Friday, February 18, 2011

On Vaccines: A Matter of Life

Science & Society

Vaccines save lives and protect against the spread of disease. If you decide not to immunize your child, you put your child at risk. Your child could catch a disease that is dangerous or deadly. Getting vaccinated is much better than getting the disease.
American Academy of Pediatrics, January 2010

[A]s anti-vaccine activists continue to push more states to allow for easy philosophical exemptions one thing is clear, more and more children will suffer and occasionally die from vaccine preventable diseases...
Paul Offit, MD, pediatrician, Chief of the Division of Infectious Diseases
at the Children's Hospital of Philadelphia

Generally, vaccines are safe and very effective. In my mind, the benefits of immunization far outweigh any risks. The bottom line is that I believe that vaccines are safe and necessary — my children are fully vaccinated.
Paul Roumeliotis, MD, Medical Officer of Health
at the Eastern Ontario Health Unit

H. Fred Clark and Paul Offit, the inventors of RotaTeq, a pentavalent rotavirus vaccine. We are living in more skeptical times, as the following statement  from the Children's Hospital of Philadelphia suggests: "When researchers announced in 1955 that a nationwide trial showed that the first polio vaccine was safe and effective, inventor Jonas Salk was greeted as a national hero. Today, rotavirus vaccine inventor Paul Offit (right, with co-inventor H. Fred Clark) routinely endures vitriolic attacks on his credibility, along with death threats, for defending the safety of vaccines"
Photo credit: The Children's Hospital of Philadelphia, 2009
Source: Wikipedia
Some of you might have noticed that I have been publishing a series of articles on the discovery of many of the vaccines that we now take for granted, including polio, hepatitis, and measles mumps and rubella (MMR). Most of the world, notably the developing nations, are happy about such vaccination programs, including a notable one undertaken by the Bill and Melinda Gates Foundation to eradicate polio. Polio is on the verge of being the second disease after smallpox to become eradicated in the world.

Such nation as India, Pakistan, Haiti and Nigeria, for example, know first-hand about the scourge of such diseases as polio, cholera, and plague. And with good reason. Ever since Edward Jenner, an English scientist, vaccinated a young eight-year-old boy, James Phipps, with the smallpox vaccine on May 14, 1796, lives have been saved, and lifespans have greatly increased. (For those interested, here is a time line of the history of vaccines.)

But a few in the highly developed nations view things differently, questioning the efficacy of such long-standing vaccination programs. For such persons, some fed on conspiracies of Big Pharma, some on a mistrust of government and scientific institutions, and some on an Internet with thousands of sites with conflicting if not equal information.

This also speaks about a lack of trust of government and the many agencies that oversee how health care services are delivered. The result is some very worried (if not confused) parents, and the questioning of the very foundation of sound heath-care policy.

Now, asking questions, inquiring, debating, thinking and testing and validating are all wonderful and necessary traits of a well-functioning democracy. They are also the foundations of the Scientific Method. I applaud such efforts.

Even so, there's questioning and there's ignorance in action. I would like to address the latter point. Well-meaning but scientifically ignorant people can cause more harm than good. While this makes for sensational headlines in some quarters, it's not backed by scientific thinking or any  sound measurable and easily verifiable evidence of any sort.

That suggests that governments and the agencies might have to do a better job of explaining the importance of vaccines, particularly the effects of not vaccinating children. The alternative to vaccines, no vaccines, is as ill-conceived as it is detrimental to society's well-being. One has to only look at recent history to see the deleterious and debilitating effects on society before vaccines were commonly available.


Listening to Celebrities

It matters where you get your information. Consider the case of Jenny McCarthy, an American model and actress. McCarthy is perhaps the most famous recent example of someone who not only questioned the efficacy of vaccines, but  in her case, said that the MMR vaccine caused autism. Her activism was likely given more urgency by her son being diagnosed with autism in 2005.

It's true that there are more cases of autism diagnosed today; but, unfortunately, autism is a developmental disorder with no known cause. Many parents seeking a cause for their children’s illness seized upon the apparent link between the routine vaccination and autism. When McCarthy wrote a book, Louder than Words: A Mother's Journey in Healing Autism, published in 2007, the case for parents seemed even stronger. The book and her received a lot of attention from the entertainment media industry.

Polio Vaccine: Child receiving oral polio vaccine in India.
Source: Wikipedia
Across the ocean, in England, Andrew Wakefield, an academic gastroenterologist and a medical doctor, had published a controversial paper in the respected British medical journal The Lancet in February 1998, linking the MMR vaccine with autism. But when put under the lights of scientific scrutiny, the evidence seemed thinner than thin, a point that a Wikipedia article made:
McCarthy's claims that vaccines cause autism are not supported by any medical evidence, and the original paper by Andrew Wakefield that formed the basis for the claims (and for whose book McCarthy wrote a foreword [36]) has been shown to be based on manipulated data and fraudulent research [37-40].
After a thorough investigation, first by the media (Brian Deer for the Sunday Times) and then by the General Medical Council (GMC), which licenses doctors in Britain, 12 years after initial publication, the paper was retracted by The Lancet on February 2, 2010.

