Frontline: The Vaccine War

[Pangloss]

Another great Frontline, this time on the war between doctors and some parents on the safety of vaccines. The entire program can be watched online.

 

http://www.pbs.org/wgbh/pages/frontline/vaccines/?utm_campaign=homepage&utm_medium=bigimage&utm_source=bigimage

 

One thing that surprised me is that I had been under the impression that this issue was being driven by the religious right, but in fact there wasn't a Bible-thumper anywhere in sight. The Oregon community shown in the opening scenes is full of new age stores, holistic medicine shops and organic foods cooperatives, which actually suggests the opposite, but no specific ideologies were mentioned in the program. Of course that makes sense, really -- parenting seems to know no ideological boundaries. As with the issue of video game censorship, the vaccination debate seems to transcend the usual politics of left-versus-right.

 

But in the end they sure took apart opponents. Piece by piece the argument for avoiding vaccines was completely destroyed. It was some pretty impressive journalism. (Who says journalists are too stupid to understand science? Wait, I do. Remind me to stop saying that.)

[iNow]

It's queued up on my DVR, but I'm on business travel this week. Hope to watch it this weekend after I land back home. I've seen some buzz about it on the blogosphere already... People excited about the fact that a news story actually used facts and science to support a position instead of giving both sides equal time... like they so often do even though one side has no evidence going for it and the other side all of it in their favor.

 

Glad to hear it was a good episode. I hope to have something more meaningful and meaty to contribute soon to the thread after I've seen it.

[Pangloss]

Just to add a bit, they did give the opponents a full opportunity to present their case, but they really focused on their proposed evidence and its accuracy. I think this is a very good approach, because many of the concerns raised by parents are perfectly valid, and indeed important concerns to raise. As one scientist put it, it's perfectly logical to see a change following an event and question whether that event caused the outcome. It's a clear case of needing to explain that correlation does not imply causation. As the same scientist put it in Frontline, just because the rooster crows before dawn doesn't mean that dawn happened because the rooster crowed.

 

I think this issue underscores the problem of basic science education in this country better than some of the more ideologically-oriented questions that face us today. When we challenge a religious belief, for example, we poke into something that people aren't asking to have challenged. But parents (at least the good ones) generally want good information. They don't like to be ordered to comply, but they do like to be given good advice.

 

Unfortunately in this case the best "advice" may be to remove legal loopholes that allow them to make bad choices. But perhaps we can do a better job of education on this issue, so that concerned parents will understand that it really does serve a purpose, and that it's not about padding the bank accounts of big pharma and its lobbying arm.

 

In the end, Frontline suggests, it's all about the outreach. Opponents have all the cards stacked in their favor, with YouTube and advocacy sites all over the place, and no way to directly challenge them. If it wasn't for other independent voices setting the record straight, the situation would probably be worse than it is, but the medical establishment needs to do better than robot voices on CDC hotlines and cold, detached FAQs on government Web sites.

 

One of the most interesting moments in the piece was of a focus group of parents who were asked questions about the issue. The parents universally declared that they felt that the most important thing was to be given a choice and not to just be told what they had to do. It was clear that none of the parents in the group was familiar with the concept of herd immunity. They didn't realize that their behavior could cause others to become sick who, say, haven't become old enough to receive the vaccine yet. But they sure-as-shootin' understood that they didn't trust the government and large pharmaceutical companies!

 

Anyway, y'all check it out. Good stuff.

[bascule]

As it were, I'm also travelling... presently sitting at the Incheon airport lounge in South Korea. I've received my obligatory "I'm Travelling!" dose of Fox News, but sadly the airport lounges don't play Frontline. Perhaps when I get home.

[ecoli]

looking forward to watching this when I get new headphones

[Mr Skeptic]

I watched it, and it is a very good piece. I don't think it was biased; it seemed a very accurate portrayal of the vaccine situation -- the facts, the myths, and the reasons for these decisions.

 

I do see some potential problem from a liberty perspective, of requiring people to receive a vaccine from the government. Obviously this would only be done with absurdly safe vaccines, but it would be nice if that requirement were officially recognized rather than a side-effect of democracy. Alternately, if the choice were left up to the parents/individuals but likewise responsibility for any people they infect, including compensation for medical costs, disability, and death.

