma.” Olmsted then writes: “According to Wikipedia, this kind of cancer is increasing, and affecting younger people.” Case 3 was born November 17, 1937, so he was 73½ at the time of his death, certainly not young and well within historical statistics for cancer deaths. Though Wikipedia science articles are well-referenced, this one specifically stated: “Citation needed.” This gives just one example of Olmsted’s illogic and cherry-picking articles that confirm his pre-existing beliefs, ignoring the “Citation needed.”
While Olmsted claims measles is a benign childhood disease, both historical and current statistics tell a quite different story. “In the United States in the prevaccine era, approximately 500,000 cases of measles were reported each year, but, in reality, an entire birth cohort of approximately 4 million persons was infected annually. Associated with these cases were an estimated 500 deaths, 150,000 cases with respiratory complications, 100,000 cases of otitis media, 48,000 hospitalizations, 7,000 seizure episodes, and 4,000 cases of encephalitis, which left up to one quarter of patients permanently brain damaged or deaf.” (Strebel, 2013, p. 358) Prior to the development of antibiotics, opportunistic bacterial pneumonias killed many more. Measles is just as infectious today, just a plane flight away. Given a much larger population and the increasing risk of deaths from secondary bacterial pneumonias due to increasing rates of antibiotic-resistant microbes, without vaccination the above numbers could be significantly higher.
Cancer results from a succession of mutations in normal cells. These mutations occur during cell divisions. Every time a cell divides, approximately six random mutations occur. Most are harmless; but over time, one may not be and then another until cancer develops. Most mutations are random; but environmental factors such as chemicals and microbes can sometimes cause mutations. The more times, the faster the rate of cell divisions, the more chance of mutations. Measles is a system-wide disease that damages and kills cells throughout our bodies. Though initially suppressing our immune systems, the immune response involves an exponential production of immune cells to combat the infection. In other words, the exact opposite of Olmsted’s speculation would occur, that is, the risk of mutations would, if anything, accelerate from “wild-type measles.” Measles vaccines are attenuated (extremely weakened) to elicit a local short-lived infection, just enough to allow the immune system to recognize it and create memory cells ready to defend against any future exposure.
There is a history of microbes and vaccines used to treat cancer and other diseases such as syphilis. For instance, malaria was used to treat syphilis and a tuberculosis vaccine is still used to treat bladder cancer. No one today in their right mind has ever promoted mass infection with malaria to prevent syphilis or mass infection with tuberculosis to prevent bladder cancer.
Olmsted writes regarding Case 3 from the first medical article that diagnosed autism: “Leo Kanner, the author of that first autism paper, noted that “following smallpox vaccination at 12 months, he had an attack of diarrhea and fever, from which he recovered in somewhat less than a week.” (We can assume he had measles.)” Kanner described the mother as a college graduate whose father was a physician, that she took copious notes which “indicated obsessive preoccupation with details. . . She watched (and recorded) every gesture and every “look.” Measles was ubiquitous at the time with a distinct rash that was well-known to those who were raised during this time period. One could, therefore, question why an educated women, with a propensity towards taking copious notes, would fail to recognize and subsequently document her son’s case as suspected measles or, at the very least, document the presence of a measles-like rash along with the fever and diarrhea? It is more likely that the fever and diarrhea either resulted from the smallpox vaccine or from coincident infection by any number of commonly circulating viruses, or even from mild food poisoning. Olmsted’s “we can assume he had measles” is nonsensical.
Olmsted claims Kanner missed a big clue as Case 3’s mother noted his failure to talk: “I can’t be sure just when he stopped the imitation of word sounds. It seems that he has gone backward mentally gradually for the last two years.” Olmsted assumes this resulted from the smallpox vaccination. However, the mother also, in comparing her two children, explained how Case 3 had shown NO anticipatory response to being picked up as Kanner writes in his discussion: “the children’s aloneness from the beginning of life . . . We must, then, assume that these children have come into the world with innate inability to form the usual, biologically provided affective contact with people.” So Olmsted missed that Case 3 showed clear signs of autism almost from birth and, though the mother was uncertain when “he stopped the imitation of word sounds,” Olmsted decides it must have stemmed from the smallpox vaccination. It appears that it is Olmsted that missed big clues.
Olmsted writes: “In short, the first commercial uses of ethyl mercury triggered the first cases of autism; the explosion in vaccines containing it triggered the autism explosion beginning around 1990.” Olmsted ignores the fact that Kanner, in the first article describing autism discusses how most of his cases had been previously diagnosed as either retarded or suffering from childhood schizophrenia and had shown signs of “extreme aloneness” from birth. There is a long history of the classification of medical conditions changing with new data and medical knowledge, though the conditions were not new, something Olmsted seems to be unaware of. There is good evidence that autism is not a new condition.
Based mainly on one recent article by Classen, “Review of Vaccine Induced Immune Overload and the Resulting Epidemics of Type 1 Diabetes and Metabolic Syndrome, Emphasis on Explaining the Recent Accelerations in the Risk of Prediabetes and other Immune Medicated Diseases” (February 2014), Olmsted discusses how vaccines overload a young child’s immune system. Nowhere does he or Classen discuss what is known about the number of antigens our immune system can deal with at any one time in relation to the number a child is exposed to daily from the environment compared to the minute number even when five vaccines are given at once. Classen's article is not a systematic review; but a cherry-picked biased presentation. In addition, he fails to deal with all credible alternative hypotheses and he may have misrepresented one article’s findings.
Olmsted claims to be a citizen scientist; but his writing gives NO indication he has attempted to learn the basics of epidemiology, biostatistics, microbiology, immunology and other relevant subjects, nor that he has attempted to learn the history and current status of vaccine-preventable diseases. In fact, he writes in another post: “I am not a chi square guy. I'm an English major. I am in no position to evaluate the techniques used to calibrate the autism rate in black males, or anybody else, before or after the MMR shot.” In addition, given his profession as journalist, his use of newspaper articles without indication he read the actual research article and his use of Classen’s article because it confirmed his pre-existing beliefs fails the minimal requirements of fact-checking/verification expected of any journalist.
Olmsted writes: “It seems almost too simple, but then, as Mark Blaxill says, epidemics are simple by their very nature, once the cause is identified and the truth is told.” The rate of knowledge is doubling at ever decreasing time intervals. The world has become very complex. It may be psychologically advantageous in the short run to retreat into a more simplistic world; but Olmsted and Age of Autism’s use of “belief” falls into one of the caveats for doing science as Neil deGrass Tyson explains in the recent TV series Cosmos: “Believing something doesn’t make it so.” Though we do sometimes find causes of epidemics that lead to interventions, either preventative or for developing treatments, these causes are often situation-specific within a chain of and matrix of events and are often tentative. The science needed to make such determinations is far from simple.
Don’t Sacrifice The Good For The Perfect: Cathy Jameson’s “A Strong Message About Vaccines”
by Joel A. Harrison, PhD, MPH
Posted: February 4, 2015
Don’t Sacrifice The Good For The Perfect:
A Review of Cathy Jameson’s
“A Strong Message About Vaccines.”
(Age of Autism, January 18, 2015)
Despite ever increasing outbreaks of vaccine-preventable diseases, resulting in unnecessary suffering, hospitalizations, long-term disabilities, and even deaths, the number of parents opting not to vaccinate their children is increasing. Websites abound encouraging parents to "rethink" vaccinations, that is, to avoid them. Should one pay heed to these warnings? Not if they display a lack of understanding of basic scientific principles and methods. Not if they display poor scholarship. And not if they display a blatant lack of common sense.
A recent article on Age of Autism, one of the more popular and influential antivaccination websites, displays a typical lack of any of the above. The author, Cathy Jameson, is a Contributing Editor to Age of Autism.
According to Age of Autism: "We are published to give voice to those who believe [my emphasis] autism is an environmentally induced illness." I emphasized the word "believe" as this paper clearly shows that Jameson's article reflects her antivaccination beliefs, devoid of any scholarly scientific information and based on an illogic that if applied consistently would have devastating consequences.
Jameson writes: "How can anyone continue to say that vaccines work and that they are effective when people who are vaccinated come down with the very disease the vaccine was supposedly going to prevent? Sadly, we hear nothing of that in these types of news stories. We hear nothing of how for those 11 people that the vaccines failed. That the vaccines were obviously not effective. But so says the vaccine industry. So says those benefiting from its profits."
In a second article posted a few days afterwards, "A Very Brady Measles" (Age of Autism, January 25, 2015), Jameson, apparently, bases her knowledge of measles either completely or mainly on a TV sitcom, the Brady Bunch, writing: "a TV family portrayed what real-life families encountered - surviving a short-lived disease . . . [just a] common disease of childhood."
To Summarize this Paper:
Jameson, posting an article on Age of Autism, a website where beliefs trump logic, science, and common sense, finds fault with the measles vaccine because it isn’t 100% effective. She complains that we are not told that vaccines don’t work 100% of the time, even though a web search would find this information and anyone assuming any medical intervention works all the time would be naive and foolish. Using her illogic, one would reject just about all interventions, ranging from penicillin to seat belts; although each have saved millions of lives, some have died despite their use.
In the real world, measles is a serious disease, "an entire birth cohort of approximately 4 million persons was infected annually. Associated with these cases were an estimated 500 deaths, 150,000 cases with respiratory complications, 100,000 cases of otitis media, 48,000 hospitalizations, 7,000 seizure episodes, and 4,000 cases of encephalitis, which left up to one quarter of patients permanently brain damaged or deaf." (Strebel, 2013, p.358) Even for the families of children who didn't experience any of the above, "the initial symptoms usually include a high fever (often > 40°C [104°F]) . . . malaise, loss of appetite, hacking cough (although this may be the last symptom to appear), runny nose and red eyes. After this comes a spot-like rash that covers much of the body. The course of measles, provided there are no complications, such as bacterial infections, usually lasts about 7–10 days." So, even the normal course of measles involves a week or more of suffering, a week or more of missing school, and a week or more of a parent staying home from work to take care of the child.
Regarding Jameson's implication that the vaccine industry cannot be trusted because they benefit from profits on their products, then one should not trust any product since everything sold is done so to make a profit. Using Jameson's logic, nothing we purchase can be trusted. The car companies build the cost of seat belts into the price of cars and the pharmaceutical industry makes a profit on antibiotics, insulin, and everything else they sell. Vaccines are complex biologics that are expensive to produce and have much more stringent regulatory burdens attached to them than for other drugs. Further, persons use vaccines only a few times throughout their lives, whereas many drugs require daily use, often for a lifetime. Drugs certainly generate more revenue than vaccines. An analysis of sales data from 2013 indicated that vaccine sales constituted only 1.82% of "Big Pharma’s" total annual revenues. The author of this analysis concluded that this is "essentially a rounding error in estimating revenues." In other words, the sales from vaccines is so insignificant in the context of total pharmaceutical sales that it’s practically not worth including when estimating revenue. (Skeptical Raptor, 2014)
The irony of this is that if vaccine manufacturers were to stop making vaccines their public image, already tarnished, would take an even bigger hit.
It would be nice if medical science could develop vaccines that worked 100% of the time with zero possibility of even the mildest side effects and perhaps someday they will or at least get close; but what we have today are vaccines that are exponentially safer than the actual diseases. Given the inaccuracies in Jameson's article and the fact that Age of Autism actually posted it, says a lot about the website, namely, that its articles lack any credibility. For another example of the poor scholarship, poor science, and deficient common sense displayed on Age of Autism, see my previous ECBT article (Harrison, 2015) and stay tuned for future ones.
