This isn’t my usual area of journalistic interest, but I read a recent blog post by Linzy Browning and thought it deserved a response.

While I can’t argue that we have become poor critical thinkers in general and take a lot of what we are told for granted, there is a reason that things are done the way they are in the medical world. The reason is evidence-based practice – basing the things we do not on anecdote or expert opinion in most cases, but on data collected over many years of practice. First up, I better declare our biases. We are both medical students, and vaccine proponents. And on that front, we are trying to promote awareness of the importance of vaccination. 

Linzy Browning’s post follows, with our response inline. My writing is in green text, and Sarah’s writing is in purple:

The Brownings: On Vaccines

As I’ve watched the events of the current measles outbreak unfold, along with the accompanying flare up in the Great Vaccination Debate, I thought I would throw my two cents in.

Our Story

First, I am not an unbiased blogger. I am the mother of a vaccine injured child. When Guildy was born in 2005, we refused the day-of-birth Hepatitis B shot, thinking it seemed illogical, but she received the normally scheduled shots at 2 months.

I agree with you regarding the hepatitis B vaccination. It is not a part of the routine UK vaccination schedule – I am vaccinated, but that is only because I am a healthcare worker and may be at risk from hep B from needlestick injuries. I welcome the vaccination of at risk individuals, but in otherwise healthy babies with no risk factors, it does not seem necessary. 

She seemed “off” afterward for several weeks, much crankier and more difficult to console than before. I mentioned this at her 4 month appointment. The pediatrician acknowledged my observations and reported them to the VAERS (Vaccine Adverse Event Reporting System), but still recommended more vaccines, thinking the reactions were in the “normal” range. In the couple days after receiving her 4-month shots, Guildy was fevered and vomited once. Then, in the following week, we noticed that she had become highly sensitive to loud sounds. The blender or vacuum cleaner running in the next room sent her into fits, accompanied by a high pitched scream we had never heard before. We learned later that that cry has a name – “cri encephalique” – and is caused by brain swelling or central nervous system irritation. We also noticed that she had fallen almost completely silent, except for crying. She was alert and awake and looked fine, but she no longer babbled and cooed as she had done before. After about a month (and much to our relief), she started to make non-crying vocalizations again, but her sensitivity to sound persisted through her preschool years. Of our four kids, the other three of whom are unvaccinated, she is the only one to ever need to visit a doctor because of illness, the only to receive antibiotics, and the only to struggle with food and environmental allergies and asthma.

The recurrent illness, allergies, and predisposition to vaccine reactions could all be a product of immune dysfunction, or coincidence. The allergies, asthma etc could be due to a highly sensitive immune system, which would make you more likely to have a reaction to the vaccine, as opposed to the vaccine being the cause of the allergies.

So it was from this platform of experience that I embarked on my research of vaccine safety.  After all, there’s nothing like a bout of vaccine-induced neurological irritation and developmental regression to send a parent hunting to figure out what the heck happened.

Whenever whooping cough or measles or some other disease for which a vaccine exists make the news, I am reminded of several deep-seated problems within the debate.

Problem #1: Lack of Vaccine Information in the General Public

In the classical model of education, there are three stages: grammar, dialectic, and rhetoric. During the grammar stage (i.e. grammar school), a child learns all the building blocks of their subjects. She memorize math facts, timelines, definitions, lists of pronouns, rules of spelling, etc. The dialectic stage, which starts after about age 10, sees children connecting all those pieces of information and figuring out how they work together. By the time a student reaches the rhetoric stage in junior high or high school, he has the knowledge and understanding needed to analyze information and contribute intelligently to conversations, both formally and informally. He also has in place a learning model that progresses through the three stages when encountering any new learning task. I believe that anything we ever truly learned was learned classically, first, with a grasp of the vocabulary and other basics of the topic, followed by figuring out “how it works,” and finally possessing a mastery that allows one to expound upon the topic or master the skill.

Why all that seemingly unrelated explanation in an article about vaccines? Well, in my observation, participants on both sides of the Great Vaccine Debate haveskipped the grammar and dialectic stages. The very basic knowledge needed by all participants to intelligently debate the topic is largely absent. In the insane busy-ness of modern life, most rely on snippets of emotionally charged “information” to base their vaccine-related decisions. We Americans are distracted and lazy in regard to vaccine knowledge, opting to passively accept information without critical thought.

