Friday, March 4, 2011

Informed Parents: Making Good Choices

Book Review



Title: Deadly Choices: How the Anti-Vaccine Movement Threatens Us All
Author: Paul Offit, MD
Date: 2011
Publisher: Basic Books: New York City, NY

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The modern American anti-vaccine movement was born on April 19, 1982, when WRC-TV, a local NBC affiliate in Washington, D.C., aired a one-hour documentary titled DPT: Vaccine Roulette.
Paul Offit, Deadly Choices, p. 2

To the contrary, I was pro-vaccine. But I was pro-vaccine safety. I was knowledgeable enough to know the history that many more people's children and adults have been saved by vaccines than have ever died from them.
John Salamone, who effectively changed polio-vaccine policy in the United States after his son, David, suffering a crippling side-effect from the Sabin vaccine.
—Deadly Choices, p.81

Parents need to understand that when they choose not to vaccinate, they are making a decision for other people's children as well.
Brendalee Flint, whose daughter suffered bacterial meningitis in Jan 2008. They resided  in Minnesota, which had seen a sixfold increase in parents refusing to give their children the Hib vaccine.
—Deadly Choices, p. 214

In Deadly Choices, Paul Offit pushes back against the threats, allegations and fear-mongering of the anti-vaccine movement. His weapons of choice are historical evidence, reams of scientific studies and court cases, which individually and collectively prove, with acute clarity, that vaccines in general are not only considered safe, but are necessary for the sound health of our children and society in general

Offit's well-balanced book offers us a detailed example how ignorance and distrust of science and medicine, ignited by grass-roots politics, has led to a step backwards in health-care policy and prevention, notably in the United States. Throw in a few medical doctors and health officials raising the alarm bells, and fear-mongering from a willing media, and an entertainment industry built on sensationalism, and you have a witch's brew that has had and will continue to have deadly consequences for children.

Much of the credit for the modern anti-vaccine movement dates to 1982, when an NBC station in Washington, the nation's capital, aired a program, called DPT: Vaccine Roulette. Its focus was on the dangers of the pertussis vaccine, used to immunize children from whooping cough. The  program showed many images of children, both mentally and physically handicapped, easily provoking viewers to draw the conclusion that the pertussis vaccine for whooping cough caused this. Case closed.

Except for one thing. The show's images of children were as compelling as the science behind it was false. Scientifically False. It would take fifteen years of epidemiological studies in England, Sweden, Denmark and the U.S. to show no causal link between the vaccine and any long-term consequences.  But it would also take a 1988 court case, (Loveday v. Renton and Wellcome Foundation Ltd.), a class-action lawsuit that included two hundred other children in England to put the matter to rest.

The ruling by Lord Justice Murray Stuart-Smith concluded: "On all the evidence, a plaintiff has failed to establish, on a balance of probability, that pertussis vaccine used in the United Kingdom and administered intramuscularly in normal doses could cause permanent brain damage in young children." Another landmark case in Canada came to a similar verdict.

As for the likely cause of the seizures and mental retardation noted in Vaccine Roulette, Samuel Berkovic, a neurologist at the University of Melbourne and director of the Epilepsy Research Center, determined that a genetic defect in a gene (SCN1A) that regulates the transport of sodium in brain cells was primarily responsible. It was an important discovery, and such results ought to be good news for all parents, especially those who second-guessed themselves for vaccinating their children.
Berkovic wrote, "The identification of a genetic cause of encephalopathy in a particular child should finally put to rest the case for vaccination being the primary cause."
But, of course, there's money to be made. In this case, billions of dollars to doctors, lawyers and other special-interest groups, when accusations can be made and legal proceedings instituted against Big Pharma. Another example cited in the book is the MMR-autism controversy. One of the persons responsible for stoking the fears is Andrew Wakefield, an academic gastroenterologist and a medical doctor, who had published a controversial paper in the respected British medical journal The Lancet in February 1998, linking the MMR vaccine with autism.

It would take solid investigative journalism in England and a court case in the U.S. to again prove no causal link between the MMR vaccine and autism, which has no known cause. 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.

Equally important, Wakefield has been struck off the Medical Registrar and may no longer practice medicine in the U.K. (For more information see On Vaccines: a Matter of Life.)

In 1988, the National Vaccine Injury Compensation Program, or VICP, was set up by the U.S. federal government to protect vaccine makers from expensive civil lawsuits. Under VICP, cases are heard in what has been called Vaccine Court, a no-fault forum for legal proceeding in front of special masters.

The result? None of the allegations have been proven in this court in what was essentially a class-action lawsuit involving 5,000 cases and tens of thousands of pages of documentary evidence. In its first ruling, on February 12, 2009, all the masters unanimously "rejected the notion that MMR plus thimerosal-containing vaccines caused autism, finding not a shred of evidence to support the theory," Offit writes.

In the second ruling, on whether thimerosal alone was responsible for autism, the Vaccine Court, on March 12, 2010, called the plaintiff's arguments "scientifically unsupportable." Yet much damage has been done, clouding if not outright confusing the issue for parents.