In conclusion, Jameson literally doesn’t know what she is talking about. With vaccines, she sees the glass as, say 5% empty, rather than as 95% full. She sees a TV sitcom as giving an accurate portrayal of the real world. This is more than a lack of common sense, it's a prime example of the Nirvana fallacy of comparing actual things with unrealistic, idealized alternatives, creating a false dichotomy. Though it’s unfortunate that the measles vaccine doesn’t perfectly protect everyone, it does protect most, preventing unnecessary suffering, hospitalizations, disabilities, and even deaths. And, if everyone were vaccinated, then the risks to those with weaker immune systems would also be significantly reduced. In other words, "Don’t Sacrifice the Good for the Perfect"!
Wrong About Genetic Research & Autism: Teresa Conrick’s “Dear America, You Are Being Bamboozled”
by Joel A. Harrison, PhD, MPH
Posted: January 7, 2015
Revised: April 20, 2015
Another Antivaccinationist Wrong About Genetic
Research and Autism: A Review of Teresa
Conrick’s “Dear America, You Are Being Bamboozled
Again About Autism and Genes”
(Age of Autism, July 23, 2014)
A number of organizations as well as bloggers have arisen over the past several decades claiming that vaccines and/or their ingredients cause a number of disorders, foremost among these is autism. The results of their efforts have been a decline in vaccine coverage and a rise in previously rare childhood diseases, resulting in unnecessary suffering, hospitalizations, long-term disabilities, and even death. The following paper will demonstrate, using one article by Teresa Conrick, a contributing editor to Age of Autism, the poor scholarship and science displayed by many antivaccinationists. If people are to decide on whether to vaccinate their children or not, it should be based on scholarly, well-grounded science, and reflect basic common sense, not claims made by people who are deficient in these.
Conrick’s recent post on Age of Autism, “Dear America, You Are Being Bamboozled Again About Autism and Genes,” should raise a number of red flags regarding her scholarship, basic understanding of science, common sense, and, perhaps, even her ethics. Conrick’s article claims that a recent study, looking at genetics and autism, published in the journal Nature Genetics by Gaugler et al., “Most Genetic Risk for Autism Resides Within Common Variation,” reflects an “onslaught of studies and articles to try and persuade [people] that AUTISM is a genetic ONLY disorder,” that the Gaugler et al. study “is completely denying ANY ENVIRONMENTAL OR TOXIC EXPOSURE.”
The conclusions of this paper are:
The Gaugler et al. study, “Most Genetic Risk for Autism Resides Within Common Variation” (August 2014), based on Swedish data, looked at the contribution of various types of genes to the genetic component of autism, which was estimated to be around 52%. No mention was made of environmental or toxic exposure, so, obviously, it couldn’t be denying either.
Conrick contradicts herself by following her claim that “studies . . . try[ing] to persuade that AUTISM is a genetic ONLY disorder” with a follow up statement that the Gaugler et al. study estimates the genetic contribution to be 52%. The math I learned doesn’t equate 52% with 100%.
Conrick partly bases her article on an online article by Paul Hamaker, “Largest Study to Date Shows Majority of Autism is Genetic,” found on the blog “Birmingham Sci-ence News Examiner,” which stated the Gaugler et al. “study included the contribu-tion of environmental causes of autism and found that genetics trumps any environmen-tal cause for autism.”
It appears that Conrick is using Hamaker’s paper together with the Gaugler study as straw men, given her belief that autism is all or mainly environmentally determined, to persuade the reader that there is too much research emphasis on genetics, something I refuted in this paper. However, the Gaugler study did not address environmental factors at all, while Hamaker simply claimed it “found that genetics trumps any environmental cause.”
Conrick's claim that the study “is completely denying ANY ENVIRONMENTAL OR TOXIC EXPOSURE,” is just plain WRONG! If Conrick wants to express her belief that too much research is being devoted to genetics, then she should do so; but not by such hyperbole and misrepresenting the research that has been conducted. What in Conrick’s opinion would be an acceptable division of research funding and what per-centage of genetic contributions to autism would she agree with? And is she capable of supporting her position with good science?
Remarkably, in his article, Hamaker also implies that, by focusing on genetics, Gaugler et al. advocated a discredited eugenics approach. I find it despicable that Conrick would draw attention to anyone advocating eugenics, which was used to justi-fy racism and discrimination against various groups, leading to untold suffering from forced sterilizations to Nazi death camps.
Conrick, apparently, doesn't understand the role that genetics, environment, and their interaction play in just about all aspects of human life nor the extensive research on these and the advances being made in diagnostics, prevention, and treatment.
Though the Gaugler et al. study did not discuss nor discount the environment’s role in ASD, Conrick uses her claim that they did as a straw man to attack genetic studies. She posits the role of pesticides, vitamin D, sunlight and other factors to discount the relevance of the study’s findings. Conrick refers to one exploratory study looking at pesticides and ASD by Shelton et al. published in the journal Environmental Health Perspectives, “Neurodevelopmental Disorders and Prenatal Residential Proximity to Agricultural Pesticides: The CHARGE Study,” citing the study’s findings. She speculates regarding the role of vitamin D’s affect on the incidence of ASD without any foundation nor evidence that she has even bothered to research the subject. In fact, if further research were to implicate pesticides and/or vitamin D, it would weaken the main claim by Conrick and Age of Autism contributors of the role of vaccines in ASD, given that any effect from either of the above would occur in utero.
Conrick bases her article on a press release of the Gaugler et al. study and a blog post discussing it. She based her mention of the pesticide study on a PubMed Health post about the actual study, giving only the “conclusions” of the study, while failing to acknowledge any inconvenient facts or suggested weaknesses. With regard to either actual study, Conrick gives no indication she attempted to read either of them and/or understood them, though both were available. In addition, she bases her outrage on an obscure bloggist, unethically implying he was reflecting sentiments contained in the Gaugler study.
As stated on the website, Age of Autism: “We are published to give voice to those who believe [my emphasis] autism is an environmentally induced illness.” In my opinion, Conrick mind is made up. They are absolutely certain they are right, despite gross deficiencies in scholarship, science, and common sense. My review of Conrick’s article as well as my previous review of an article by Lynn Redwood of SafeMinds (Harrison, 2014) clearly indicates the desperate lengths they will go to in order to promote their ideologically rigid beliefs. Given that both are major advocates among antivaccinationists, and SafeMinds, Redwood’s organization, is even listed as a sponsor of Age of Autism, why would anyone accord either Age of Autism or SafeMinds any credibility?
The only conclusion for Conrick’s and Redwood’s papers, and Stone’s Comment is “don’t be bamboozled” by people who literally don’t know what they are talking about.
Wrong About Genetic Research & Autism: Lyn Redwood’s “Science as a Means of Social Control”
by Joel A. Harrison, PhD, MPH
Posted: November 4, 2014
Wrong About Genetic Research and
Autism: A Review of Lyn
Redwood’s Article “Science as a
Means of Social Control”
(SafeMinds, August 23, 2013)
A number of organizations as well as bloggers have arisen over the past several decades claiming that vaccines and/or their ingredients cause a number of disorders. The results of their efforts have been a decline in vaccine coverage and a rise in previously rare childhood diseases, resulting in unnecessary suffering, hospitalizations, long term disabilities, and even death. The following paper will demonstrate, using one article by Lyn Redwood, co-founder of SafeMinds and a leading figure among antivaccinationists, the poor scholarship and science displayed by many antivaccinationists. If people are to decide on whether to vaccinate their children or not, it should be based on scholarly, well-grounded science, and reflect basic common sense, not claims made by people who are deficient in these.
A recent article/post by Redwood on SafeMinds, “Science as a Means of Social Control,” should raise a number of red flags regarding her scholarship, basic understanding of science and common sense and, given her key position in SafeMinds, of the overall credibility of the organization. Redwood’s article claims that a recent study in the journal Science by Rietveld et al., “GWAS of 126,559 Individuals Identifies Genetic Variants Associated with Educational Attainment," found that environment contributed 98% to educational attainment and genetics only 2% and, by implication, the same applied to Autism Spectrum Disorders.
The conclusions of this paper are:
Redwood found an article on the online magazine Truthout by Jonathan Latham, “Science as Social Con-trol: Political Paralysis and the Genetics Agenda,” that discussed the Rietveld et al study, and based her own article on Latham’s. However, a careful reading of Rietveld et al’s article suggests that either Redwood did not bother to read the easily available Rietveld et al’s article and supplement or did not understand them. The Latham article that she based her article on was wrong about the Rietveld et al’s study findings.
Redwood’s claim that 98% of educational attainment is accounted for by environmental factors is not what the Rietveld et al study found which attributed 40% to genetics, thus 60% to environment. Redwood's claim is so extreme that one would expect a scholarly scientific rendition of peer-reviewed findings, not “what [she] instinctively knew.”
Redwood’s article contradicts an earlier article she herself co-authored, "Autism: A Novel Form of Mercury Poisoning," where genetics was considered a significant component of autism.
Redwood rejects the progress being made on the genetic contribution to various aspects of human personality, cognitive abilities, and behaviors, including Autism Spectrum Disorders (ASD), that has already led to a variety of interventions and the prospect of many more to come. In addition, she ignores the evidence that half of our genome is mainly devoted to our brains.
Redwood seems to assume that the genetic findings for educational attainment would apply to Autism Spectrum Disorders, ignoring the extensive research evidence that genetic vs environmental contributions and their interactions vary widely between traits, cognitive abilities, and behaviors.
Redwood misunderstands that de novo mutations, while not present in either parent, are mutations in the germ line, sperm and ova, prior to conception. These mutations often can be random or associated with environmental factors, e.g. toxins, infections, radiation.
Redwood would like us to believe that finding genetic contributions will lead to “blaming the victim,” always possible among some; but this is not a prevailing attitude and certainly NOT the goal of researchers. Researchers’ goals, rather, are to improve diagnosis and both prevention and treatment.
As stated on their website: “SafeMinds ultimate goal is to find the truth - - to encourage and support efforts to conduct medical research that provide credible findings to support that the mercury-autism hypothesis is true.” They obviously don’t see the contradiction between having “the ultimate goal . . . to find the truth [and] to support that the mercury-autism hypothesis is true.” In my opinion, Redwood’s mind is made up. She is absolutely certain she is right so she searches the internet to find something that supports her position, even if just one paper, without thoroughly vetting it.
Her article shows the desperate lengths that she will go to. Redwood does not apply a scholarly scientific approach and even ignores common sense. Why would anyone accord what she writes any credibility? And if, as a co-founder of SafeMinds as well as a driving force and advocate for their position, she represents their standard of writing on scientific matters, how can anyone accord anything SafeMinds writes any credibility?
Wrong About Vaccine Safety: A Review of Andrew Wakefield’s “Callous Disregard”
After reading Callous Disregard, Dr. Harrison felt compelled to refute each and every point that Andrew Wakefield attempted to make about vaccine safety and his article was ultimately published in a peer-reviewed online open-source medical journal.
by Joel A. Harrison, PhD, MPH, The Open Vaccine Journal, Vol. 6, 2013, p. 9-25.
“This paper systematically examines the claims in Wakefield’s book as an example of similar erroneous claims being made within the anti-vaccination movement, contrasting these approaches to scientific foundations of vaccine risk and benefit. It is hoped that this review will be used by doctors and public health personnel to encourage parents hesitating to have their children vaccinated to question anti-vaccination claims in general, given that many proponents often refer to Wakefield as an authority and display in their writings and pronouncements similar examples of erroneous claims. The public health risks from decreased vaccination are significant. Based on the old adage “trust but verify,” readers should examine the references and, where possible (URLs to many documents are included), obtain and read the original papers rather than rely on the “interpretations” of others.”
by Brith Christenson, MD, PhD, The Open Vaccine Journal, Vol. 6, 2013, p. 26.
