Pots and kettles

Last night, while going on an emergency formula/bum wipe run, I caught an interview on "All Things Considered" with Amy Wallace. Ms. Wallace is the author of an article in the most recent issue of Wired about the anti-vaccine panic, and the ill effects it is doing to the health of the public at large. It's a very well-written piece, and worth reading in its entirety.

Perhaps the most important bit is this:
Consider: In certain parts of the US, vaccination rates have dropped so low that occurrences of some children’s diseases are approaching pre-vaccine levels for the first time ever. And the number of people who choose not to vaccinate their children (so-called philosophical exemptions are available in about 20 states, including Pennsylvania, Texas, and much of the West) continues to rise. In states where such opting out is allowed, 2.6 percent of parents did so last year, up from 1 percent in 1991, according to the CDC. In some communities, like California’s affluent Marin County, just north of San Francisco, non-vaccination rates are approaching 6 percent (counterintuitively, higher rates of non-vaccination often correspond with higher levels of education and wealth).

That may not sound like much, but a recent study by the Los Angeles Times indicates that the impact can be devastating. The Times found that even though only about 2 percent of California’s kindergartners are unvaccinated (10,000 kids, or about twice the number as in 1997), they tend to be clustered, disproportionately increasing the risk of an outbreak of such largely eradicated diseases as measles, mumps, and pertussis (whooping cough). The clustering means almost 10 percent of elementary schools statewide may already be at risk.

In May, The New England Journal of Medicine laid the blame for clusters of disease outbreaks throughout the US squarely at the feet of declining vaccination rates, while nonprofit health care provider Kaiser Permanente reported that unvaccinated children were 23 times more likely to get pertussis, a highly contagious bacterial disease that causes violent coughing and is potentially lethal to infants. In the June issue of the journal Pediatrics, Jason Glanz, an epidemiologist at Kaiser’s Institute for Health Research, revealed that the number of reported pertussis cases jumped from 1,000 in 1976 to 26,000 in 2004. A disease that vaccines made rare, in other words, is making a comeback. “This study helps dispel one of the commonly held beliefs among vaccine-refusing parents: that their children are not at risk for vaccine-preventable diseases,” Glanz says.
Ms. Wallace was interviewed in large part to discuss the reaction she has received since the piece was published. It has been precisely as intelligent and well-reasoned as I would have expected.
"I've heard a lot of anger. I've heard that I'm stupid. I've heard that I'm greedy. I've heard that I did this to get famous," Wallace tells NPR's Melissa Block. "I've heard that I'm a whore, I'm a prostitute."
I will get to a particular reaction in just a moment. But first, let's look at something that Ms. Wallace reported in her piece.
To hear his enemies talk, you might think Paul Offit is the most hated man in America. A pediatrician in Philadelphia, he is the coinventor of a rotavirus vaccine that could save tens of thousands of lives every year. Yet environmental activist Robert F. Kennedy Jr. slams Offit as a “biostitute” who whores for the pharmaceutical industry. Actor Jim Carrey calls him a profiteer and distills the doctor’s attitude toward childhood vaccination down to this chilling mantra: “Grab ‘em and stab ‘em.” Recently, Carrey and his girlfriend, Jenny McCarthy, went on CNN’s Larry King Live and singled out Offit’s vaccine, RotaTeq, as one of many unnecessary vaccines, all administered, they said, for just one reason: “Greed.”
I have already written about the flagrantly dishonest stance Jim Carrey takes with regard to his own scientific expertise and knowledge about vaccines. I find the quote above nauseating.

Rotavirus is a deadly illness. Before we started vaccinating children regularly, it was an inevitability that every season at least a few children from our practice would be hospitalized (sometimes for a week or more) with severe dehydration and intractable vomiting. We vaccinate children because we do not want them to die, regardless of what the awful Jim Carrey has to say.

But speaking of Fire Marshall Bill, let's see what JB Handley, who founded the organization Operation Rescue (for which Jim Carrey sits on the board), has to say.
Unbelievable. That was my first reaction to reading Wired Magazine’s new cover story on vaccines and autism that you can read HERE. It’s not a thoughtful look at both sides of the debate. It’s not a piece providing a new spin on a well-known conflict. It’s simply a regurgitation of Paul Offit’s talking points that he’s been dishing out to the uninformed media now for years. Ms. Wallace didn’t just drink Offit’s Kool-aid, shit, she scooped the Kool-Aid out of the rusty old bucket to make enough for everyone!
Read the whole piece, I urge you. Look at what this man, who is one of the leading anti-vaccine voices in America today, has to say. Examine the quality of thought of the man who speaks in opposition to the Centers for Disease Control, American Academy of Pediatrics, and essentially every single reputable scientific body that has addressed the question.