In his book, Offit boils down the problem to one of trust: :
Unfortunately, nothing will change if the push to vaccinate comes only from doctors, vaccine advocates, public health officials, and hospital; administrators. Some parents will always view these groups as biased; and it hasn't been hard for anti-vaccine groups to appeal to the sentiment that they can't be trusted.
Undoubtedly, this has been the case thus far. Yet, it can change if parents make informed choices on the importance and necessity of vaccines. Offit's book in its purest form is a plea to parents to make a fully informed choice, based on scientific evidence, and to weigh this evidence against the fears and hysteria offered by anti-vaccine advocates. (Anti-vaccine movements have appeared periodically throughout modern history, first in England in the 1860s, and then in the U.S. in the 1890s.)

Herd Immunity

The necessity centres on reams of statistical data from credible sources, which posits that a certain percentage of the population are required to be vaccinated to take advantage of the protection afforded by herd immunity. If we want to avoid any epidemics of diseases like measles, mumps and diphtheria, the only proven method are vaccinations. And the scientific data supports this contention. Yet, too many parents remain unconvinced.

Conspiring against herd immunity are a number of important factors, including 1) The prevalence of international travel, in which travelers returning from nations with low immunization rates, increasingly are returning to North America with cases of such diseases; 2) Lack of scientific literacy; and 3) The success of the anti-vaccine movement in lowering vaccine rates, thus depriving the population, which includes you and I, the protection offered by herd immunity.It's also important to remember that no vaccine is 100% effective.

In herd immunity, a proven scientific concept, if more people are immune to a certain virus, either through vaccination or having already had the disease, then more people in the population, even if they themselves aren't immune, are protected from the disease.The greater the percentage of people vaccinated, the smaller chance of having an epidemic. Diseases are typically transmitted from a person who's been infected to another person. If that person has been vaccinated, he does not become a transmission point.

That percentage of the population that requires vaccination varies, from 85% for mumps, rubella and diphtheria to 95% for measles and pertussis or whooping cough. Because of emphasis on vaccines in the 1960s and 1970s, many of these diseases, once considered a rite of passage for childhood, were considered almost eliminated in North America.

But then came the assiduous efforts of the anti-vaccine movement, and their success in convincing parents of the validity of their message has translated to lowering vaccination rates, Offit says:  "Some aren't giving any vaccines at all; since 1991 the percentage of unvaccinated children has more than doubled."

On a personal note, I experienced first-hand on the effects of Offit's subtitle: How the Anti-Vaccine Movement Threatens Us All. When  children remain unvaccinated, others remain unprotected as herd immunity breaks down. I contacted  chickenpox (varicella) at a conference for families in Schroon Lake, New York, in June 2002, at age 45. My oldest daughter (then 12) and wife had already had chickenpox as young children, before the varicella vaccine became licensed for use in the U.S. in 1995. My four-month-old son had garnered immunity from my wife's antibodies while being breastfed.

My reaction was far more serious. It left me debilitated for almost four weeks, where I suffered hundreds of vesicular lesions, or blisters, over my entire body, a fever hovering above 40 degrees Celsius (104 F) and general discomfort. After I recovered, I found out that the consequences of adult chickenpox are more severe than in young children, sometimes leading to pneumonia, transient hepatitis, and encephalitis.

That experience marked me for life. I have always been convinced of the need for vaccinations, but after that I was an advocate. Equally compelling, I had thought that everyone, especially parents, favored vaccines. But I was wrong and ill-informed. Unknown to me at the time was that the effects of the anti-vaccine movement was being felt across the United States.

Paul Offit:"The fear of vaccines, the choice to act on that fear, the consequences of that choice, and the voices rising in protest are the subject of this book."
Courtesy: PaulOffit.com
Source: http://www.paul-offit.com/images/pic1.jpg

Recent Outbreaks

Here's only a few examples that Offit has mentioned in his book:
  • Washington: An outbreak of pertussis (whopping cough) on Vachon Island, a small commuter island in Kings County, home to ten thousand people, most wealthy and and well educated. About one in seven children are unvaccinated. In 1994, 48 cases of whopping cough were reported. It increased to 263 in 1995, and 458 in 1999.
  • Indiana: In May 2005, a seventeen-year-old unvaccinated girl from Indiana traveled to Romania on a church mission. She visited an orphanage and hospital in  Romania, which was then undergoing a measles epidemic.On the way home, she felt ill, but unaware that she had contacted measles and  excited to share her overseas experience, she went to a church picnic attended by 500 people. Of the 35 unvaccinated people at the picnic, 31 contacted measles. "The girl who had contacted measles in Romania—after spending only a few hours in a crowd of 500 people—had managed to infect almost every person susceptible to the disease," Offit says.
  • New York & New Jersey: In June 2009, there was an outbreak of mumps among Hasidic Jews in New York and New Jersey. An eleven-year-old boy traveled to England and contacted mumps. Then, thousands of British children had not received the vaccine for measles-mumps-rubella (MMR), afraid that it caused autism. The boy flew back to New York, attended a summer camp for Hasidic Jews, and, unfortunately, started a massive epidemic. By January 2010, fifteen hundred people had been infected with mumps, the book's author says: "When it was over, mumps was found to have caused pancreatitis, meningitis, deafness, facial paralysis, or inflammation of the ovaries in sixty-five people; nineteen were hospitalized."
And the cases continue.