Dr. Harrison’s Biography and Mission Statement
Joel and dog Zip flashing a "V" for Vaccinate
I am a retired epidemiologist who has worked in the areas of preventive medicine, infectious diseases, medical outcomes research, and evidence-based clinical practice guidelines. For some time I have been following the so-called “vaccine controversy.” Outbreaks of totally unnecessary vaccine-preventable diseases have been occurring as a consequence of misinformation and disinformation from anti-vaccine advocates who don’t understand science, don’t apply critical thinking, display poor scholarship (e.g. relying on one blog post rather than reading the actual research, etc.); but when confronted fall back on paranoid conspiracy theories and ad hominem attacks. Mainly children, but adults as well, have suffered through various diseases; sometimes resulting in hospitalizations, long-term disabilities, and even death.
I have had a life-long interest in history and science. Since reading years ago a book by William H. McNeil, “Plagues and People,” which made a compelling case that infectious diseases have played a major role in human history, I was hooked. Since then I have tried to read as many books and articles as possible on the history of infectious diseases in general and specific diseases such as polio, measles, influenza, smallpox, etc. My other main area of interest has been and continues to be research methodology, causal thinking, and how we know/form opinions, e.g. cognitive psychology, critical thinking, etc. In retirement I try to keep up with what is going on in the world of diseases, including being on the CDC, WHO, Swedish public health (I’m fluent in Swedish) and the Canadian public health listservs. The outbreak of Ebola in Africa is just the latest; but basically, besides compassion for the suffering of others, we in the United States are just a plane flight away from diseases, some previously eliminated in this country by vaccines, and others that, hopefully, vaccines will be developed for.
As a retiree and life-long proponent of public health and vaccines I decided to devote time combating the misinformation and disinformation of the anti-vaccinationist by showing the level of poor scholarship, irrational, unscientific, and sometimes even lacking common sense claims made by anti-vaccinationists. My approach is quite simple. I will use accurate direct quotes from their articles and show, using accurate direct quotes from other articles and documents, together with clear explanations of scientific method, etc. that literally they don’t know what they are talking about. Each of my articles will contain detailed footnotes, including page numbers, and references with the URL/hyperlink to any papers available on the web.
Though I believe I am reasonably intelligent, well-educated, and well-read, I try to recognize at all times that I am a mere mortal and that the world is quite complex. As such, though unlikely, I could misquote or misunderstand something, miss some caveat written later in an article, or, even through extensive searches, miss relevant articles.
Any critique pointing out the aforementioned will be taken seriously and, if correct, will lead to my posting a correction online; but even if someone were to find such an error, it does not mean that everything else I have written is incorrect. This is one of the major flaws in the anti-vaccinationists' logic. Imagine if you will a criminal trial where the prosecutor presents DNA evidence, 12-point fingerprint matches, and 10 eye witnesses. The defense employs a quality private detective who finds that one of the witnesses was either near-sighted with glasses in the repair shop or mistook the dates; but despite all efforts could find no problems with any of the other witnesses or forensic evidence. Well, obviously, in summation the defense attorney will play up the one discredited witness; but would any jury ignore all the remaining compelling evidence? Well, that is exactly what many anti-vaccinationist would like.
While I accept my being human, I devote considerable time and effort to my articles, often reading articles and documents several times, using a split screen to double check the accuracy of my quotes, and running drafts by several people for review, editorial comments, and critiques. I believe that anyone carefully reading my articles, including checking the references, will find my arguments compelling and credible.
Some Additional Remarks
Numerous scientific studies and reviews have found no credible association between vaccines and/or their constituents and Autism Spectrum Disorders. There is basically no such thing as the “perfect” study. Each and every study can be found to have some problem(s) which is why science demands peer-review, why journals and conferences allow for/encourage critiques, and why replication(s) are essential.
Even randomized clinical trials have problems. To name one, the randomization process is intended to distribute “equally” any other variables, known and unknown, that could affect the outcome. The larger the trial, the better adhered to the methodology, the more likely this is; but it is never certain. Randomization only “guarantees” equal distribution in the long run, that is, replications. And there is seldom if ever perfect replications, each study is both different and the same. However, when numerous studies using varied methodologies, different researchers, different countries, different populations, and different measures, come to similar conclusions, the scientific consensus is sound. However, as opposed to non-scientist, scientist do not speak in absolutes, they use phrases such as “no evidence of harm was found.” This doesn't mean there is evidence that they just missed; but that NO study is assumed to be perfect and, though highly unlikely, there is always a remote possibility that future research will lead to different conclusions. A possibility that becomes ever more remote as more and more studies find similar results. Even in this case, new research often just leads to slight modifications, not out and out rejection of a consensus based on numerous studies.
While adverse events can result from vaccines, most are mild, though a few can be severe; but compared with the risks posed by the natural diseases, the benefit to risk ratio is astronomical. And, despite claims by anti-vaccinationists, numerous credible scientific studies have found no association between vaccines and/or their ingredients and Autism Spectrum Disorders! Any rational person should understand this. Just as a few people are injured by seat belts, no one in their right mind would exchange the literally thousands of deaths and many more injuries prevented by seat belts to prevent the few seat belt caused injuries. In my case, I have worn a seat belt religiously for over 40 years, long before it was mandatory and, thankfully, have never been in a situation where they were needed; but I continue to wear them. As opposed to years ago, we in the United States don’t directly see the diseases that vaccines prevent; but they are just a plane flight away. it only takes one time and the risk is always there. Even herd immunity does not guarantee protection of the unvaccinated if directly exposed to someone who has been abroad.
As mentioned above, scientists seldom if ever make claims of absolute certainty, whereas many anti-vaccinationists assert a level of certainty that no scientist would make. There are a number of explanations for this, among them is “Confirmation Bias.” “Confirmation bias is the tendency to search for or interpret information in a way that confirms one's beliefs or hypotheses. People display this bias when they gather or remember information selectively, or when they interpret it in a biased way. The effect is stronger for emotionally charged issues and for deeply entrenched beliefs. People also tend to interpret ambiguous evidence as supporting their existing position.” (Wikipedia, “Confirmation Bias”) (For additional information on Confirmation Bias and other fallacies of reasoning see: Carroll, 2013; Gilovich, 1991; Shermer, 1997, especially Chapter 3)
And “The Dunning-Kruger effect, named after David Dunning and Justin Kruger of Cornell University, occurs where people fail to adequately assess their level of competence — or specifically, their incompetence — at a task and thus consider themselves much more competent than everyone else. This lack of awareness is attributed to their lower level of competence robbing them of the ability to critically analyse their performance, leading to a significant overestimate of themselves. . . The inverse also applies: competent people tend to underestimate their ability compared to others.” (RationalWiki, Dunning-Kruger effect)
Carroll, Robert Todd (2013). The Critical Thinker’s Dictionary: Biases, Fallacies, and Illusions and what you can do about them. Lulu. [available as e-book, information about at: http://www.skepdic.com/authorpage.html]
Gilovich, Thomas (1991). How We Know What Isn’t So: The Fallibility of Human Reason in Everyday Life. New York: The Free Press.
Shermer, Michael (1997). Why People Believe Weird Things: Pseudo-Science, Superstition, and Bogus Notions of Our Time. New York: MJF Books.
Welcome to the expert commentary section where we post reviews of current issues for you by content experts. While the opinions in these articles reflect the views of the authors who are not employees of Every Child By Two and do not necessarily reflect the views of Every Child By Two, they are well-researched, well-written, and offer to our readers in-depth analyses of current topics.
Joel A. Harrison, PhD, MPH
Joel A Harrison, PhD, MPH. Dr. Harrison has been closely following what he deems “the so-called vaccine controversy,” and is eager to volunteer his time to provide expert analysis of a variety of articles, research papers and books in order to systematically debunk the false claims made about the safety of vaccines. We hope you find Dr. Harrison's articles enlightening and we urge you to share them with your friends and colleagues.
Dorit Rubinstein Reiss, Professor of Law, UC Hastings College of Law
Dorit Reiss is a Professor of Law at UC Hastings and writes blog posts and articles about legal issues related to vaccines. She is also a member of the Parent Advisory Board of Voices for Vaccines.
What is Shingles? Shingles, also known as Zoster or Herpes Zoster, is a painful localized skin rash often with blisters that is caused by the varicella zoster virus (VZV) - the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays in the body in a dormant state. For reasons that are not fully known, the virus can reactivate years later, causing shingles. A shingles rash usually appears on one side of the face or body and lasts from 2 to 4 weeks
People who develop shingles typically have only one episode in their lifetime, but long-term pain often occurs. In rare cases, a person may have second or even a third episode. The only way to reduce the risk of developing shingles and the long-term pain that can follow shingles is to get vaccinated.
The Statistics Almost 1 out of every 3 people in the United States will develop shingles. The risk of the disease increases as a person gets older and about half of all cases occur among men and women over 60 years of age. However, it is important to note than even children can get shingles. There are an estimated 1 million cases of the disease each year in the United States.
The shingles (herpes zoster) vaccine prevents against shingles. One dose is recommended for adults 60 years of age and older.
What is Meningococcal Disease? Meningococcal disease is a serious illness caused by the Neisseria meningitidis bacterium, also called meningococcus. The two most severe and common forms of meningococcal disease are meningitis and septicemia. Meningitis is an infection of the fluid and lining around the brain and spinal cord, which can lead to brain damage, hearing loss, learning disabilities, and even death. Septicemia is a bloodstream infection, which can lead to loss of an arm or leg and possibly death.
The bacterium are spread through the exchange of nose and throat droplets, such as when coughing, sneezing or kissing. Symptoms of the disease may develop over several hours or over 1 to 2 days, and may include sudden onset of fever, stiff neck, severe headache, nausea, vomiting, sensitivity to light, and confusion or difficulty concentrating.
Anyone can contract meningococcal disease but it is most common in infants less than one year of age, in adolescents 16-21 years of age, and in people with certain medical conditions, such as the lack of a spleen. College freshmen who live in dormitories have an increased risk of getting meningococcal disease.
The Statistics About 1,000 people get meningococcal disease each year in the United States. Even if they get treatment, about 1 in 10 people with meningococcal disease will die from it. Of those who survive, 1 in 5 will suffer permanent disabilities, such as brain damage, hearing loss, loss of kidney function or limb amputations.
The Vaccine The meningococcal conjugate vaccine (MCV4) protects against many types of meningococcal disease. Children between 2 months and 10 years old with certain high-risk conditions should receive the meningococcal conjugate vaccine However, the number of doses of vaccine depends upon the specific high-risk condition.
Adolescents should be vaccinated with two doses of meningococcal conjugate vaccine, which protects against serogroups A, C, W, and Y. The first dose is given at 11 or 12 years of age. The second dose is given at 16 years of age. First-year college students up through age 21 years who are living in residence halls should be vaccinated if they have not received a dose on or after their 16th birthday. Military recruits should also be vaccinated before they move into military barracks.
One or more doses of meningococcal vaccine are needed for adults with certain medical conditions or risk factors.
What is Measles? Measles is caused by a virus that grows in the cells that line the back of the throat and lungs. The disease spreads quickly and can be serious or even fatal for small children. Measles spreads when a person infected with the measles virus breathes, coughs, or sneezes. People can catch measles just by being in a room where an infected person has been, even up to 2 hours after that person is gone. Almost everyone who has not been vaccinated will get measles if they are exposed to the measles virus. Symptoms of measles typically include fever, dry cough, runny nose, sore throat, inflamed eyes, sensitivity to light, tiny white spots inside the mouth, and a skin rash made up of large, flat blotches.The rash usually starts on the head and then spreads to the rest of the body.
The Statistics/Outbreaks Even in previously healthy children, measles can be a serious illness requiring hospitalization. As many as 1 out every 20 children with measles get pneumonia and about 1 child in every 1,000 who get measles will develop encephalitis (inflammation of the brain). For every 1,000 children who get measles in a developed country like the United States, 1 to 3 of them die, despite the best treatment
Measles continues to be a common disease in many parts of the world including some countries in Europe. According to the CDC, there are currently a record number of measles cases in the U.S. In 2014, there were almost 650 cases of measles reported to the CDC, and in 2015, measles cases continue to be reported. Almost all measles cases have been associated with importations from other countries. The most frequent sources of importations were unvaccinated U.S. travelers returning from abroad and transmitting the disease among groups of unvaccinated individuals, mostly unvaccinated due to philosophical or religious beliefs. For the most updated outbreak information, visit the CDC's measles webpage.
