Wednesday, November 02, 2011

Vaccination conversation, Part 1

In August 2010 I posted a link to the video below with the following comment: "Yes, some drug companies behave badly (to put it mildly) and yes, occasionally mistakes are made that sicken some. But children used to die by the tens of thousands EVERY YEAR to smallpox and polio (never mind the occasionally fatal cases of measles, mumps, and others). Why is vaccination so vilified by so many?" This led to an extensive discussion on the merits and risks of vaccinations, which I will summarize over the course of a few posts. I would enjoy continuing the conversation with a broad audience. Please feel free to comment with questions  and opinions of your own.

All entries have been lightly edited for clarity and to remove personally identifiable references. Comments from others are indented.

I do not argue that all vaccines are needed for everyone, all the time. I only sometimes get the flu vaccine, and was a little skeptical about the extent of hysteria surrounding new strains of influenza in the past couple of years. But it's a HUGE leap from wondering whether swine flu is truly an apocalyptic disease to denouncing (say) polio vaccinations. That's what bewilders me.
It's interesting that you use the polio vaccine as your example. Many people I encounter are unaware of the fact that between the 1920s and the early 1950s (before the vaccine was introduced) the polio death rate had already decreased on its own by about 50% in most developed countries. Also, the polio epidemic ended in countries where the polio vaccine was not systematically administered. It is also important to note that when the polio vaccine was administered systematically to the US population, a very large percentage of the vaccines were contaminated with SV-40, a monkey virus which causes cancer in humans, and incidentally is passed from mother to child. There's lots more info about the polio vaccine which leads me to believe that it was a big and dangerous flop.
I did not know polio death rates decreased dramatically even prior to vaccination programs, but find it unsurprising and it in no way clears my confusion. Polio was a disease that killed or permanently maimed tens of thousands of people (mostly children) every year. Medical scientists researched the disease, discovered early detection mechanisms, devised more effective quarantine procedures to slow its spread, and invented better treatments for its victims - hence mortality rates fell. Each of these is a significant accomplishment, and taken together they had a major beneficial impact. But to say that because of this, vaccinations were unnecessary or unwarranted brings be back to bewilderment.

Of course, vaccinations do not have an immaculate history. Many doses (especially at the outset) were contaminated. Administering vaccinations often left permanent scars in decades past. We are not beyond incompetence and corruption along the chain of vaccine creation, distribution, storage, and application today. All instances of such behaviour must be investigated, exposed, punished, and (most importantly) corrected.

But let's compare where we were and where we are: Tens of thousands of children dying every year, compared with a much smaller number of people suffering with decidedly less severe conditions.

Again, I ask, thoroughly confused: while openly and freely acknowledging that no technology, including vaccination, is 100% perfect, why are so many people so passionately against vaccination?
Vaccines are cultured in monkey kidneys, chicken eggs, and nuts. This means that along with the actual "desired" substances, and neurotoxic preservatives, we are also exposing those injected with vaccines to the RNA of other species. For example since we have been culturing vaccines in nuts we have seen an unprecedented rise in lethal nut allergies in children. I am not claiming that the former causes the latter. As with all of my arguments, I am concerned that the question is being framed in a way to eliminate a large proportion of the data in favour of the pharmacology argument.
Serious allergic reactions are certainly on the rise. That this is due to vaccines is one (unproven) hypothesis. Allergies are caused by chemicals in the air and water is another hypothesis, though I suspect you continue to breathe and drink. Terminating breast feeding at an earlier age is another hypothesis. And (I'm now making this up) too much sunscreen use is another hypothesis. (Or what about radiation from radio / cell phones / wireless LAN hotspots?) Hypotheses are easy, cheap (free even), and plentiful.

One can imagine any potential harm (autism, AIDS, nut allergy, zombification) and attribute it to an arbitrary cause (in this discussion, vaccines), but hypotheses need data to be deemed valid. We have proof that vaccinations work. Is there substantial harm being done by vaccines? If so, I'd like to know - but documented harms, not potential, theoretical, or excessively vague health issues. Do arguments against vaccinations really boil down to fanciful (that is, data-free) ideas?

I asked a simple question: Given vaccination's aggregate benefit of saving millions of lives and tens of millions of permanent, crippling conditions over the past several decades, what prompts so many to be against them?

This does not imply that there is nothing on the negative side of the ledger. Vaccinations have occasional side effects, and rarely these can be non-trivial. Sometimes they don't take in a very few individuals. Sometimes doses or batches are contaminated. All freely granted.

I am still baffled: If you fairly weigh the benefits and the costs (actual and potential), why is this a contentious issue at all?
When I learned that the death rate from polio was already on the decline, I was no longer able to firmly believe that the polio vaccine was responsible for the declining death rate in the decades following the introduction of the vaccine.
To answer your question about why I feel vaccinations to be a contentious issue, I have many answers. I do not believe that a program that is designed to be "one size fits all" is good medical practice. Just the notion that everyone should get the same vaccines in the same doses regardless of age, sex, heredity etc. seems quite the opposite of good scientific practice. Also, I am not sure that vaccines are quite as effective and save as many lives as you are claiming. In my research, the safety of vaccines has yet to be determined in a sufficient enough manner, and should be determined on a case by case basis (both in terms of the possible illness and the person receiving the vaccine). And I believe (not with blind faith) that due to lax investigations into the true short and long term safety of vaccines, the way vaccines are being manufactured, the rate and method of administration and any combination thereof, that vaccines may be causing more harm than good. So yes, I understand why so many find this to be a very contentious issue indeed.
 I have two questions:

1) When dealing with entire populations (300 million+ in the USA), how do you effectively administer a program on a "case by case" basis? Without guidelines along the lines of, "Do this with all eighteen month olds unless they exhibit one or more of the following symptoms," how does a doctor come up with a "case by case" approach? (I assume you mean something more than a doctor using her/his knowledge of the specific patient and professional judgment, which absolutely should override general guidelines.)

2) There are many published, publicly available, large scale, peer reviewed studies on the efficacy, safety, and risks of vaccinations, performed by national health agencies, academic researchers, medical professionals, and (yes) drug manufacturers.What would you consider to be a sufficient level of investigation, study, research, results, and/or proof?

The conversation will continue in my next blog post.

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