[Pangloss]

looking forward to watching this when I get new headphones

 

I think there's some stimulus money for that.

[SH3RL0CK]

I'll have to watch it when I get more time.

 

But I do have a concern about getting a vaccine for every little possible germ. At some point the costs to society outweigh the benefits to society (but not the benefits, or should I say profits at our expense, to Big Pharma). I'd rather have the sniffles for a day than get a vaccine shot with my arm sore for the next week and worrying about getting one of the "rare" side effects with "minor" complications (at least rare and minor as defined by the pharmacutical companies).

 

After all, pharmacutical companies do make money on vaccines, and from a business perspective they will push as many as they can. Of couse they will claim that the vaccine is necessary. And, they will use government to help them make their profit, which IIRC was a concern (albeit I think unwarranted in this case) about gardasil in Texas. http://en.wikipedia.org/wiki/Gardasil

 

The governor of Texas, Rick Perry, issued an executive order mandating vaccination against HPV which was later overturned by the Texas legislature. Through lobbying efforts, Merck has suggested that governments make vaccination with Gardasil mandatory for school attendance, which has upset some conservative groups and libertarian groups

(emphasis mine)

 

Who can say that in the future Merck won't want our government to mandate (for a profit to them of course) a vaccine with serious side effects to prevent diseases which nobody would ever realistically get anyway?

 

Anyway I'll try to take a look at this tonight if I get time.

[Pangloss]

I have mixed feelings about that. Somebody has to decide when it's appropriate to mandate a vaccine, and it can't be parents. The choice has to be made scientifically, but that doesn't mean it's an easy decision since the decision may have to be made based on variables that cannot be fully measured.

 

But I think these decisions are made with objective inputs, aren't they? Advice from people who don't have an iron in the fire, as opposed to the study authors who proposed it or the drug company that stands to profit. If that's the case it would seem to be well-handled.

[SH3RL0CK]

But I think these decisions are made with objective inputs, aren't they? Advice from people who don't have an iron in the fire, as opposed to the study authors who proposed it or the drug company that stands to profit. If that's the case it would seem to be well-handled.

 

If only this were the case, I can't quickly find what Rick Perry used to scientifically decide this vaccine was warranted. However see the following...

 

http://en.wikipedia.org/wiki/Rick_Perry#HPV_vaccine

 

...Apparent financial connections between Merck and Rick Perry have been reported by news outlets, such as a $6,000 campaign contribution, as well as Merck's hiring of former Perry Chief of Staff Mike Toomey to handle its Texas lobbying work.[30]

 

Adding to the criticism of Perry's order is what is viewed by some as a high price of the vaccine which is approximately $US360 in Texas.[31] Gardasil is a patent-restricted vaccine and Merck is the sole producer.

 

Now maybe all the above is coincidence and the decision was the right decision, though poorly handled. But given the above reference, I have to believe that financial gain for both Gov. Perry and Merck was some factor in this decision.

[Moontanman]

Isn't more important to determine the basis for the vaccine than who profits from it? The vaccine for polio no doubt made money but did that make it unnecessary? Guardasil protects people from a very bad virus that can have terrible consequences. If the vaccine is effective why shouldn't it be mandatory? At some point the elimination of the disease is more important than some one who believes their kids can avoid the disease by abstinence.

 

BTW, can you give a real example of a mandatory vaccine that protects from something no worse than the sniffles. Our world would be a very different place with out vaccines, to denigrate the idea of vaccines this way is questionable to say the lest.

[Mr Skeptic]

I'd rather have the sniffles for a day than get a vaccine shot with my arm sore for the next week and worrying about getting one of the "rare" side effects with "minor" complications (at least rare and minor as defined by the pharmacutical companies).

 

Don't forget that "the sniffles" does on occasion also have rare side effects, such as death. The common cold kills about a thousand people yearly, and also can have other complications.

[CharonY]

Well, one should keep in mind that there are in fact only a minuscule amount of vaccines out there, compared to what one is surrounded with.

While pharma may benefit from trying to sell everything, the regulatory bodies usually only allow vaccinations into the market when there is a demonstrated need and if may increase health of the population (as opposed to individual health).

Of these vaccines only a few actually become mandatory.