The Vaccine The MMR (measles, mumps, rubella) vaccine is the currently recommended vaccine to protect against measles. For the best protection, children need two doses of the vaccine. The first dose is recommended between 12-15 months of age and the second dose between 4 and 6 years of age. For younger children traveling internationally, the MMR vaccine may be given as early as 6 months of age. However, children who get the shot between 6-11 months of age will still need to get two more doses of the vaccine. MMRV, which protects against measles, mumps, rubella and varicella, is also available.
One dose of MMR vaccine is approximately 93% effective at preventing measles and two doses are approximately 97% effective.
Students at post-high school educational institutions (e.g., college, vocational school, etc.) who have not already received 2 appropriately-spaced doses of MMR vaccine and who don’t have evidence of immunity need 2 doses of the MMR vaccine.
Adults born after 1957 who have not had the measles or the MMR vaccine (and don’t show evidence of immunity) should receive at least 1 dose of the MMR vaccine. Healthcare personnel and childcare providers need to receive 2 doses of MMR vaccine if they don’t have evidence of immunity from measles. Pregnant women and immunocompromised individuals should not receive the MMR vaccine.
What is Mumps?
Mumps is a contagious disease that is caused by the mumps virus. About half of the people who get mumps have very mild or no symptoms, and don't know they are infected. For those who do show symptoms, mumps typically starts with a few days of fever, headache, muscle aches, tiredness, and loss of appetite, and is followed by swelling of salivary glands.
Mumps spreads from an infected person to a healthy person through coughing, sneezing and regular conversation. People with mumps usually recover after a week or two, but mumps can occasionally cause serious complications. The most common complication is inflammation of the testicles in boys who have reached puberty. Other rarer complications include swelling of the brain and/or tissue covering the brain and spinal cord; swelling of the ovaries and/or breasts in girls who have reached puberty; and deafness. Anyone who is not immune from either previous mumps infection or from vaccination can get the mumps.
Prior to the mumps vaccine, approximately 200,000 cases of mumps and 20 to 30 deaths occurred each year in the U.S. Mumps is no longer as common in the United States.; however, outbreaks of mumps still occur in the U.S. In 2014, 42 states in the U.S. and D.C. reported mumps infections in 1,223 people. In 2015, 40 states in the U.S. reported mumps infections in 1,057 people, and in 2016, 31 states reported mumps infections in 727 people to the CDC (as of the beginning of April).
The MMR (measles, mumps, and rubella) vaccine is the best way to protect against mumps. Children need two doses of MMR to be fully protected. The first dose of MMR should be given between 12-15 months of age and the second dose between 4-6 years of age. The catch up schedule is followed for children who miss either or both of the doses.
Adults born after 1957 who have not had the mumps and have not had the MMR vaccine are recommended to get 2 doses of MMR vaccine.
Rubella (German Measles)
What is Rubella?
Rubella is also called German measles because the disease was first described by German physicians in the mid-18th century. While the disease is usually mild in children and adults, up to 90 percent of infants born to mothers infected with rubella during the first trimester of pregnancy will develop Congenital Rubella Syndrome (CRS), resulting in heart defects, cataracts, mental retardation and/or deafness in the newborn child. It can also cause premature birth, low birth weight, neonatal thrombocytopenia (an abnormal drop in the number of blood cells involved in forming blood clots), anemia and hepatitis.
Before the rubella vaccine was introduced in 1969, widespread outbreaks usually occurred every six to nine years in the United States, mostly affecting children in the five-to-nine year age group. Between 1962 and 1965, rubella infections during pregnancy were estimated to have caused 30,000 still births and 20,000 children to be born impaired or disabled.
Due to the widespread, routine immunization only 18 cases of rubella and one case of CRS were reported in 2002; in 2004 the Centers for Disease Control and Prevention (CDC) announced that both the congenital and acquired forms of rubella had been eliminated from the United States. We continue to vaccinate to prevent the possibility of rubella being imported from countries where it is still common.
The MMR vaccine is the currently recommended vaccine to protect against rubella. For children, two doses of the vaccine are needed. The first dose is scheduled to be given between 12-15 months of age and the second dose between 4 and 6 years of age. The catch up schedule is followed for children who miss either or both of the doses.
Adult women of childbearing age should have their immunity to rubella determined and be vaccinated if they are not yet pregnant and there is no evidence of immunity. If they are pregnant then they should be immediately vaccinated after the conclusion of the pregnancy following the Adult Schedule.
What is Varicella?
Although generally mild, varicella (chickenpox) is a highly contagious virus. It causes a blister-like rash, itching, tiredness, and fever. Chickenpox can be serious, especially in babies, adults, and people with weakened immune systems. These individuals may have more severe symptoms and may be at higher risk for complications. Chickenpox spreads easily from infected people to others who have never had chickenpox or received the chickenpox vaccine. The virus spreads in the air through coughing or sneezing. It can also be spread by touching or breathing in the virus particles that come from chickenpox blisters. Once the varicella virus infects the body, it remains there for life and may reappear as shingles, particularly in people over 60 years old.
The virus can pass from infected pregnant women to the fetus, resulting in abnormalities in two percent of cases. The fetus can develop scars on the skin and limb(s), limb deformities (hypoplesia), eye damage, low birth weight, brain atrophy (loss of neurons) and mental retardation. The virus sometimes leads to fetal death and/or spontaneous abortion. Some babies who got infected in the fetal stage die in infancy.
Before the varicella vaccine, the U.S. reported an estimated 4 million cases of disease a year, leading to approximately 11,000 hospitalizations and 100 deaths. Historically one out of every 10,000 cases of chickenpox proved fatal with 23 out of every 10,000 cases progressing to pneumonia. Since the chickenpox vaccine was licensed in 1995, the number of people who get chickenpox as well as hospitalizations and deaths from chickenpox each year has declined dramatically in the United States.
The varicella vaccine protects against varicella, also known as chickenpox. The first dose is given to children between 12 and 15 months of age. The second dose is given between 4 and 6 years of age. The catch up schedule is followed for children who miss either or both of the doses. The measles, mumps, rubella, and varicella vaccine (MMRV) is also available.
All adults (without evidence of immunity to varicella) need 2 doses of varicella vaccine or a second dose if they have received only 1 dose. Pregnant women should be assessed for evidence of varicella immunity. Those who are not immune to varicella should receive the first dose of vaccine upon completion or termination of pregnancy and before discharge from the healthcare facility. The second dose should be administered 4–8 weeks after the first dose.
What is Diphtheria? Diphtheria is a very contagious and serious bacterial disease. Symptoms include sore throat, low-grade fever, and swollen neck glands. The toxin or poison, caused by the bacteria also causes a thick coating on the tonsils, throat, and/or nasal cavity. As the infection progresses, the person may have difficulty breathing or swallowing, complain of double vision, have slurred speech and signs of shock with pale/cold skin, rapid heartbeat, sweating, and an anxious appearance. If the disease progresses beyond this point the toxin can spread into the blood stream and cause life-threatening injury to the heart, kidney and other organs. Nerve damage and paralysis can also result.
Before the diphtheria vaccine was introduced, the United States had between 100,000 to 200,000 cases of diphtheria each year. Since the introduction of the vaccine for diphtheria, the disease has dramatically declined in the U.S. In the past decade, there were less than five cases of diphtheria in the U.S. reported to CDC. However, several thousand cases of diphtheria still occur around the world every year.
For some people, diphtheria can lead to death. Even with treatment about 1 out of 10 (10%) diphtheria patients die (with higher death rates - up to 20% - in children younger than 5 years old and adults older than 40 years old). Without treatment, as many as 1 out of 2 (50%) patients can die from the disease.
The Vaccine The DTaP vaccine (diphtheria and tetanus toxoids and acellular pertussis) protects children from diphtheria. Five doses of DTaP are recommended and should be given to children at 2 months, 4 months, 6 months, between 15 and 18 months, and between 4 and 6 years of age.
The Td vaccine (diphtheria and tetanus toxoids vaccine) and the Tdap vaccine (diphtheria and tetanus toxoids vaccine and acellular pertussis) protect adolescents and adults against the disease. Two doses of Tdap are recommended for adolescents. The first dose at age 11 or 12 and the second dose between 13 and 18 years of age.
Adults should receive one dose of Td every 10 years, and should substitute a one time dose of Tdap for one of their Td boosters. Women should receive a dose of Tdap at each pregnancy, preferably in their third trimester.
What is Tetanus?
Tetanus, also known as lockjaw, is a severe disease caused by a toxin made by a bacteria. Tetanus can cause breathing problems, painful muscle spasms and stiffness, and paralysis. It can also be deadly. Tetanus kills 1 out of 5 of those who contract the bacteria. Unlike other vaccine-preventable diseases, which are transferred from person to person, tetanus bacteria grow in soil and can therefore never be eradicated. The bacterium usually enters the body through a cut or a puncture wound to the skin. A person can also be infected after a burn or animal bite.
From 1922 to 1926, there were an estimated 1,314 cases of tetanus per year in the U.S. By 2002, as a result of extensive immunization, only 25 cases of tetanus were reported and those low rates continued through 2008 (the most recent year in which data are available).
The diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) protects children from tetanus. A five doses series of DTaP is required and should be given to children at 2 months, 4 months, 6 months, between 15 and 18 months, and between 4 and 6 years.
The diphtheria and tetanus toxoids vaccine (Td) and the diphtheria and tetanus toxoids vaccine and acellular pertussis vaccine (Tdap) protect adolescents and adults against the disease. Two doses of the Tdap vaccine are recommended for adolescents. The first dose at age 11 or 12 and the second dose between 13 and 18 years of age.
Adults should receive one dose of Td every 10 years, and should substitute a one time dose of Tdap for one of their Td boosters.
Pertussis (Whooping Cough)
What is Pertussis?
Also known as whooping cough, pertussis is a highly contagious disease. It is also the most common vaccine-preventable disease in the U.S. Pertussis can cause serious and sometimes life-threatening complications in infants and young children, especially those who are not fully vaccinated.
The disease begins as a mild respiratory infection with symptoms such as coughing, sneezing, and runny nose. After one to two weeks, the cough increases and develops a "whooping" sound. Above is a video showing a child during a pertussis coughing episode. (Notice how the cough is continuous and the child has difficulty catching it's breath.)
In severe cases, vomiting induced by the coughing fits can lead to malnutrition and dehydration. Pneumonia, encephalitis, pulmonary hypertension and secondary bacterial super infections are among the many side effects that pertussis victims may face.
In adults, the disease often seems like a bad cold with mild symptoms. Since most adults won't recognize that they have pertussis, it is not unusual for them to spread the disease to vulnerable children. In approximately 85% of infant pertussis cases, babies are infected by a member of their immediate or extended family. Most unvaccinated children living with a family member with pertussis will contract the disease.
The Centers for Disease Control and Prevention (CDC) reported that the introduction of the pertussis vaccine in the mid-1940s decreased pertussis incidence to only 1,010 cases by 1976, an all-time low. However, pertussis is a cyclical disease with a higher number of cases in certain years. Ninety-percent of pertussis-associated deaths have been among babies less than one year old. More than half of infants younger than 1 year of age who contract the disease must be hospitalized. About 1 in 5 infants with pertussis develop pneumonia, and approximately 1 in 100 will experience convulsions. In some cases (1 in 100), pertussis can be deadly, especially in infants.
Research published in the Journal of the American Medical Association (JAMA) Pediatrics in September 2013 showed that undervaccination is associated with a higher risk of pertussis in children. The investigators of the case-control study of children ages 3 to 36 months found that those who missed three doses of the DTaP vaccine were nearly 19 times more likely to develop pertussis than those appropriately vaccinated, and those who missed four doses were 28 times more likely to develop the disease.
