Evidence Based Medicine

This item was emailed to this blog. -AR

The double edged sword of vaccines is that as we increase their use we will increase adverse events particularly as relates to autoimmune phenomena. Where is the simple science that assesses the rates of autoimmune disease as a function of number of vaccinations received?

For the protection of the children of this country and improved health outcomes without threatening herd immunity we have to do more checking of vaccine efficacy rather than assume we need 3 boosters in every child in some series of vaccines. Where is the safety data that ensures giving multiple vaccines at one clinic visit is as safe as separating them. Where is the safety data with a normal saline (NOT ADJUVANT) placebo control on the hepatitis B series?

Participants in such a study who got placebo after safety assessments were in for day of birth immunization would have plenty of time to get catch-up vaccination, I never got hepatitis B shots until college clearly such a disease that have a major behavioral component to transmission could be intensely scrutinized for safety in childhood; there is no medical literature, no documented evidence that indicates these safety assessments have been done.

Focused, smarter protocols with titer checks will easily accomplish this. Concerned parents and a growing number of concerned physicians can develop a congress of "the evidence based" schedule. In the end it will be more appropriate to make decisions on clinical evidence of need. Boosters are inappropriate in those who have documented immunity, titer levels are all I ever had to prove immunity to the diseases of childhood when I started medical school (my vaccine records were lost). Grassroots public awareness campaigns can get the word out that titer level documentation of immunity is actually more appropriate documentation of immunity than a written record of shots that could be forged anyway. Such social nightmares for both sides of the arguments of safety and need such as occurred in Maryland recently could easily be avoided with this simple information.

Nothing is 100% safe and I do think the risks of certain diseases at certain ages warrant vaccination with serial titers for follow up, why waste the shot though if you don't need it? If parents don't want to pursue that slightly more arduous course they can make the assumptions of safety similar to the CDC, but the atmosphere needs to change so that patient education leads to this consideration of this approach as a primary discussion point.

Teasing out the small percentage of vaccine-intolerant kids on the basis of biochemical screening is the goal that government research dollars should be driven towards-it is the HONORABLE thing to do, admitting that there are vulnerable patients who will have a discordantly high risk of injury due to a universal mandate is not easy, those with character will at least admit this goal should be pursued.

I see this same point being made in other areas of medicine with much less angst. Why is this goal ignored, is it conditioning? I have on many occasions turned a friendly colleague around in their thinking on this after getting through the conditioning of medical culture.

We can come together and improve the lives of children in both areas of safety and immunity by taking these simple steps. Even if hubris prevents it coming from the CDC, the culture of pediatrics, and academia; the grassroots efforts of many Great Americans can pull this idea together for the good of our nation's health.

Its hard to argue against this approach in a way that can be justified on truly medical grounds. Simple fact is we have no good evidence of what the rates of vaccine-related iatrogenesis are because there are no prospective controlled studies on this liability issue, the onus is
on the CDC to provide that evidence; is it 1/100, 1/1000, 1/10,000 or 1/1,000,000?

Even at a 1/1,000,000 rate of adverse contrast reactions ,radiologists are still going to be put to task for how they attempted to avoid an ill fated injection by patients, lawyers and health advocates. I am glad we are; we continually improve our safety, most often by the prodding of our colleagues outside of our specialty.

Many thanks again to the KOMU staff and the University of Missouri
School of Journalism,

You have provided a brave investigation that others with a greater
audience could never endeavor!

Edward F. Fogarty, M.D.
Chairman of Radiology
University of North Dakota School of Medicine
Father of a great kid who is slowly beginning to speak.