The Changing '80s

How things have changed. Vaccinations, once considered the gold standard of a health-care prevention policy, are now often looked at suspiciously by parents, who want the best for children. When most of the developed world were once looking at the United States with awe and envy at how they improved the lifespans of children, they must now wonder what is going on.

When the U.S. was once at the forefront in the battle to eradicate many of the diseases that debilitated children, including measles, mumps, rubella, diphtheria, pertussis and polio, many parents have decided to not vaccinate their children.

Pharmaceutical companies, so-called Big Pharma, have made mistakes in manufacturing vaccines, particularly in the early history of production. In his book, Offit cites cases where huge mistakes were made, resulting in severe outbreaks and death.
Yellow fever vaccine: American soldiers receiving this vaccine in the 1940s were inadvertently given a vaccine that contained hepatitis B. Offit writes: "In March 1942, the US Surgeon General's Office noted a striking number of recruits were infected by hepatitis; more than three hundred thousand soldiers were infected with what we now know as hepatitis B virus; sixty-two died from the disease."

Polio vaccine: When the Salk vaccine was licensed for sale, one of the three manufacturers, Cutter Laboratories in Berkeley, California, had done a horrible job, in 1955, of producing the Salk vaccine, failing to inactivate the live polio vaccine. "As a consequence, Offit writes, "one hundred and twenty thousand children were inadvertently infected with a vaccine that contained a live, potentially deadly poliovirus: seventy thousand suffered mild polio, two hundred were severely and permanently paralyzed, and ten died. It was one of the worst biological disasters in American history."
Two things resulted from this disaster: Cutter Laboratories ceased making polio vaccines (It was bought by Bayer in the 1970s), and the creation of a vaccine regulatory system. As well, not cited in the book since it's not about a vaccine, but about an antibiotic, penicillin, is the recent discovery of research experiments conducted on prisoners, mental patients and soldiers in Guatemala during the 1940s and 1950s to test the efficacy of penicillin.

This was done without informed consent, despite stringent regulations in effect after the drafting of the Nuremberg Code in 1947 (see Unwilling Participants).  Such are the issues that tarnish the otherwise exemplary work going on in today's medical- research establishments.

The Evidence is Solid

Despite such mistakes, they are rare, and many controls are in place to reduce such incidents. For persons who hold particular ideologies, facts don't generally persuade them. Yet, their solution of zero vaccines falls short of a sound and proven health-care policy, and is be a menu for epidemics that would result in many more family tragedies and deaths.

Consider the following: If you speak to an older generation of adults, those born before the 1940s, before the widespread availability of vaccines, you will get a different picture. This generation is thankful for the benefits that vaccines offer to humanity.

Dr. Offit does an excellent job of explaining the history of vaccines and why they are necessary, effective and safe. For this, he ought to be commended. His book is well-researched and well-documented tour-de-force on his area of expertise.

He is a scientist with not only a fine mind, but a well-operating heart. He would prefer that people were united, and refers to the tragedy of September 11, 2001, as a time when people were more united toward a common good. "And if we can recapture it—recapture the feeling that we are all in this together, all part of a large immunological cooperative—the growing tragedy of children dying from preventable infections can be avoided."

As a writer and journalist, I recommend this book for anyone who wants to be well informed on vaccines and the history of the anti-vaccine movement. As a parent. I recommend this book to other parents who want to be well-informed on making the best choices for your children's health and well-being.

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Paul Offit, MD, is the chief of the division of infection diseases and the director of the Vaccine Education Center at the Children's Hospital of Philadelphia. He is the Maurice R. Hilleman Professor of Vaccinology and a professor of pediatrics at University of Pennsylvania's School of Medicine. Dr. Offit is a founding advisory board member of the Autism Science Foundation, to which he is donating the royalties to this book. He resides outside Philadelphia.

4 comments:

  1. Vaccines are one of the greatest triumphs in human history, ranking with the wheel. The anti-vaccine movement is part of the pro-ignorance movement that is sweeping the world--a movement that has given us Iran's current government.

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  2. A vaccine, is merely an attenuated microbial formulation, that reinforces one's immunity against the pathogen for which exoposure to it is likely.So long as the vaccine is sterile, exempt of deleterious components, and competently administered intramuscularly,the benefits will invariably outweigh the detriments. Thank God we have healers .

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  3. The incidence of whooping cough, for which there is a vaccine, is spiking. University of Michigan Mott Children's Hospital is holding a free web chat on Wednesday, March 16 from noon to 1 pm. You can ask their specialist in infectious diseases all about the vaccine and how to prevent the spread of whooping cough. To register go to www.metroparent.com/mottwebchats

    ReplyDelete
  4. Ruth,

    Thank you for the information.

    ReplyDelete

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