Large outbreaks of pertussis have been occurring in the U.S. in recent years. In 2010, more than 27,000 cases were reported and by 2012 that number rose to more than 48,000 cases, marking a 58-year high. There were almost 33,000 cases in 2014; approximately 18,000 cases in 2015; and outbreaks have continued in 2016.
There are several reasons that help explain why there have been more cases of pertussis over the last few years including increased awareness, improved diagnostic tests, better reporting, more circulation of the bacteria, and waning immunity. Pertussis vaccines are effective, but not perfect. They typically offer high levels of protection within the first 2 years of getting vaccinated, but then protection wanes over time. In addition, many children fail to receive all of the required doses and remain vulnerable.
There are two vaccines used to protect against pertussis, Children need to receive all 5 doses of DTaP, a combined tetanus, diphtheria and pertussis vaccine, to be protected. One dose is needed at 2 months, 4 months, and 6 months, between 15-18 months and between 4-6 years. Preteens should receive one dose of Tdap at 11 or 12 years old. Adults 19 years of age and older who didn't get Tdap as a preteen or teen should also get one dose of Tdap.
Adults can help to protect themselves and the young children around them by getting immunized with the adult pertussis vaccine (Tdap).
Pregnant women should be vaccinated with Tdap during each pregnancy (preferably in the third trimester between the 27th and 36th weeks of pregnancy). By getting vaccinated during pregnancy, mothers build antibodies that are transferred to the newborn providing protection against pertussis before the baby can start getting DTaP vaccine at 2 months old. Tdap also protects mothers during delivery, which makes them less likely to transmit pertussis to their infants. This recommendation is supported by The American College of Obstetricians and Gynecologists and The American College of Nurse-Midwives.
Parents should proactively request that all those who will be in contact with their newborn, including healthcare workers, get a Tdap vaccine at least two weeks prior to delivery to help protect their infant until they are fully vaccinated.
Hepatitis B (HepB)
What is Hepatitis B?
Hepatitis B, caused by infection with the Hepatitis B virus, is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Acute Hepatitis B is a short-term illness that occurs within the first 6 months after someone is exposed to the virus. Acute infection may lead to chronic infection. Chronic Hepatitis B virus infection is a long-term illness that occurs when the Hepatitis B virus remains in a person’s body. This can eventually lead to serious health problems, including liver damage, liver cancer, and even death.
Hepatitis B is spread when blood, semen, or other body fluid infected with the Hepatitis B virus enters the body of a person who is not infected. People can become infected with the virus during activities such as birth (spread from an infected mother to her baby); sex with an infected partner; sharing needles or syringes; sharing items such as razors or toothbrushes with an infected person; direct contact with the blood or open sores of an infected person; and exposure to blood from needlesticks or other sharp instruments.
Not all people with acute Hepatitis B have symptoms. However, if they appear, symptoms can include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, and jaundice (yellow color in the skin or the eyes).
Unfortunately, many parents mistakenly believe that Hepatitis B is strictly a sexually transmitted disease and are therefore reluctant to have their child vaccinated at the recommended ages.
In the United States, an estimated 800,000 to 1.4 million persons have chronic Hepatitis B virus infection. About 5,000 persons will die each year from hepatitis B-related liver disease resulting in over $700 million in medical and work loss costs.
Newborns that become infected with Hepatitis B virus have a 90% chance of developing chronic Hepatitis B. However, with the recommendation for routine Hepatitis B vaccination of children the number of new infections per year has declined approximately 82 percent.
The HepB vaccine protects against the Hepatitis B virus. Children need three doses of the vaccine. The first dose should be given at birth (before leaving the hospital), the second dose between 1 and 2 months, and the third dose between 6 and 18 months of age. A woman with Hepatitis B can pass the disease on to her baby at birth. However, almost all cases of Hepatitis B can be prevented if a baby born to an infected woman receives the necessary vaccinations at the recommended times. The infant should receive a shot called Hepatitis B immune globulin (HBIG) and the first dose of Hepatitis B vaccine within 12 hours of birth. Two or three additional shots of vaccine are needed over the next 1–15 months to help prevent Hepatitis B.
The HepB vaccine should be given to adults with certain risk factors (on the basis of medical, occupation, lifestyle or specific other indications) and to anyone who wants to be protected against Hepatitis B. Three doses of the vaccine are needed usually over a 6 month time period.
What is Rotavirus?
Rotavirus is a disease of the digestive tract caused by one of the three strains of rotavirus. Infection from rotavirus causes acute gastroenteritis (vomiting and diarrhea). People of all ages are susceptible to rotavirus infection. Children 6 months to 2 years of age, premature infants, the elderly and the immune-compromised are particularly prone to more severe symptoms.Rotavirus infection is also known by other names such as "infantile diarrhea," "winter diarrhea," "stomach flu," "acute nonbacterial infectious gastroenteritis" and "acute viral gastroenteritis."
The disease is the most common cause of severe diarrhea in children worldwide, infecting about 120 million people every year. It is also responsible for the death of about 600,000 children per year in developing countries.
In the United States, the death rate from rotavirus infections has lowered substantially because of successful hospital treatment of the often severe vomiting and diarrhea caused by the disease. In 2006, rotavirus vaccination was recommended for children in the United States. Prior to that, almost every child had been infected with rotavirus by age 5 and the disease was responsible for more than 200,000 emergency room visits and 55,000 to 70,000 hospitalizations of young children each year. In addition, 20-60 children under five years of age died each year.
The rotavirus vaccine (RV) protects against rotavirus. Children need two or three doses of the vaccine (depending on the vaccine brand). The first dose should be given at 2 months, the second dose at 4 months and third dose at 6 months of age.
There is currently no routine recommendation for adults to receive the rotavirus vaccine.
Haemophilus Influenzae type b (Hib)
What is Haemophilus Influenzae type b? Haemophilus Influenzae type b (Hib) is a very serious bacterial illness that often affects children under 5 years old. The most common types of severe Hib disease are meningitis (infection of the covering of the brain and spinal cord), pneumonia, bacteremia (blood stream infection) and epiglottitis (infection and swelling of the throat). Hib can cause lifelong disability and may be deadly.
The Statistics Most children with Hib disease need care in the hospital. Even with treatment, as many as 1 out of 20 children with Hib meningitis dies. As many as 1 out of 5 children who survive Hib meningitis will have brain damage or become deaf.
Before the Hib vaccine was available, Hib caused serious infections in 20,000 children and killed about1,000 children each year. Since the vaccine's introduction in 1987, the incidence of severe Hib disease have dropped more than 99% in the United States.
Recent outbreaks of Hib have resulted in the deaths of children in Minnesota, Pennsylvania and New Jersey. Additionally, several children have been hospitalized with the disease, indicating that this dangerous disease is spreading once again.
The Vaccine The Hib (Haemophilus Influenzae type b) vaccine protects children against Haemophilus influenzae type b. Three or four doses of Hib vaccine are recommended (depending on the vaccine brand). The first dose should be given at 2 months, the second dose at 4 months, the third dose at 6 months (if needed), and the last dose between 12 and 15 months.
There is currently no routine recommendation for adults to receive this vaccine.
What is Influenza?
Influenza (flu) is a serious disease. It is a highly contagious viral infection of the respiratory tract (nose, throat, and lungs). Flu is spread by direct and indirect contact with an infected person. The flu usually comes on suddenly. Symptoms may include fever or feeling feverish/chills; cough; sore throat; runny or stuffy nose; muscle or body aches; headaches; fatigue; vomiting; and diarrhea.
Even healthy people can become very severely ill due to the flu. Some people are at higher risk of developing serious flu-related complications including people 65 years and older, people of any age with certain chronic medical conditions (e.g., asthma, diabetes, heart disease), pregnant women, and young children.
Each year, between 10 and 20 percent of the U.S. population is infected with the virus. In an average year, the seasonal flu causes anywhere between 3,300 and 48,600 deaths and 200,000 hospitalizations in the U.S.
While the majority of deaths resulting from flu occur in the elderly during a typical flu season, rates of infection are highest among children. Hospitalization rates among children less than one-year-old are similar to those of the elderly. In fact, more than 20,000 children under the age of five are hospitalized due to the flu each year. In addition, influenza kills approximately 100 American children less than five years of age every year. As of August 2017, a total of 104 flu-associated pediatric deaths were reported to the CDC for the 2016-17 influenza season.
Since the flu vaccine is not approved for use in infants younger than 6 months old, the best way to protect these children is to make certain that their household contacts and caregivers are vaccinated. Additionally, since flu is more likely to cause severe illness in pregnant women than in healthy women, pregnant women should be vaccinated against influenza (in any trimester). This will help protect them against the flu, and will provide some protection to their baby after he or she is born (up to 6 months old). This recommendation is supported by the American College of Obstetricians and Gynecologists. Once the baby is born, breastfeeding will also help an infant stay healthy during flu season. Breast milk passes a mother’s antibodies to her baby, which help fight off infection. The flu vaccine is safe for pregnant women and their unborn babies.
A new vaccine is created for each flu season. A variety of influenza vaccines formulations are available for the 2017-18 flu season including quadrivalent vaccines that prevent against 4 strains of influenza and trivalent vaccines that prevent against 3 strains of influenza. The CDC’s Advisory Committee on Immunization Practices (ACIP) states that live attenuated influenza vaccine (LAIV), also known as the “nasal spray” flu vaccine and FluMist, should not be used during the 2017-18 flu season due to a lack of effectiveness.
Adults aged 65 years and older can receive the standard dose or the high-dose flu vaccine.
People at high risk of serious flu complications and people who are very sick with flu should get antiviral drugs. Other people may be treated with antivirals at their healthcare professional’s discretion. Treatment with antivirals works best when begun within 48 hours of getting sick.
See the complete 2017-18 Summary of Flu Vaccine Recommendations on the CDC website.
What is Pneumococcal Disease?
Pneumococcal Disease is caused by a bacterium known as pneumococcus bacterium. While pneumococcus bacterium is present in many people's noses and throats, it is still unknown why it suddenly invades the body and causes the disease.
Pneumococcus bacterium is spread by coughing and sneezing. It is the most common cause of pneumonia, meningitis (inflammation of the coverings of the brain and spinal cord), bacteremia (bloodstream infection), ear infections and sinusitis (sinus infections) in children under 2 years of age. Serious pneumococcal infections are most common in infants, toddlers and the elderly.
Each year in the United States, pneumococcus causes about 4,000 cases of bacteremia, meningitis, or other invasive disease in children younger than 5 years of age. Children under 2 years of age average more than 1 middle ear infection each year, many of which are caused by pneumococcus.
Pneumococcal disease has a higher incidence in individuals with certain health problems such as immune deficiencies, sickle cell disease or lack of a functioning spleen. Additionally, there is a higher rate of infection in children of certain ethnic populations including African-American, Alaskan Native and specific Native American populations. Children younger than 5 years of age in out-of-home day care are at increased risk (approximately 2 fold higher) of experiencing invasive pneumococcal infections than other children.
Pneumococcal Conjugate Vaccine (PCV13) is used to protect children and adolescents against pneumococcal disease. Four doses of the vaccine are needed. The first dose is given at 2 months of age, the second dose at 4 months, the third dose at 6 months and the fourth dose between 12 and 15 months. The catch-up schedule should be referenced when doses are missed.
Children 6–18 years old and adults 19-64 years old with immunocompromising conditions also need pneumococcal vaccines. Learn about the specific recommendations for these populations.
What is Polio?
Polio is a crippling and potentially deadly infectious disease caused by a virus that invades the brain and spinal cord and causing paralysis. Polio is spread by person-to-person contact.