As the Canadian Medical Association Journal said about the controversy:
In fact, as Britain’s General Medical Council ruled in January, the children that Wakefield studied were carefully selected and some of Wakefield’s research was funded by lawyers acting for parents who were involved in lawsuits against vaccine manufacturers. The council found Wakefield had acted unethically and had shown “callous disregard” for the children in his study, upon whom invasive tests were performed.
Wakefield was struck off the Medical Register in May 2010, and may no longer practise medicine in the UK. In January 2011, Wakefield issued a statement, from Austin, Texas, in which he defended his work, and said:
I want to make one thing crystal clear for the record—my research and the serious medical problems found in those children were not a hoax and there was no fraud whatsoever. Nor did I seek to profit from our findings.

I stand by the Lancet paper's methodology and the results which call for more research into whether environmental triggers cause gastrointestinal disease and developmental regression in children. In fact, despite media reports to the contrary, the results of my research have been duplicated in five other countries (to see citations to studies, visit http://tinyurl.com/4hrdt5y.)
It seems that this story is not yet over, and its repercussions will be felt for years. Paul Hébert, editor-in-chief of the Canadian Medical Association Journal (CMAJ) said: "There has been a huge impact from the Wakefield fiasco ... This spawned a whole anti-vaccine movement. Great Britain has seen measles outbreaks. It probably resulted in a lot of deaths."


Polio Victim: Man on street with atrophy and paralysis of the right leg and foot due to polio.
Courtesy: US Center for Disease Control and Prevention
Source:Wikimedia



Ignorance can kill. Which raises the larger question of why celebrities, who have scant scientific knowledge, feel compelled to weigh in on matters they do not comprehend? The short answer is narcissism made more virulent in a post-modern age, says Prof Gad Saad, an evolutionary psychologist at Concordia University in Montreal.

In a recent article, "I'm Not a Doctor, But...," published in Psychology Today (November/December 2009), Prof Saad, who also holds the Research Chair in Evolutionary Behavioral Sciences and Darwinian Consumption, wrote:
This is exactly what happens with celebrities. They are repeatedly provided with positive feedback regarding their "laudable" scientific interventions, reinforcing their grandiose idiocy. Negative feedback, as difficult as it might be to share, serves a crucial role in guiding behavior. Failure to receive any such feedback ensures that celebrities will maintain their grandiosity.…
My purpose here is not to censure celebrities, who are always looking for a box to stand on and share their views, no matter how ill-conceived or thoughtless they might be. They are entitled to their views, private or otherwise. Yet, we are also equally entitled to dismiss them as nonesense.

As entertainers and performers they are as a group wonderful and charming. As individual who should dispense medical advice, they are ignorant, lacking the knowledge and education to do so. Their advice, although sincere, can be deadly.

Good Parents, Good Science

As a parent—I have three children, all whom have received a full schedule of vaccinations—I can understand some parents' fears, given the conflicting information on the Internet, thus muddling the choices. The Internet, being a democratic medium, contains both credible and incredible information. Science tends to use the former and discredit the latter.

Much depends on how you view science and the scientific process: whether or not you think the vast majority of scientists are dedicated to helping humanity. I think they are, and Paul Offit is an exceptional scientist who cares about the welfare of humanity, particularly children.

And he holds a number of impressive credentials to give him credibility and knowledge on his area of expertise. Dr Offit is the chief of the division of infectious diseases and the director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, and Maurice Hilleman professor of vaccinology and professor of pediatrics at University of Pennsylvania's School of Medicine.

No doubt, he is a strong advocate of vaccines. At the Children's Hospital in Philadelphia,  one of his mentors was Maurice Hilleman, inventor of 40 vaccines, including for MMR. His towering presence likely influenced Offit. So much so that he, along with his colleagues Fred Clark and Stanley Plotkin, developed RotaTeq, a pentavalent rotavirus vaccine. Rotavirus, is a cause of gastroenteritis, which kills as many as 600,000 children a year worldwide.

His reasons are undoubtedly clear. In his position, he has seen the effects of an unvaccinated population. It's not good. It's not pretty. It's downright scary, as needless deaths and pandemics always are.

Thus, if you have read about the long history of a world without vaccines, as I have done, you would understand the enthusiasm that the announcement of a new vaccine historically received, as the polio vaccine did 50 years ago. The scientists were greeted as national and international heroes, as saviors to humanity who were making the world better, safer and more healthy.

In that regard, Dr. Offit is not working to harm humanity, as some erroneously think, but rather working hard to better it. Yet he has been the unkind recipient of hate mail, threats and all kinds of abuse, something one would expect from the 16th century anti-intellectuals during the time of Galileo, and not the 21st century.

Such loutish behavior is outside the acceptable bounds of freedom of speech. Dr.Offit deserves recognition for his outstanding efforts in science for helping humanity, and especially children.We require healthy debate, not bullying and threats. which do nothing for the advancement of society.

This brings us back to parents. Without a doubt, parents ought to make informed choices, out of love for their children. Such an informed choice, in an ideal circumstance, ought to be based on the best and most-reliable evidence available. That, after all, is what your children would expect from you. 

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2 comments:

  1. Knowledge is expanding rapidly, too rapidly for anyone to keep up with. We can't learn about every field or every area of research. As a result, many people have given up, and ignorance is growing despite the fact that information is increasing. Silly superstitions arise, and people who ought to know better develop fears of vaccines. Who would ever have believed that knowledge leads to ignorance?

    ReplyDelete
  2. You raise a valid point about the expansion of knowledge, and the inability to keep up in every field. But that is why we have academics, researchers and scientists, who do keep up. As I said in the article, it depends from whom and what sources you get your information.

    ReplyDelete

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