[JohnB]

We have the same discussions down here and I admit to being "concerned" about vaccinations.

 

I thought the program was balanced and made some very good points. It also didn't address some others.

 

It strikes me that there is a "Catch 22" in vaccination programs, taking the Autism as an example. Autism presents itself around the time of the third round of vaccinations, so as was said, it is reasonable to assume a link. (Prima Facie) This could be avoided by either changing the time of the third round or a general change in the vaccination regimen. However, as was also shown, the very young can still fall ill with certain diseases if not vaccinated, so the more vaccinations the better. (The herd thing)

 

So if you change the regimen you would remove the apparent link, but would probably increase the likelihood of certain diseases in children, especially babies. Catch 22.

 

Writing off concerned parents as somehow silly or uninformed is insulting at best. The reference to "pseudo science" and moving the goalposts were uncalled for. The parents like Ms. Mc Carthy might be wrong, but they are facing a life with a disabled child and they want to know why. So they ask "Is it the MMR?". When the answer is "No" they ask "Is it ...?". This isn't moving the goalposts, it's asking questions to try and find out why something happened.

 

If your child suddenly changed wouldn't you ask every question under the sun as to why? I know I would. Each possibility would be argued in turn until there was only one left. Rather than moving goalposts, they're using a process of elimination. It should be accepted as such, rather than written off as pseudo science.

 

When you look at all those protestors, each holding a photo, it obvious to blind freddy that "something" funny is going on. Calling it "anecdotal" is not an answer as they can produce many thousands of "anecdotes". And it would appear that "something" is indeed going on, the "something" unfortunately being the fact that Autism normally presents in children at around the same time as the third round of vaccinations. There is a connection, but it is "timing", not "causal". Authorities might be better off simply explaining this fact rather than saying "There is no connection". There is a connection, just not the one the parents think. Admit that and explain it, you'll go further than you will by insulting them.

 

The concern about multiple vaccinations was also not clearly addressed. Each vaccine may well be safe given singly, but what is the result of many given at the same time? No mention was made of any studies that looked at that situation. (By analogy, Salt Petre, Charcoal and Sulphur are not individually explosive, but mix them together and things tend to go bang.) This is a valid question that has not been fully investigated, or if investigated not fully answered publicly.

 

You have to admit that each round is quite a cocktail of dead diseases and chemicals to be injected into very young children.

 

The "establishment" also has another problem. The message is inconsistent between differing areas. In the AGW debate the establishment says, "Don't listen to him, he's in the pay of Big Oil and is compromised" while in the Health debate they say "How much money he makes is irrelevent, he's and expert, listen to him", and the people say "What?" This inconsistency is bad, especially for the Health debate. *Note SH3LOCKs comments re Gardasil.

 

While on that, I think it was just poorly handled, 6 grand is not a large contribution to a campaign fund. I'll add that Oz began it's Gardasil immunisation program a couple years ago. We immunised all girls at High School and we will continue to do so. Each young woman will be immunised in their first year at High School from now on. It will cost us around $50 million a year to do so, but we will have a nation where Cervical Cancer is going to join Polio, in the history books. This is a Federal Government funded program that once we got past the initial "Gov is forcing us to do this" debate, is widely approved of.

 

We view this, like Universal HealthCare as simply another benefit of living in an advanced, civilised society. A national future without Cervical Cancer is worth a measly $50 million/year to us. Yes, "Big Pharma" will make a profit financially, but we make a societal profit, so we both win.

[Moontanman]

Here in the US we believe it's more important to scare young girls into sexual abstinence by telling them they will die of cancer if they see a penis... cheaper too...

[Mr Skeptic]

The "establishment" also has another problem. The message is inconsistent between differing areas. In the AGW debate the establishment says, "Don't listen to him, he's in the pay of Big Oil and is compromised" while in the Health debate they say "How much money he makes is irrelevent, he's and expert, listen to him", and the people say "What?" This inconsistency is bad, especially for the Health debate.

 

How so? We have consistently said to listen to the experts on an issue -- the people studying medicine about medicine, the people studying the climate about the climate. We've always been suspicious of people selling a product and then claiming expertise in a different area -- oil finding and manufacturing experts claiming to be experts in science, tobacco farming and processing experts claiming to be experts in health. And whenever an expert has a financial conflict of interest, we are always wary of what they have to say.