Polio was one of the most dreaded childhood diseases of the 20th century with annual epidemics, primarily during the summer months. Before polio vaccines were available, polio outbreaks caused more than 15,000 cases of paralysis each year in the U.S. Because polio can paralyze the diaphragm, in the 1940s and 1950s, entire wards of hospitals housed polio victims who were dependent on large iron lungs that breathed for them.
Thanks to the discovery of the vaccine, polio has been eradicated from the United States and the entire Western Hemisphere. We continue to vaccinate against polio because it still remains a threat in some countries and could easily be transported by an infected person back into the United States.
Inactive Polio Vaccine (IPV) protects against polio. Children need four doses of the vaccine. The first dose is given at 2 months, the second dose at 4 months, the third dose is given between 6 and 18 months of age and the fourth dose is given between 4 and 6 years old.
Most adults do not need polio vaccine because they were already vaccinated as children. However, some adults are at higher risk and should consider polio vaccination in the following situations:
You are traveling to polio-endemic or high-risk areas of the world.
You are working in a laboratory and handling specimens that might contain polioviruses.
You are a healthcare worker treating patients who could have polio or have close contact with a person who could be infected with poliovirus.
Adults in these three groups who have never been vaccinated against polio should get 3 doses of IPV: Adults in these three groups who have had 1 or 2 doses of polio vaccine in the past should get the remaining 1 or 2 doses. It doesn’t matter how long it has been since the earlier dose(s). Adults who are at increased risk of exposure to poliovirus and who have previously completed a routine series of polio vaccine can receive one lifetime booster dose of IPV.
What is Hepatitis A?
Hepatitis A is a viral disease that affects the liver. It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months.
Hepatitis A is usually spread by contact with people who are infected or from contact with objects, food, water or drinks contaminated by the feces of an infected person, which can easily happen if someone doesn’t properly wash his or her hands after using the toilet. Hepatitis A disease tends to occur in community-wide outbreaks when many people eat from the same hepatitis A-infected food. It also transmits from person-to-person in households and extended family settings.
Not all people with hepatitis A have symptoms. Adults are more likely to have symptoms than children. If symptoms develop, they usually appear two to six weeks after being infected and may include fatigue; nausea and vomiting; abdominal pain or discomfort; loss of appetite; low-grade fever; dark urine; clay-colored stools; muscle pain; and yellowing of the skin and eyes (jaundice).
Since the introduction of the Hepatitis A vaccine in 1995, rates of the disease have been on the decline. Since only infections with symptoms are reported, and most infected children have no symptoms, the actual number of hepatitis A virus infections is estimated to be about 10 times higher that what is reported to the CDC. In 2013, 1,781 acute symptomatic cases of hepatitis A were reported. After adjusting for asymptomatic infection and underreporting, the estimated number of new hepatitis A infections was 3,473. About 1 out of 5 people with hepatitis A is hospitalized, and approximately 100 people die each year from hepatitis A.
Hepatitis A vaccine (HepA) protects against Hepatitis A infection. For children and adolescents two doses of the vaccine are needed. The first dose should be given to children between 12 and 23 months of age. The second dose should be given 6 to 18 months after the first dose.
Adults with specific risk factors for Hepatitis A or adults who just want to be protected from this disease should receive the vaccine. Two doses of the vaccine are needed.
Human Papilomavirus (HPV)
What is Human Papillomavirus (HPV)?
Human Papillomavirus (HPV) is a virus that is spread through sexual contact. Anyone who has sex or any type of intimate sexual contact can get HPV; however, most of the time HPV has no symptoms so people do not know they have it. It is the most common sexually transmitted disease, and can be passed even when an infected person has no symptoms.
HPV can have many serious consequences in both men and women including:
Recurrent respiratory papillomatosis (RRP),
Oropharyngeal cancer (cancer in the back of the throat including the base of the tongue and tonsils)
Very rarely, a pregnant woman with genital HPV can pass HPV to her baby during delivery.
The Statistics About 79 million Americans are currently infected with HPV. Each year in the U.S., HPV causes approximately 17,000 cancers in women and about 9,000 cancers in men. Cervical cancer causes about 4,000 deaths in women each year in the U.S. About 1 in 100 sexually active adults in the U.S. have genital warts at any given time.
The Vaccine HPV (Human papillomavirus) vaccines help protect both girls and boys from HPV infection and cancer caused by HPV. For the best protection, three doses of the vaccine are needed and should be given to adolescent girls and boys beginning at 11 or 12 years of age. If possible, HPV vaccines should be given to preteens and teens BEFORE they become sexually active. However, even if they are already sexually active, women who were not previously vaccinated and are 26 years of age or younger should receive three doses of the vaccine. Men who were not previously vaccinated and are 21 years of age and younger should also receive three doses of the vaccine. Men who are 22 to 26 years of age with certain risk conditions that put them at higher risk for HPV should also be vaccinated.
The FDA has licensed three different HPV vaccines for use in the United States: 2-valent HPV vaccine (Cervarix), 4-valent HPV vaccine (Gardasil), and 9-valent HPV vaccine (Gardasil-9).
No serious safety concerns have been linked to HPV vaccination. These studies continue to show that HPV vaccines are safe. As with all vaccines, the CDC and FDA continue to monitor the safety of these vaccines very carefully.
Low HPV vaccination rates are leaving another generation of boys and girls vulnerable to devastating HPV cancers. Vaccination could prevent most of these cancers. The CDC is looking to healthcare providers to make a strong recommendation for HPV vaccination when kids are 11 and 12 years old. To assist them, the CDC created a campaign titled HPV: You are the Key to Cancer Prevention, which contains a variety of resources for healthcare providers, including tips for speaking with parents about HPV vaccination and patient handouts.
Good Science vs Bad Science
Science follows certain rules and guidelines based upon the scientific method which says that you must:
ask a question
do some background research
construct a hypothesis
test your hypothesis by doing an experiment
analyze the data from the experiment and draw a conclusion regarding the hypothesis that you tested
if your experiment shows that your hypothesis is false, think some more and go back to step 3
if your experiment shows that your hypothesis is true communicate your results.
There are many steps along the way to getting to a result and then communicating those results and there are many pitfalls along that road. The first pitfall comes from our very nature as humans and the fact that science is a human endeavor. In our eagerness to prove or disprove something that we are passionate about we may unwittingly skip a step, discredit an observation or overemphasize an observation, take shortcuts to proper methodology or construct a weak test of the hypothesis. We may interject opinions into our observations and treat them as facts and we may, often without realizing it, start with a conclusion instead of a hypothesis and then design a “study” that proves the conclusion. This is why a most important part of good science is that the work be published. If it is not published then no one can try to reproduce it and prove that the conclusions are valid. And in good science, if others cannot reliably duplicate the findings using the same methods then there is reason to doubt that the hypothesis has been proven and the hypothesis must be considered to be invalid.
The good scientist is also their own greatest critic. Noted American physicist Richard Feynman (1918 – 1988) is noted for saying, “…if you're doing an experiment, you should report everything that you think might make it invalid — not only what you think is right about it; other causes that could possibly explain your results; and things you thought of that you've eliminated by some other experiment, and how they worked — to make sure the other fellow can tell they have been eliminated.
Details that could throw doubt on your interpretation must be given, if you know them. You must do the best you can — if you know anything at all wrong, or possibly wrong — to explain it. If you make a theory, for example, and advertise it, or put it out, then you must also put down all the facts that disagree with it, as well as those that agree with it. There is also a more subtle problem. When you have put a lot of ideas together to make an elaborate theory, you want to make sure, when explaining what it fits, that those things it fits are not just the things that gave you the idea for the theory; but that the finished theory makes something else come out right, in addition.
In summary, the idea is to try to give all of the information to help others to judge the value of your contribution; not just the information that leads to judgment in one particular direction or another.”
How to Evaluate Medical Research
Every day medical research is reported on by the popular press. By its very nature, medical research can be confusing to read and to understand. Most researchers write their studies in the language of science and, lacking a good working knowledge of that particular medical field, you may find the concepts and terms to be very confusing at best. Additionally, you must keep in mind that having a study reported on in the popular press doesn’t make if a good or “valid” study. Digging down into the study and asking some very critical questions about it can help you evaluate the study and better understand it.
Who paid for the study?
A lot can be garnered just by knowing who paid to have a study done. For example, a 1998 publication of a research paper in the medical journal The Lancet by Andrew Wakefield lent support to a subsequently discredited theory that colitis and autism spectrum disorders “could” be caused by the combined Measles, Mumps and Rubella (MMR) vaccine. The popular press ran with the story, immunization rates for MMR dropped, the incidence of the three diseases that the combined vaccine prevents increased and at least one death from measles occurred. Yet no one looked at who paid Wakefield to do his research study until February 2004 when a reporter, Brian Deer, wrote in The Sunday Times of London that, prior to submitting his research paper to the Lancet Wakefield received a payment of £55,000 from Legal Aid Board solicitors who were seeking evidence to use against vaccine manufacturers. Deer further revealed that several of the parents that Wakefield quoted in his study as saying that MMR had damaged their children were part of the group of litigants in the case. The Lancet eventually retracted the paper and Wakefield eventually lost his medical license.
Did the researcher study animals or people?
Not all animals study directly correlates to what will happen in humans. Differences in physiology, anatomy and other factors mean that the best that you can do from an animal study is suggest that a human trial would or would not be successful. However, until a human study is done you cannot be sure that the same results will be achieved.
Who are the people that were observed in the study?
Sometimes a very specific group or “class” of individuals is being studied and you need to know that. When a researcher narrows the focus to a specific class of individuals it limits how broadly the conclusions of the study can be applied to the general population. While the research may be important, it may be very limited in its scope.
Was the study a randomized controlled clinical trial.
By using a randomized controlled trial approach the researcher ends up with study subjects who are randomly allocated to receive either one or the other of the alternative treatments within the study. All study subjects are followed in exactly the same way with the exceptions of the variable being studied. This type of study minimizes bias in the study because the assignment of the variable being study is done essentially like the flip of a coin.
Where was the research done?
This may seem like a matter of little importance but there is a growing body of evidence that says that the physical setting can greatly influence study outcomes.
Were there side effects?
It is important to note how the researchers monitored for side effects and what those side effects were. All potential side effects should be noted during a study, but then it is important for the researchers to dig down into the data and determine whether a potential side effect becomes a recognized side effect or not. Just because a researcher observes a potential side effect after a medical intervention does not necessarily mean that the medical intervention caused that side effect. A + B does not always equal C, in other words, a correlation between the two phenomena does not equal cause-and-effect..
Who is reporting the results and through what publication(s)?
Both your researcher and the venue through which they publish should be trusted. Is the researcher known for doing quality research? Has his or her research ever been discredited or identified as a “weak” study? Is the publisher known for publishing peer reviewed studies? A peer reviewed study is one where “peers” of the researcher who are qualified members of the profession within the relevant field and of similar competence to the author review the work so that standards of quality are maintained and credibility of the research is provided.
Vaccines for Children Program
The Vaccines For Children (VFC) program is a federally funded program that provides vaccines at no cost to children who might not otherwise be vaccinated because of inability to pay. Children who are eligible for VFC vaccines are entitled to receive all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). The CDC buys vaccines at a discount and distributes them to their grantees (i.e., state health departments and certain local and territorial public health agencies), which in turn distribute them at no charge to those private physicians' offices and public health clinics registered as VFC providers.
Who is Eligible for VFC?
Children through 18 years of age who meet at least one of the following criteria are eligible to receive VFC vaccine:
Medicaid eligible: A child who is eligible for the Medicaid program. (For the purposes of the VFC program, the terms "Medicaid-eligible" and "Medicaid-enrolled" are equivalent and refer to children who have health insurance covered by a state Medicaid program)
Uninsured: A child who has no health insurance coverage
American Indian or Alaska Native: As defined by the Indian Health Care Improvement Act (25 U.S.C. 1603)
Underinsured (i.e., child has health insurance, but it doesn't cover vaccines, doesn't cover certain vaccines, or covers vaccines but has a fixed dollar limit or cap for vaccines. Once that fixed dollar amount is reached, a child is then eligible. Underinsured children must receive VFC vaccine at Federally Qualified Health Centers or Rural Health Clinics). With the implementation of the ACA, the number of underinsured children should be significantly reduced.
