Vaccine Safety: A Debate

As I said on Christmas Eve,  thanks to Web comments and blogs, you can now hear many voices in a debate in a way you never could before. The New York Times has just added a vote-like recommendation feature to help sift through a large number of comments. (I hope they add a “sort by” feature to make the most popular comments easy to find.) People you could not usually hear from turn out to have enormously interesting and helpful things to say — again and again and again.

A new example is the debate over vaccine safety. A 2007 book called The Vaccine Book: Making the Right Decision For Your Child by Robert Sears took a middle ground: A way that parents can space out vaccines. This seems to have offended Dr. Paul Offit, a vaccine inventor. With Charlotte Moser he wrote a critique (may be gated) of the book, just published in Pediatrics, that is actually an attack on it. Would the critique be full of well-reasoned arguments? New facts? Nope. It reminds me of my surgeon claiming that a certain surgery was beneficial and, when questioned, saying that of course evidence supported her claim but never producing any evidence. However, overstatement from doctors is nothing new. What’s new is the comments section on the critique (may be gated), which contains several fascinating observations.

From John Trainer, a family doctor:

[For Offit and Moser] to castigate [Sears] for offering information to the laity is to fall prey to the same mindset as the early church. By controlling access to the Bible, the leaders of the church exerted control over all.

From Corrinne Zoli, a Syracuse University researcher:

The vaccine debate plays out against a backdrop not only of facts vs. falsehoods, refereed vs. non- mainstream journals and studies, science vs. speculation, a complicated enough arena, but of conflicting cultural ‘facts,’ which may be equally important as the science. For instance, parental concerns over the safe cumulative levels of thimerosal (ethyl mercury) in vaccines were unwittingly validated by the American Academy of Pediatrics (AAP) and the U.S. Public Health Service and others’ recommending their removal (which largely occurred in 2001)—even while these organizations were steadfast in public declarations of no causal link between the preservative and various neurotoxic or neuropathological ill-effects. What did parents learn from this decision? Aside from the fact that the preservative had been long removed in many countries of the world (i.e., the UK and even Russia), or that infants may have received doses exceeding EPA recommendations, they learned that organizations designed to serve the public trust were contradictory in their words and deeds. . . . The larger ‘lesson learned’ by parents was to fear the decision making processes of medical and public health institutions and to become critically engaged with them using whatever tools at one’s disposal (i.e., online information, reading scientific studies, discussion groups, etc.).

Fifty years ago, when doctors wouldn’t justify their claims, you couldn’t do much about it. Few had access to medical libraries or the time to visit them. Now there is an enormous amount you can do. Water will simply flow around the rocks, such as Dr. Offit, who get in the way of better decisions.

This sort of open discussion is so helpful it should be standard scientific practice: allow your research to be commented on by anyone for anyone to read.

9 Replies to “Vaccine Safety: A Debate”

  1. Offit and Moser spend their 8 pages pointing out misinformation provided by Dr. Sears’ book, when he claims to be acting as a neutral source. Nearly every paragraph has a citation. For example, when addressing Dr. Sears’ implication that cow-derived vaccines could be a source of mad cow disease, he references a study in the UK showing there was no risk. One not similarly justified paragraph, for example, notes that Dr. Sears uses a fallacy of personal anecdotes in saying he hasn’t seen many meningitis infections around. Unbelievable. There are more than 30 references.

    Their complaint is mostly that Dr. Sears is misinforming his readers. You are right that there is no new information. In particular though, the highlighted comments do nothing to refute the critique. The only place where the critique is inadequate is in quantifying the harm done by this alternative schedule. They do a poor job of putting a number on it, simply noting several diseases, say where waiting until 5 for influenza vaccine, has led to the hospitalization of X young children (ie, where such studies exist).

    But yes, they provide evidence against not just his misdirections and falsehoods, but concerning the thesis of the book. The justifictions for not getting them, and even for simply delaying or spacing them are attacked. With references.

    I don’t see where Dr. Offit is getting in the way of better decisions. He has identified a book full of misinformation, one that gives phantom support to anti-vaxxers. It actually appears that the fulltext has been made public. If any readers are interested in the references, my experience has been that the authors are always willing to send a pdf copy to polite emailers.

  2. NE1, well said. Pretty much the only things that need to be adding:

    http://newsimg.bbc.co.uk/media/images/45360000/gif/_45360950_measles_cases_gr_226.gif

    “Take a bow, morons.” -Ben Goldacre

    It is also worth mentioning that the ‘parents of vaccine injured children’ in the comments section of the paediatrics article, on the whole, have very little evidence for the title they claim. If there is no statistical link shown in large epidemiological studies between the harm they/their kids suffered and the vaccine they received, the best they can do is post hoc ergo procter hoc. And thar be dragons. If we ran things that way… there would be little point in doing science.

  3. Yes, unlike my surgeon, Offit and Moser give citations. The similarity is the overstatement. Offit and Moser claim to be giving a fair description — or at least that should be the purpose of all Pediatrics book reviews — when in fact it is an attack (less valuable) that can’t be trusted to tell both sides. There is nothing interesting about such attacks or their one-sidedness; I only mentioned it to introduce the comments, which are interesting. But I agree with you — my post seems to imply that Offit and Moser don’t have citations, which is wrong. I have corrected the post.

    Offit is getting in the way of better decisions by presenting an attack as a fair description. And, as an attack, it is a joke. “Sears never discusses the fact that mercury is present on the earth’s surface,” Offit and Moser write.

    Cam, large epidemiological studies are far from perfect. Gary Taubes wrote an article in the NY Times Sunday magazine about some of their problems.

  4. If you get a mob of people looking in excruciating detail at anything they can come up with infinite amounts of “evidence.” Look at the 9-11 “truthers,” for instance. The medical establishment takes a more 50,000-foot view, and that’s the way to go, I think.

    Are there any psycholigists who study conspiracy buffs? To me there seem to be common qualities (but my interest is not great enough that care to try to categorize them myself). My gut feeling is that the anti-vaccine crowd has a lot in common with Kennedy assisination investigators, as well as the followers of this guy:

    http://www.enterprisemission.com/

  5. . . . . early church . . .bible. . . . wait, huhh???

    I’ve heard this one before — – – – transmitted even by religion professors. There is more to the story. Oral tradition was a central part of Jewish culture and the way teachings were passed on from century to century. Then came christ, then came the letters of St. Paul, then came various gospel accounts, then came the bible—-along side that oral tradition that had existed forever. These bibles could be reproduced only through painstaking word by word transcription. And that caused just a few bibles. A problem which was exacerbated by the generally low levels of literacy. Moreover, the world’s first “internets” a.k.a the printing press, was used to publish the bible—sparking the widespread distribution of the bible and, of course, literacy and other books.

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  7. Doctors don’t even know what they are injecting into people. All the ingredients of vaccines do not appear on vaccine package inserts. Vaccines are not food and is not subject to different labelling laws than food is. This is called trade secret protection. Why is this a problem? An example: Peanut oil can be used as an ingredient in the vaccine adjuvant and does not have to appear on the label.

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