 

The thing about medicine, however, is that the questions relate to the field of expertise of the researchers, and the manufacturers of a specific medical product have done many tests with it to determine its safety and effectiveness, sometimes being the only ones to have done so. If I had a question about the quality of oil produced in a certain oil well, if it were somehow different from other oil, I'd ask the oil experts about it. But really, their area of expertise is not very interesting to most people.

[JohnB]

And whenever an expert has a financial conflict of interest, we are always wary of what they have to say.

 

And you don't see a conflict between this and trusting a scientist who is for immunisation and who has also personally made millions out of vaccinations?

 

I happen to agree with him that the fact he made money is irrelevent, but the conflict of interest is obvious.

 

and the manufacturers of a specific medical product have done many tests with it to determine its safety and effectiveness

 

Far too many people remember Thalidomide to take Pharmas word on "safety" at face value.

 

Whether you like it or not, parents have real concerns. Declaring them silly, uninformed, etc is insulting and does not further the debate or the push for immunisation.

 

Here's a novel idea. Instead of being insulting and dismissive, listen to what they have to say and then answer their points. As I said above, this is not being done except in very limited ways.

 

Ms Mc Carthy and many other parents have children that are "suddenly" autistic or "changed" and they want to know why. Calling them names does not lessen the very real grief and anguish they are feeling.

 

It's not so much about immunisation. You have thousands of scared, upset and confused parents asking questions because they want a reason for what has happened to their children. Immunisation, because of the timing, is the obvious candidate and so they target it. Not to remove immunisation, but to prevent other parents enduring what they went through.

 

The sad fact is that we don't really know enough in certain areas to answer the very basic question these parents are asking;

 

"If immunisation didn't do this to my child, then what did?"

 

Answer that question and the "battle" is over.

[iNow]

There was a woman who made a comment about herd immunity, and how it's like building a wall around the city to protect against invaders. That wall being there offers tremendous protection for those within it.

 

Now, of course there will be people within that wall who don't want it there... Who feel it impacts their freedom. I get that.

 

However, I don't believe the proper response to protecting that freedom is to start taking bricks out of that wall and putting the rest of the community residents at risk to attack.

 

I'm okay with mandating vaccines... unless, of course, we collectively accept that involuntary population control is an unintended side effect of not taking them.

[CharonY]

And you don't see a conflict between this and trusting a scientist who is for immunisation and who has also personally made millions out of vaccinations?

Actually I would be surprised to find many overlaps in those areas. Companies sell drugs but epidemiological studies, safety evaluations etc. are not handled by them.

They do perform clinicals according to rigid rules enforeced by the governement to demonstrate the safety of their products, but any additional studies are often done by universities national labs etc. Those do not make a penny out of the vaccines and in fact may promote their careers by quite a bit by finding a link.

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Also it should be noted that to date no one really knows what the mechanisms of autism are and what contributes to it. If you want an answer, invest more in research. However, clinging to something, just because no answer exists is a bit random, especially given the absence of direct evidence for a link. If parents were concerned about, say saccharin and do not want kids to ingest it anymore, it would be one thing. But denying vaccinations, which have a proven record of benefits, not only for the vaccinated individual but also for the rest of the population is quite another.

Of course parents are concerned, but accepting the known risks of not being vaccinated (and potentially spreading the diseases further) just because they think there may be something is akin to stop wearing seatbelts because you think the chemicals in it may be deleterious to your health.

[JohnB]

They do perform clinicals according to rigid rules enforeced by the governement to demonstrate the safety of their products

And how many of those who "enforce" those rigid rules and approve drugs as safe go on to very high paying jobs with the Pharma companies?

[iNow]

And how many of those who "enforce" those rigid rules and approve drugs as safe go on to very high paying jobs with the Pharma companies?

 

While I appreciate your point, it is sort of not relevant. Until you can demonstrate that these enforcers gave false representations or let flawed results into the literature to pad their own bank accounts then you've got nothing but a bunch of well poisoning and insinuation. Sure, it's possible wrongs were done, but the possibility alone is not enough to negate the validity of the science demonstrating vaccines to be safe, effective, and also unrelated to autism and autistic spectrum disorders.