Proponents and critics alike should know the “grammar and dialect” of the subject. A CDC list of ingredients in every common vaccine is available HERE. A great page listing the ingredients, along with the ingredients of the ingredients is HERE. After all, something called “Medium 199” is bound to have some other stuff in it!. Either page is a great place to start gathering basic information. Then, one has to figure out what those ingredients actually are. What does the research literature say about those individual ingredients? Are there moral implications with any of them?  Is there a difference between injecting these ingredients intramuscularly and ingesting them? What is the history of the disease in question? In order to intelligently form and discuss opinions, everyone needs to be on the same page about the basic facts.

Don’t let strange names alarm you. “Medium” is just referring to growth medium cells were grown in, and is a combination of nutrients needed for cell growth.

With measles currently in the news, I will go through this process with that particular disease and vaccine.

First, what are the ingredients? According to the CDC, the MMR-II contains

• Medium 199
• Minimum Essential Medium
• Phosphate
• Recombinant human albumin
• Neomycin
• Sorbitol
• Hydrolyzed gelatin
• Chick embryo cell culture
• WI-38 human diploid lung fibroblasts

The three ingredients that cause me the most concern are recombinant human albumin, WI-38 human lung fibroblasts, and chick embryo cell culture. Let’s start with WI-38 human lung fibroblasts.WI-38 stands for Winstar Institute 38, a cell line developed from human diploid lung fibroblasts derived from the lung tissues of a female fetus aborted in 1964 in the United States because the family felt they had too many children. Now, I realize that this particular fetus was aborted 51 years ago and that the cell lines used in vaccines don’t require new aborted fetal tissue. However, that doesn’t make the use of aborted fetal tissue in any form less morally questionable or, well, gross.

First off, lets get the facts straight. It’s the Wistar Institute, and the tissue was derived from a foetus legally aborted in Sweden, not the USA. Would you rather aborted foetal tissue was wasted than used to help people through vaccine production and research? Many embryos produced in the process of in-vitro fertilisation (IVF) are otherwise disposed of– is that a better outcome? The cells are long removed from the originals, and have made important contributions to the study of virology, immunology, and vaccine production. They’re actually credited with saving the lives of “millions of people”. I know that seems over the top, but it’s hard to overstate the importance of this cell line. 

Both WI-38 and recombinant human albumin, which has yeast DNA spliced into it, introduce human DNA into recipients, and chick embryo cell culture introduces chicken DNA. Is it a good idea to introduce human or animal DNA anywhere outside the gut?  I dont’ think so, but parents need to look it up and decide for themselves. All ingredients need a similar analysis in order for parents to decide if they are safe to inject into their children.

Introducing DNA isn’t really an issue. It’s just deoxyribonucleic acid, and without a vector to deliver it into cells, it won’t be an issue. Why would one object to DNA being introduced outside the gut, but not inside the gut? It doesn’t change the host DNA and it is not something the body would react to, not having any antibodies attached to it. DNA is comprised of sugars, phosphates and nitrogenous bases.

Next, on to a basic understanding of the disease and its history. The CDC says that in the decade prior to the introduction of the first measles vaccine in 1963, 400-500 Americans died from measles of the estimated 3-4 million who had it annually. Yikes, right? Not really. 450/3,000,000= .015% death rate. 1,000 people/year suffered brain damage from measles, equating to a .05% risk of suffering that complication. This page does a great job of taking current and past measles statistics and putting them in perspective. And yes, it is a blatantly biased page. Consider it anyway.

Stats may be part of the issue here. 3-4 million is an estimation, whereas ~450 annual deaths is the reported figure. You have to compare the deaths attributed to measles (450) to the average 542,000 reported cases, giving a mortality rate closer to 1 in 1000 (0.083%). The 3-4 million case estimation shouldn’t be used simply because children dying without a measles diagnosis probably wouldn’t have their death attributed to measles. Closer to 0.7%, almost 1 in 100 patients with measles had encephalitis on average in the 1950s prior to widespread vaccination. (http://jid.oxfordjournals.org/content/189/Supplement_1/S1.long)

While I am aware that measles has killed millions of people since it presumably hopped over into the human population from cattle back in the Middle Ages and that in developing countries it continues to wreak havoc, I just can’t conjure up much fear. Improved nutrition and sanitation had already reduced measles deaths as mentioned above.Our parents and grandparents all had it. It was just part of life.

Simply stating that something was part of life does not mean we shouldn’t aim to eradicate it. Cholera, dying at 30, rickets, these were all simply part of life at some stage, but we as a species have aimed to overcome these.

However, while measles was a common, endemic disease in the past, I don’t think we should be flippant about current measles outbreaks. Any communicable disease deserves respect, knowing it has the potential to cause harm. I don’t want to go too far off topic, but I do think that for a variety of reasons (diet, lifestyle, stress, vaccines, chemical exposure, etc), Americans are generally less healthy and robust than in generations past. That being the case, the average American’s ability to handle measles could very well be diminished compared to past generations. Respect is warranted.