More than 40,000 doctors participate in the VFC program nationwide. Becoming a VFC provider is a simple process. Participating in VFC reduces the out of pocket costs to providers who don't have to buy vaccine for eligible patients. The VFC program directly pays the doctor an administrative fee to offset costs
Concerned citizens have questioned the use of and the safety of vaccines since the advent of the first vaccine against smallpox back in 1796 by Edward Jenner. Political cartoons of the era reflect concerns that people who received the cow pox inoculation would grow horns, tails and other attributes of cows.
In recent years vaccines have been targeted as the cause of the increase in autism rates throughout the world. Hypothesis were generated suggesting that either combined Measles, Mumps, Rubella (MMR) vaccine or the ingredient thimerosal, found in some vaccines could be the cause of autism or other neurodevelopmental disorders.
Fortunately, the worldwide scientific community, the U.S. government and partner agencies take such accusations very seriously, investigating potential vaccine safety issues in great depth by conducting rigorous studies to determine the feasibility of harm. ECBT's Vaccinate Your Family website provides details on peer-reviewed articles and studies by medical experts who adhere to rigorous scientific standards when researching possible connections between vaccines and long term ailments.
Unfortunately, there is a great deal of misinformation disseminated regarding the safety of vaccines which can be countered using a variety of resources.
Affordable Care Act (ACA)
The Affordable Care Act (ACA), sometimes negatively referred to as "Obamacare", is aimed at increasing the level of health insurance coverage for Americans while reducing the overall costs of health care. The Health Insurance Marketplace is a new way to find quality health coverage. It can help if you don’t have coverage now or if you have it but want to look at other options.
The ACA has some key components that impact on immunization delivery to America’s citizens. A key provision in the effort to see that all citizens are immunized with disease preventing vaccines is a provision that took effect on September 23, 2010 to cover preventative services and eliminate cost sharing. Specifically this provision states that all new insurance plans must cover both childhood immunizations and adult immunizations as recommended by the Advisory Committee on Immunization Practices (ACIP) without charging a co-payment, co-insurance, or a deductible when the vaccine is provided by an in-network provider.
Beginning on September 23, 2010 children up to age 18 years that are enrolled in new group or individual private health plans became eligible to receive any of the vaccines that the ACIP recommended prior to September 2009. Any new ACIP immunization recommendations that go into effect after September 23, 2009 are required to be covered by health plans in the next plan year that occurs one year after the effective date of the ACIP recommendation.
In addition to expanding access to immunization, the ACA:
-provides states with the authority to purchase adult vaccines with state funds from the federally-negotiated vaccine purchase contracts;
-reauthorized the Section 317 Immunization Grant Program through which 64 grantees including the 50 states, six large cities including the District of Columbia, five territories, and three Pacific Freely associated States receive block grants to run their immunization programs; and
-requires that the General Accountability Office (GAO) study and report to Congress about Medicare beneficiary access to recommended vaccines under Medicare Part D benefits.
Research and Studies
Parents can be confident that the medical and public health communities strongly support the safety and benefits of immunizations. The Institute of Medicine, American Academy of Pediatrics, American Medical Association, World Health Organization, National Institutes of Health, Food and Drug Administration, Centers for Disease Control and Prevention support the scientific conclusion that vaccines are both safe and life-saving.
At Every Child By Two, we trust the conclusions of the scientific community, which stands behind the science proving that vaccines do not cause autism, or other major disorders in children.
Visit our Vaccinate Your Family website and the studies/articles listed on this page under "Additional Resources" to review the scientific research and expert commentary on the safety of vaccines.
Continuous Monitoring for Safety
Once on the market, samples of every new lot of vaccine must be submitted to the FDA before it is sold. This ensures that each batch is as safe and effective as the last. Continuous monitoring of vaccines being administered ensures that each dose of the vaccine remains safe and effective, tracking any side-effects from the vaccine and responding to any potential safety issues.
The Center for Biologics Evaluation and Research (CBER) at the United States Food and Drug Administration (FDA) receives the results of key tests, along with samples of the product, sent by manufacturers who must continually test and submit their products for evaluation before the CBER will approve the release of that lot of vaccine for administration. Tests performed on the final product may include those for sterility, identity, purity, and potency to assess immunogenicity (the ability to produce an immune response) and/or immunological content, among others. The Vaccines and Related Biological Products Advisory Committee reviews and evaluates data concerning the safety, effectiveness, and appropriate use of vaccines, reporting regularly to the FDA.
The Vaccine Safety Datalink (VSD) has collected statistics from more than 7 million people in major health plans who have received vaccines since 1990. The VSD was developed to monitor immunization safety and address the gaps in scientific knowledge about rare and serious events following immunization. The VSD has proven to be a highly effective tool for evaluating immunization safety, publishing numerous scientific studies on the best ways to use existing immunization safety data. The VSD has conducted a variety of analysis including:
A study that compares the risk of febrile seizures in children who receive MMRV vaccine versus children who receive MMR and varicella vaccine separately.
An evaluation of the VSD data to examine the safety of thimerosal-containing vaccines.
An evaluation of the risk of intussusceptions following rotavirus vaccine (which was essential in the eventual withdrawal of the vaccine from the market due to confirmed link to intussusceptions).
Active surveillance of 2009 H1N1 influenza vaccine which provided real-time data to public health official tasked with ensuring the safe vaccination of the population.
The Vaccine Adverse Event Reporting System (VAERS) gathers information about any side effects patients have experienced from vaccines. Medical personnel are required by law to report any adverse events to the system, however reports may be submitted by any individual. The system was developed in 1990 by the CDC and the FDA. In 1999 the VAERS system detected that infants receiving Rotashield rotavirus vaccine were at increased risk for intussusception following vaccination. The vaccine was temporarily halted until epidemiological studies could be conducted; these studies confirmed the VAERS results and the vaccine was permanently removed from the market. A new vaccine was later developed, which has saved the lives of millions of children worldwide with no reported issues.
The Clinical Immunization Safety Assessment (CISA) Network is a national network of six medical research centers with expertise in immunization safety conducting clinical research on immunization associated health risks. CISA was established in 2001 as a collaborative project between the Immunization Safety Office, six medical research centers, and America's Health Insurance Plans.
Experts in vaccinology and vaccine safety from the six academic medical centers convene a monthly conference call, during which a complex vaccine safety issue is addressed in a structured format. An investigator presents a case, which includes the history of present illness (the adverse event reported following vaccination), and detailed physical and diagnostic (laboratory and other) findings. A summary of a literature review on this subject and the Vaccine Adverse Event Reporting System (VAERS) data are also presented. The experts discuss the findings and formulate a general assessment and plan. When appropriate, these conclusions are shared with the concerned provider.
The Brighton Collaboration is an international voluntary collaboration that aims to enhance the science of vaccine research by providing standardized, validated, and objective methods for monitoring safety profiles and benefit to risk ratios of vaccines. This objective group of scientists from around the globe are committed to ensuring that the world has the safest, most effective vaccines available based on rigorous science.
The National Vaccine Injury Compensation Program (NVICP)
Although severe adverse events are rare, the NVICP was created to compensate people who may have been injured by vaccines. More information on this program including how to file a claim is available on the NVICP website.
Paying for Vaccines
No child should miss immunizations due to an inability to pay for the vaccines. There are several programs available to families who can't afford to pay for vaccines. These include the Vaccines for Children Program (VFC), the Children's Health Insurance Program (CHIP) and the Affordable Care Act (ACA). In fact, immunizations are one of the only medical interventions specifically covered under the ACA. Due to their tremendous cost-saving attributes, all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) are covered under the Act. Therefore, a person with health insurance should be able to receive an ACIP-recommended vaccine without having to pay a co-pay or deductible.
Learn more about these programs by clicking the links below.
Creating the Immunization Schedule
Once vaccines are licensed…How is the immunization schedule determined for children?
The Advisory Committee on Immunization Practices (ACIP) is a group of medical and public health experts who carefully review all available data about each vaccine from clinical trials and other studies to develop recommendations for vaccine use for children, adolescents and adults. The recommendations include the age(s) when the vaccine should be given, the number of doses needed, amount of time between doses, and precautions and contraindications regarding the use of the vaccine.
When making recommendations, the ACIP considers:
How safe is the vaccine when given at specific ages and in combination with other vaccines?
How well does the vaccine work at specific ages?
How serious is the disease this vaccine prevents?
How many individuals would get the disease the vaccine prevents if we didn’t have the vaccine?
After the committee evaluates all the available materials about the vaccine a recommendation is made. This deliberation is conducted in a public forum to ensure complete transparency. Once the committee’s recommendations are approved by the Director of the Centers for Disease Control and Prevention (CDC), the vaccine is incorporated into the ACIP/CDC Recommended Immunization Schedule for either children or adults
ECBT is confident in the safety of vaccines because of the elaborate systems in place to license safe vaccines and continually monitor their safety post-licensure. As vaccines are given to otherwise healthy people, they are held to the highest safety standards, requiring more rigorous testing than most medications. It can take 15 or more years and an average of $800 million dollars to thoroughly test a new vaccine before it is licensed by the U.S. Food & Drug Administration (FDA) and made available to the public. To assist parents (and others) in understanding the process of developing, licensing and monitoring vaccines, the CDC created a very helpful infographic called The Journey of Your Child’s Vaccine.
As with any medication, side effects can occur after vaccination. However, these side effects are usually minor and most often include tenderness at the injection site and a low fever (which is actually a positive sign that the body is doing its job by reacting to the vaccine). Severe reactions to vaccines are very rare. Information about possible adverse events are available in the ACIP's recommendations for each vaccine. Information for the public on possible side effects after vaccination can be found on each vaccine's Vaccine Information Statement.
For more on the vaccine monitoring, the creation of U.S. immunization schedules, and vaccine safety studies, click the links below.
Importance of Timing
Doctors and other public health experts have worked hard to come up with the optimal vaccination schedule, affording the most complete and safest protection possible. It is not advisable to skip or delay vaccines, as this will leaves children vulnerable to disease for a longer period of time. Parents should discuss any concerns with their child's pediatrician.
• Vaccines are recommended for very young children because their immune systems are not yet fully mature and also because their stomachs produce less acid, making it easier for ingested bacteria and viruses to multiply. These factors leave them the most vulnerable to the devastating effects of these serious diseases.
• When following the Recommended Immunization Schedule for Persons 0 — 6 years of age, children may receive up to 24 vaccinations to protect them from up to 14 diseases by the time they're 2 years of age. It may seem like a lot of vaccines for your child, however this is simply a drop in the bucket compared to the challenges a child’s immune system faces daily without difficulty.
• The Institute of Medicine conducted a comprehensive examination of the immunization schedule to determine whether the vaccines given to children using the recommended immunization schedule caused adverse events. The committee uncovered no evidence of major safety concerns associated with adherence to the childhood immunization schedule, including lack of concern regarding interactions between vaccines.
• When a baby is developing in the mother's womb it is in a sterile environment. The baby's immune system goes into action at birth, as the child confronts bacteria outside of the womb. But our bodies are an amazing creation with an immune system that is ready to go to work from the moment that we are born. Infants begin to immediately develop an active immune response to these bacteria -- an immune response that prevents these bacteria from entering the bloodstream and causing harm.
• Within the first two years of life a child is exposed to 11 or 12 vaccines, some of which are given over time in multiple doses. The degree to which these vaccines challenge a child's immune system is just a drop in the ocean when compared to the tens of thousands of environmental challenges that babies successfully manage every single day.
• Things you should discuss with your child's health care provider when scheduling vaccinations:
- If your child has had an allergic reaction to a previous vaccination or a vaccine ingredient, such as eggs or gelatin.