[SH3RL0CK]

the validity of the science demonstrating vaccines to be safe, effective, and also unrelated to autism and autistic spectrum disorders.

 

While this is true, many of the parents of children are understandably asking, are we sure the studies are correct? Have the studies considered all the possibilities? Probably not - I don't know that this is even possible.

 

FWIW, I agree with you. But the solution to this issue is to solve the autism question.

 

The Pharmacutical companies and the government should also recognize that people will naturally view them with suspicion...these rightfully lack public trust because they HAVE performed things like the Tuskegee experiments.

 

http://en.wikipedia.org/wiki/Tuskegee_syphilis_experiment

 

from the article:

The Tuskegee syphilis experiment[1] (also known as the Tuskegee syphilis study or Public Health Service syphilis study) was a clinical study conducted between 1932 and 1972...researchers failed to treat patients appropriately after the 1940s validation of penicillin as an effective cure for the disease...By 1947 penicillin had become the standard treatment for syphilis. Choices might have included treating all syphilitic subjects and closing the study, or splitting off a control group for testing with penicillin. Instead, the Tuskegee scientists continued the study, withholding penicillin and information about it from the patients. In addition, scientists prevented participants from accessing syphilis treatment programs available to others in the area. The study continued, under numerous supervisors, until 1972, when a leak to the press resulted in its termination. Victims included numerous men who died of syphilis, wives who contracted the disease, and children born with congenital syphilis.[4]

[ecoli]

While this is true, many of the parents of children are understandably asking, are we sure the studies are correct? Have the studies considered all the possibilities? Probably not - I don't know that this is even possible.

 

It's not possible, because no study will be good enough for people who've already made up their mind (they already 'know' from their personal anecdotes and emotional appeals).

 

As Offit says in the frontline vid, every time a new study comes out that disproves their claims, they either ignore it or move the goal post slightly (red herring of sorts). At the end of the video, you can hear Jenny McCarthy attacking epidemiological studies, after they failed to find any relationship between MMR vaccine, thimersol and autism rates. The goal has shifted to other, or amount of vaccines (something that was probably already controlled for)

 

The only way that these studies are invalid is if kids that are genetically predisposed to developing autism triggered by vaccines are more prevalent in the vaccinated group, causing autism rates to rise to 'normal' levels after vaccinations. However, there's no good reason to think that people's genetic dispositions aren't lying randomly around a normal distribution in both groups.

 

I wonder what they'll say when molecular studies start to disprove them? The whole thing is a terrible waste of resources.

[CharonY]

And how many of those who "enforce" those rigid rules and approve drugs as safe go on to very high paying jobs with the Pharma companies?

I would not know but as ecoli pointed out, it is irrelevant.

However if you want to look at the money trail how about one proven one?

It should be of interest that the autism vaccine link is largely based on a fraudulent paper by Andrew Wakefield. Now who was making money here?

 

But the investigation discovered that, while Wakefield held himself out to be a dispassionate scientist, two years before the Lancet paper was published - and before any of the 12 children were even referred to the hospital - he had been hired by a lawyer, Richard Barr: a jobbing solicitor in the small eastern English town of King's Lynn, who hoped to raise a speculative class action lawsuit against drug companies which manufactured MMR.

and

Barr [audio] paid the doctor with money from the UK legal aid fund: run by the government to give poorer people access to justice. Wakefield charged at the extraordinary rate of £150 an hour - billed through a company of his wife's - eventually totalling, for generic work alone, what the UK Legal Services Commission, pressed under the freedom of information act, said was £435,643 (about $750,000 US), plus expenses. These hourly fees - revealed in The Sunday Times in December 2006 - gave the doctor a direct, personal, but undeclared, financial interest in the results of his research: totalling more than eight times his reported annual salary, and creating an incentive not only for him to launch the alarm, but to keep it going for as long as possible.

 

Ouchies

http://briandeer.com/mmr/lancet-summary.htm

[Double K]

While I appreciate your point, it is sort of not relevant. Until you can demonstrate that these enforcers gave false representations or let flawed results into the literature to pad their own bank accounts.

 

Have a quick look into the history of aspartame, and you'll see a case of this.