One thing in particular from his screed I would like to highlight, because it sticks so uncomfortably in my craw:
Comment: If 1 in 100 kids have vaccine-induced autism, this may challenge your conclusion about “low-risk,” unless you like those odds. Few parents do, and your article is unlikely to change that.
My friends, this statement is the most unmitigated hogwash I have ever read in my life. I have been a practicing pediatrician for ten years (if you include residency), and have administered vaccines to thousands of patients. I have yet to encounter one single patient with even the faintest suggestion of vaccine-related autism. My colleagues, who have been in practice decades longer than I have, could doubtless say the same thing. If vaccines caused autism in "1 in 100 kids," we would stop administering them. We enjoy no benefit from vaccinating children beyond the knowledge that we are doing what we should to prevent deadly illnesses. If there exists any relationship between vaccines and autism, it is so minute and tenuous that no reputable study has found it. It is so small as to be scientifically, mathematically undetectable.

But charlatans like Handley create the impression of a relationship by spewing forth garbage like this to a credulous public. He has the unmitigated gall to assume Ms. Wallace has educated herself at "Google University," which is exactly where most of his followers get their information. He is a dangerous and misguided (or worse) man, and will be largely responsible for the (mark my words) inevitable re-emergence of diseases that have been unseen in America for decades.

[Ed. If you have a point you wish to make, you are free to offer a comment. Copying and pasting paragraph upon paragraph of selective information does not count as commentary, and will be summarily deleted when I come upon it.]


  1. This is such an emotionally fraught issue, with everyone, I think, trying at the root to protect children. As a newish parent who researches incessantly but has a limited scientific background (majored in molecular biology in college but declined med school in a last minute attempt to get sufficient sleep later in life; little did I know about kids and sleep) I think hysteria and misinformation in the vaccine debate are rampant. I think clinging to old ideas about single causes and not understanding the difference between causation and correlation are huge parts of the problem. I also think that autism is one of the most terrifying diseases families face because so much is unknown. I think banning thimerisol and other toxic preservatives in vaccines makes sense, and I'm kind of mad that our country is beholden to industries that poison us with chemicals they claim are not toxic in small doses (through our food, our meds, our bedding, our plastic, etc). But I think avoiding all vaccines is dangerous for the population.
    I was really lucky, I feel, to work with a pediatrician who recommended most vaccines, but was willing to point out the few that he felt weren't necessary or proven. I was also lucky to understand herd immunity and I just wish we could use this amazing technology (for it was freaking genius of Dr. Salk to figure this out and almost eradicate polio) only for diseases that are deadly and where the vaccine is 100% safe (which, I know, is wishful thinking).
    Side note: Is there a way to move the recommended dates for MMRs (or split up M and M and R) so that it doesn't coincide with the seemingly delicate nexus of factors that seems to occur at 18 months? Can we just move MMRs to age 3 or something?
    It seems to me that peanut allergies are on the rise for some toxo-chemical reason that might have more to do with pesticides and factory processing than with peanuts themselves. It seems to me that autism is on the rise for reasons that might have more to do with environmental chemicals in food and household products than with a single vaccine. It seems tragic to not know definitively if there is a genetic component or a vaccine component or a whatever component, but with all evidence, it seems that vaccines are at most a contributing factor, and at least a coincidence. I wish there were thoughtful, intelligent research and debate, but at this point, it's gotten to be Creationism vs. Science in the intolerance of dissenting opinion on both sides.
    That said, I have a really hard time trusting the pharmaceutical industry to put safe chemicals in with the useful part of the vaccine. It's hard to trust that they aren't using dead polio virus plus battery acid or something, given their track record.
    Are there vaccines you do not recommend to your patients, Dan? Do you follow the AAP schedule exactly, closely, or loosely? Is it patient dependent? Just curious.
    (delete this monstrous rambling if you'd like)

  2. Nap, I recognize that this issue is tremendously fraught. When I have parents who do not wish to comply with the AAP schedule, I discuss with them which vaccines are most pressing, and which ones can be deferred for a time. (I recommend all vaccines, in keeping with the AAP schedule, and the Critter will get them on said schedule.) I have many parents in the practice who decline vaccines, which I find very frustrating, but I continue to see them and recommend that they reconsider at regular intervals.

    I do not believe separate measles, mumps and rubella vaccines are being manufactured at this time. If the CDC and AAP were to determine that MMR could be safely delayed, then I would happily comply with that recommendation, if only to be able to put this issue to rest. But, thanks to pockets of collected vaccine refusenicks, measles has had something of a resurgence, so I don't know if delay would be a safe thing to consider.

    And, to my anonymous cutting and pasting "commenter," you will see that I have declined to provide a venue for your repurposed excerpts. If you wish to make a cogent and concise point, feel free to do so. If you wish to regurgitate that which has been on the public record for lo these many years, then you can get your own blog to do so.