In looking at measles history and the current outbreak, one can’t discount the reality that immunocompromised people rely on herd immunity to avoid vaccine preventable diseases. However, perspective is necessary when thinking through this issue, too. For an immunocompromised person, nearly any infection can be life threatening. Hundreds of colds and flu-like viruses continually make the rounds in the human population, any of which have the potential to severely sicken or kill someone with a compromised immune system. I propose that in the grand scheme of threats to the health of an immunocompromised individual, measles is not the front runner or even near the front. I also propose that daycares and schools aren’t the safest places for immunocompromised kids. Of course I don’t want immunocompromised kids shunned from society, but I also think that subjecting such children to the petri dish conditions of those institutions could border on negligence. Just a thought, wildly unpopular as it may be.

The reason we vaccinate against pathogens in the immunocompromised population is because they are at even greater risk of developing serious illness. And the reason we vaccinate against measles in the first place is because of its virulence, and the potential devastating neurological complications including encephalitis. To say that you may as well not vaccinate the children because they’re going to get something else any way is just a little bit cold. Should we not aim to reduce the number of potential pathogens these people could be exposed to?

So, we’ve looked at measles vaccine ingredients and a little measles history. We now have at least some of the “grammar” and “dialectic” information needed to think through vaccination decisions.

This leads to my second gripe within the great debate…

Problem #2: Lack of Respect on all Sides

I propose that there is no room in our discussions of vaccines for emotional, inflammatory, nearly fact-less snippets of information forwarded around on social media. The intentions of these articles slandering anyone with an opposing view, graphs with bizarrely altered scales, and gory photos are manipulative, and vaccine proponents and critics alike are guilty of using them as scare tactics.

Parents come to their decisions about vaccines from a lot of different directions. After Guildy’s bad reactions, we started reading all kinds of things: CDC statistics, studies, books. We came away with the realization that when parents ask the big, overarching questions of “Are Vaccines Safe?”  and “Are Vaccines Related to Autism?” the answers they get from mainstream doctors and medical organizations don’t actually answer those questions.I recently read all the studies cited by the American Academy of Pediatrics, which supposedly answer the question of whether or not the MMR vaccine is linked to autism with a resounding “no.” The studies themselves are just fine, each answering a specific question within the autism-vaccine debate. I don’t have a problem with any of them as stand alone studies. They answer important questions, such as whether vaccine schedules influence autism or whether different forms of the MMR vaccine effect febrile seizure rates. Great info. However, not a single one of them compares vaccinated groups to unvaccinated controls. When parents ask questions about vaccines and autism, they are logically assuming that scientists have compared autism rates in vaccinated and unvaccinated populations.  They also assume that all vaccines have been studied for their possible association with autism. They haven’t. Only the MMR vaccine has been studied in relation to autism. Thus, parents aren’t actually getting the answer they seek, and most don’t even know it.

Why study all vaccines for a link with autism? Why not study modern cars, computers, fried food, etc? Ordinarily research starts from an observation and a hypothesis – if more cases of autism had been seen in vaccinated compared to unvaccinated children, then that would be fair grounds for research, but there haven’t been. The question is, even if a methodologically sound study comparing vaccinated and unvaccinated children was conducted and the results made available, would the conclusions be believed by the anti-vaccine movement if no link was found? I think you have answered that question for me. This Danish study compares children vaccinated with MMR to those unvaccinated, and found no association between MMR and autism. (http://www.ncbi.nlm.nih.gov/pubmed/12421889?access_num=12421889&link_type=MED&dopt=Abstract). This wasn’t a tiny case control study like the disgraced Andrew Wakefield “study”. The Danish study involved over 500,000 children, 82% of which received the MMR, and compared the numbers of those with autism and autism spectrum disorders in vaccinated and unvaccinated groups. This proves strong evidence against the hypothesis that MMR vaccination causes autism.

 

Questioning parents come across pages like this, which keeps a running list of studies that point to vaccines as playing a role in autism and other developmental disorders. There are currently 96 studies on the list. I read #4 and #29, both about the deleterious effects of aluminum on all living things and particularly on the central nervous systems of humans. Remember, aluminum salt adjuvants appear in most vaccines, although not in the MMR.  (And yep, the #4 article is funded by two foundations that support research into the vaccine-autism connection. All research is funded by someone, and let’s face it, everyone funding research has an agenda. Judge content on its merit.) Am I convinced beyond a doubt that vaccines cause autism? Nope. But I view them warily.