- If your child has a high fever, or a history of fever after receiving a vaccination.
Too Many, Too Soon?
Some parents express concern that we are giving our children too many vaccines too soon, or too early in life. Critics point to the number of vaccines in 1983 versus the number administered to children today as evidence that these vaccines are overburdening children’s immune systems. This is completely inaccurate.
Advances in science have resulted in children actually receiving fewer antigens (bits of the vaccine) in their vaccines than they did historically. Overall, the number of antigens in vaccines have fallen from over 3,000 in 1980 to approximately 153 today. Even so, when you compare the amounts to the trillions of bacteria that infants are exposed to (and form an immune response against) from the moment they are born, you see that babies’ immune systems are well-equipped to handle not only those bacteria but many more external threats.
The first thing that you have to consider in any discussion about so called toxins in vaccines is that everyday compounds can be either beneficial or toxic depending on the quantity used. For example, let's consider water. No one would deny that it is important to drink plenty of water to remain healthy. But did you know that drinking too much water can kill you? While normal, healthy people have little to worry about, we still occasionally read stories about people actually dying from excess water consumption.
A second mistake that people make when looking at ingredients in vaccines is that the whole doesn't always equal the sum of its parts. A simple example of this theory can be found in the example of everyday table salt. Table salt is made of two very dangerous elements, chlorine and sodium. Chlorine is a dangerous gas; sodium is a highly reactive element that explodes when it comes into contact with water. Yet if you combine these two dangerous elements you get a very safe compound, simple table salt.
So before you classify a component as a 'toxin,' you must consider more than whether or not it is simply "in there." You have to look at the quantity, how it is used, whether it is combined with some other element, whether it is used as part of the production and then stripped back out, and many other factors.
Vaccines are made up of antigens. Antigens are small amounts of the bacteria or virus that stimulate the immune system to create antibodies that prevent future infections. Vaccines also contain some additional ingredients, and each has a specific function. These ingredients have been studied and are safe for humans in the amount used in vaccines. This amount is much less than children encounter in their environment, food and water.
Sometimes a child may be sensitive to one of the components of a vaccine, and an allergic reaction may result. For this reason, you should discuss any allergies your child may have with your health care provider.
A very small group of very vocal, but misinformed, individuals have made accusations regarding the safety of vaccines, claiming that vaccines contain a laundry list of toxins. In many instances these allegations are completely incorrect. In others, the claims are taken out of context.
Vaccines may include:
Preservatives: Preservatives help keep the vaccine vials from getting contaminated with germs. Since 1968 the United States Code of Federal Regulations (the CFR) has required, in general, the addition of a preservative to multi-dose vials of vaccines; and worldwide, preservatives are routinely added to multi-dose vials of vaccine. Tragic consequences have followed the use of multi-dose vials that did not contain a preservative (including deaths) and have served as the driving force for this requirement.
Thimerosal: Thimerosal is a commonly known preservative that was at the center of controversy a few years ago. Thimerosal, which is an ethylmercury-based preservative, was removed from vaccines in the U.S. in the late 1990s in an effort to reduce the overall burden of mercury from all sources. Unlike the methylmercury found in the environment, ethylmercury quickly leaves the body. Numerous studies have shown that autism rates are no lower in children who received vaccines without thimerosal than those who received thimerosal-containing vaccines. Measles, mumps, and rubella (MMR) vaccines do not and never did contain thimerosal. Varicella (chickenpox), inactivated polio (IPV), and pneumococcal conjugate vaccines have also never contained thimerosal. Influenza (flu) vaccines are currently available in both thimerosal-containing (for multi-dose vaccine vials) and thimerosal-free versions. The thimerosal in multi-dose vials is necessary because each time an individual dose is drawn from a multi-dose vial with a new needle and syringe, there is the potential to contaminate the vial with harmful microbes (toxins). For a complete list of vaccines and their thimerosal content level, see the U.S. Food and Drug Administration (FDA) Thimerosal in Vaccines page
Formaldehyde: Formaldehyde is used to kill viruses or inactivate toxins during the manufacturing process of vaccines. Formaldehyde is present in the environment and is a byproduct of metabolism so it is already present in the human body.
Adjuvants: Aluminum salts are an adjuvant that have been used in some vaccines for over 75 years to improve the vaccine's performance by helping to stimulate the body's immune system to produce antibodies. Without the use of an adjuvant, we would need to administer more shots in a vaccine series or face lower immunity and less protection from the disease. Aluminum is also commonly found in food, water, infant formula and even breast milk.
Egg Protein: Some vaccines are prepared in eggs which means that some egg proteins are present in the final vaccine product. The egg proteins help manufacturers to grow enough of the virus or bacteria needed to make the vaccine. Eggs are used in the production of the MMR (measles, mumps, rubella) vaccine. The American Academy of Pediatrics (AAP) indicates that the MMR vaccine can be safely given to all patients with egg allergy. Scientific evidence supports the routine use of one-dose administration to those with egg allergy, including patients with a history of severe, generalize anaphylactic reactions to egg. Egg protein is also present in small amounts in the influenza (flu) vaccines. According to the American Academy of Allergy, Asthma & Immunology (AAAAI) the flu vaccine can be safely administered to those with egg allergies. Their statement regarding flu vaccines is: "Studies show that flu vaccines can be safely administered to egg allergic individuals, whether in the primary care provider's office or allergist's office depending on the severity of the allergic reaction to eating eggs." If you or your child are allergic to eggs, make sure to tell your doctor or healthcare provider before getting vaccinated.
Gelatin:Some vaccines contain gelatin to protect them against freeze-drying or heat. People with severe allergies to gelatin should talk to their doctor or healthcare provider before getting vaccinated.
Antifreeze: You may have heard that vaccines contain products such as antifreeze and other outrageous components. This is not true. Antifreeze typically contains ethylene glycol, an unsafe and highly toxic (poisonous) component, or propylene glycol, a safer and less toxic option to ethylene glycol. Neither of these members of the glycol family of compounds is used in vaccines. In vaccines, polyethylene glycol is used to inactivate the virus in some influenza vaccines and is also used to purify other vaccines. Polyethylene glycol is approved by the FDA and considered non-toxic for medical and other uses.* It is used in a variety of products including skin cream, toothpaste, lubricating eye drops, laxatives, and as an anti-foaming agent in food. It is also used as an irrigating solution in surgical procedures.
* Victor O. Sheftel (2000). Indirect Food Additives and Polymers: Migration and Toxicology. CRC, 1114-1116.
Most parents in today’s society have never been subjected to the horrors of witnessing the devastating effects that vaccine preventable diseases can cause. The good news is that while many people continue to seek medical advice from the media and the Internet, where an abundance of scientifically unsound information can be found, studies indicate that parents place their greatest trust in the advice of their healthcare providers.
It is critical to listen to concerns and provide reliable information about the importance and safety of vaccines.
Thanks to our nation's successful vaccination program, parents in this country have been spared from having to witness the devastating effects of vaccine-preventable diseases on children.
Some families may feel that the risk of contracting a deadly or debilitating disease is so minimal that they may delay or decline vaccines for themselves and their children.
Click on the links below for facts in support of the value of vaccines; resources that can be used to discuss issues and concerns with parents; and information related to paying for vaccines.
Vaccines and Diseases
Following is a list of the vaccine-preventable diseases that affect children, adolescents and adults. Each disease page contains links to the Vaccine Information Statement, the Advisory Committee on Immunization Practices (ACIP) disease-specific recommendations, a printable fact sheet, and additional resources. Every Child By Two's Vaccine-Preventable Diseases interactive eBook is also available for downloading or viewing online.
The best way to improve overall public health is to keep people from getting sick in the first place. Immunizations do a great job of preventing epidemics of dangerous diseases such as measles, mumps and polio that used to regularly sweep through communities.
People who are not immunized put not only themselves at risk, but also increase the danger for others, including newborns.
Safety In Numbers Isn't Good Enough
Some people mistakenly believe that they do not need to vaccinate their children because so many other people have had their immunizations. It's called relying on "herd immunity," and is only effective when nearly all of the other community members are immune. But hundreds of thousands of people don't have full immunity because they cannot receive certain vaccinations (including HIV patients, young babies who are not yet fully vaccinated, people undergoing chemotherapy, children on steroids for asthma and others).
Parents must be educated about the risk of succumbing to a false sense of security that is common when disease outbreaks are rare. It is important to note that the bacteria and viruses that cause these diseases still exist, and it is only by working together that they are kept at bay.
It is important to remember that in our increasingly mobile society, diseases are just a plane ride away. When people lose their commitment to universal vaccinations, regions can experience resurgences of preventable diseases.
For example, in 2014, the United States experienced a record number of measles cases, with 667 cases from 27 states reported to CDC. This is the greatest number of cases since measles were eliminated in the U.S. in 2000. In 2015, the U.S. experienced a large, multi-state measles outbreak linked to Disneyland in California. The outbreak likely started from a traveler who became infected overseas with measles, then visited Disneyland while infectious. Measles outbreaks continued in 2016 and 2017. According to the CDC, the majority of cases in the U.S. have been among people who are not vaccinated against measles. Measles is more likely to spread and cause outbreaks in U.S. communities where groups of people are unvaccinated.
These alarming outbreaks are evidence of the need to ensure that young children receive their vaccines on time. In addition, it is critical that all older children, teens and adults get vaccinated to help protect themselves and the vulnerable people around them.
Vaccinated Yet Vulnerable
While vaccines are very effective at preventing disease, no medication is 100 percent effective. Fortunately, most people who get vaccinated do get full protection from disease. However, a very small percentage of people who are vaccinated may not attain full immunity from the disease and may still be vulnerable if exposed.
Just as you count on others not to knowingly expose you to dangerous illnesses, they rely on you. We must each do our parts to limit everyone's exposure, and that means getting vaccinated on time, every time.
Vaccines are one the most cost effective health interventions known to man. Unlike other medical interventions, which are subject to many variables that may affect their successful implementation (i.e. obesity, diabetes intervention), vaccines do not require action by the recipient other than the effort to become vaccinated. Vaccines are so effective that studies show that for every $1 spent on each of the eleven vaccines given routinely to children, our country saves $10.1 in medical costs.
Without routine vaccination, direct costs to the U.S. would be $13.5 billion and $68.8 billion in societal costs (a measurement of losses due to missed work, death and disability as well as direct medical costs)
Immunization is one of the most successful public health achievements of the 20th Century. The Centers for Disease Control and Prevention (CDC) estimated in a 2015 report that, based on data of children born between 1994 and 2013, vaccination prevents about 322 million illnesses, 21 million hospitalizations, and 732,000 deaths over the course of their lifetimes. This provides an estimated net savings of $295 billion in direct costs and $1.4 trillion in total societal costs. Annually, two to three million lives are saved worldwide due to vaccinations, a number that could double with increased support and funding.
Vaccines have eradicated smallpox, one of the deadliest diseases known to mankind from the face of the earth. Efforts to eradicate polio, a highly infectious disease that invades the nervous system and can cause irreversible paralysis in a matter of hours, have been so successful that as of September 2015 only two countries continue to report cases, Afghanistan and Pakistan. (In late September 2015 the World Health Organization announced that polio was no longer endemic in Nigeria leaving only two countries where polio remains endemic, Afghanistan and Pakistan)
Vaccine programs continue to be underfunded by Congress, despite their enormous cost savings. Please join ECBT and our 317 Coalition to learn more about how to contact members of Congress to request funding for vaccines programs in the U.S.
Vaccines have been hailed as one of the greatest public health achievements of the 20th century. Nearly 20 million cases of infectious diseases and 42,000 deaths are averted every year in the United States through timely vaccination.
Vaccines are the most economical health interventions known to man. For every $1 spent on each of the eleven vaccines given routinely to children, our country saves $10.1 in medical costs by averting costs to treat diseases.