You say that everyone funding research has an agenda. That might be true, but it doesn’t mean that it is a harmful or negative agenda. I know of plenty of research funded by charities that have no financial interests in the outcome of the studies – they are just conducting research to further understanding of the field. And on the autism front, the whole reason the hype emerged about the MMR and autism was as a result of Andrew Wakefield’s paper in 1998. His research methods included paying for blood samples at his son’s birthday party, and he falsified medical histories, and had several conflicts of interest. http://www.bmj.com/content/342/bmj.c7452

 

According to VAERS, 108 kids have died as a direct result of the MMR vaccine in the last 10 years. Put it in perspective, right? Millions of kids have received the MMR vaccine in the last 10 years. 108 lives is a small price to pay. If it ended there, the vaccination debate would be a moot point.  MMR vaccination would make complete sense numerically. However, I believe vaccines have further-reaching effects than just those that can be reported in the 2-4 week window following administration. A quick survey of the general health of American kids is pretty dismal. Something, or likely a combination of things, is causing

• 1 in 68 kids to have an autism spectrum disorder
• 1 in 11 to have an ADHD diagnosis
• 1 in 10 to have asthma
• 34% to have a food, skin, or respiratory allergy.

The problem I have with this argument is that, yes, in the past decades more children are being diagnose with these conditions, but this is due to several factors. Take autism. This is a relatively new condition in the medical world and as we understand the more about the spectrum, we are changing the definition. This would mean that more people fall in to this category. Also, awareness is increasing, so more people are recognising the symptoms and are being diagnosed. Over diagnosis is also a huge issue! ADHD is a diagnosis often sought by parents simply because their children are being children. I met a boy with “ADHD” once who’s mother was insistent he had a problem. The boy sat through the whole interaction (15 minutes) not moving and not making a sound. This was an over diagnosis. There is also a theory, though I hasten to point put it is only anecdotal, that over sanitising children and not exposing them to dust and germs is causing them to be oversensitive to things, leading to the allergies mentioned above. There is little, if any, evidence that vaccines are the cause of the above conditions.

 

Considering the overlap in these groups, somewhere between a third and half of American kids have one or more of these conditions. This means that a significant portion of parents are caring for kids with these problems, and a subset of those parents are intensively researching and discussing their findings. Tossed around in the discussion (both informally and in formal research) of possible environmental causes are things like glyphosate (Roundup herbicide), acetaminophen (Tylenol), bromides, various heavy metals, processed foods, household chemicals, GMOs, nutritional deficiencies, and vaccine ingredients. Do we need more research on links between these chronic illness and vaccines? Absolutley.  Studies like this only start to answer the question. Do parents in this group generally trust pharmaceutical companies to have their children’s best interest at heart? Nope. This September 2014 Huffington Post article certainly doesn’t inspire confidence.  

What would it take to convince the aforementioned parental group of the safety of vaccines? Easy. Real world studies comparing the long term health of vaccinated vs. unvaccinated children, considering particularly the rates of allergies, autism, asthma, ADHD, diabetes, and other autoimmune disorders in both groups. Unfortunately, that research doesn’t currently exist.

Easy is the understatement of the century! The reason that research doesn’t exist is cost. Following up that number of children regarding that huge number of conditions would be prohibitively expensive, but not impossible. There is also the issue of engagement, as that data would be based on recordings made by doctors/researchers, and not parental reports, as self-reporting is notoriously open to bias.

Parents who bring these topics up are labeled as fanatics, lunatics, idiots subscribing to pseudo-science, and on and on. I propose that these parents are not, in fact, lunatics. They’re just thinking critically, and critical thought deserves respect, no matter the conclusion.

This point I do agree on, but I advocate a healthy skepticism. We aren’t out to do the most harm, no, we aim to do the opposite. We are using evidence to shape the way we practice medicine, to help the greatest number of people. 

Also deserving respect are those who know their children’s vaccine ingredients, have read a variety of research, understand the debate, and choose to trust the mainstream medical and mainstream media interpretation of vaccine safety research. Whether or not vaccinate one’s children is, thankfully, a personal choice.

And finally, also deserving respect are parents who make the choice not to worry about vaccines and other substances they put in their kids’ bodies. That is just fine. It’s not my place or anybody else’s to dictate those decisions.

I do, however, feel strongly that if someone is going to have an opinion, he or she ought to be well informed of the grammar of the topic, and that opinion ought to be delivered in a respectful way!

Hopefully this will generate some lively discussion, and maybe make those who are polarised against vaccines think again.