Tuesday, December 18, 2007

Reply for ANB

This item was emailed to this blog. -AR

TO AUTISM NEWS BEAT:

Producing a study with protocol comparisons for efficacy and safety between current high dose over-vaccination techniques and a more appropriate approach that is evidence based wherein we vaccinate when titer levels are zero or inappropriately low would go a long way for your argument against people concerned about vaccine safety. Frankly, it would end the debate as to whether there is or isn't an associate between autism and vaccinations and it hasn't been done yet-actually that study is decades overdue at this point. I hope you will join the conversation in regards to that idea and review the food for thought below. This all seems pretty simple, protocol comparisons are nothing new in medicine-but are oddly missing from this arena.


We need to vaccinate smarter, not quit vaccinating. The increase in all auto-immune disease in U.S. children in the last 20 years seems to have one major untested variable: an overly intense early-life vaccination protocol. We really haven't fully tested the idea that we can vaccinate against all these diseases in just as an efficacious way with less boosters and less side effects. To do that now is the mature approach to address the the concerns of parents and medical professionals (the number is growing in ranks outside of pediatrics). A paper last month in the New England Journal of Medicine would suggest we have massively underestimated the decay rate of antibodies after childhood vaccination (Amanna, Carlson and Slifka).



The side effect profiles in a study between current high-intensity vaccination protocols and a lower intensity approach should be prospective monitored, not dependent on the weak reporting statistics in the VAERS database. As soon as such a study exists, we will have a much better idea as to the relationship between vaccines and autism. There is no universal mandate in medicine that occurs without some untoward events in the population, and in this instance, when the lives of millions could be affected, harming 1/500 seems like a small number but in 10,000,000 kids thats 20,000 children. Really the more mature approach would be to admit that we may harm 20,000 kids out of 10 million and the progress of science will learn how to avoid or protect the at-risk population so as to further lower those caught in the "friendly" fire of the war on infectious disease. Vaccine compensation program may help those affected, but the onus is on making this public policy measure safer each year.


The immune system is the most sophisticated of all biological systems due to molecular epitopic variability and the ability of each cell to undergo genetic rearrangements of MHC genes for protein expression; playing with this fiery system too much as we are by over-vaccinating only risks unnecessary side effects. Most auto-immune reactions take several stimuli to really upregulate a deleterious and difficult to control response resulting in clinical disease expression. Although understudied, there is significant immune system dysfunction in autistic individuals and autoimmune markers are often present in autistic children.


So wouldn't it be interesting to do some protocol comparisons? We could keep over-vaccinating some children plus add the thimerosal as preservative again on the full schedule and give others a number of protocols of lesser intensity without thimerosal. A prospective approach would appropriately actively monitor all vaccine recipients for acute side effects. The risk assessment for the development of all auto-immune phenomena over a 10 year window of follow-up could be robustly defined in this fashion. JRA, asthma, childhood MS, autism, and juvenile diabetes all seem to be on the rise in the last 15 years-maybe we are just better at diagnosing these diseases, although last I checked diagnosing diabetes is pretty straight forward. Unfortunately, there are few physicians with prestigious positions in public health and pediatrics in this country who have the guts to even try to find the grant money for a study that would connect the dots between auto-immune phenomena in children and number of vaccines received. Should such a study be performed one would bet it comes from outside such vaccine-entrenched camps, so don't blame Mrs. Weinmaster for the med-speak faux pas and what you would consider as citing seemingly inappropriate researchers, there simply are few who have any moxy for taking on the CDC with an MD behind their names and titleship and position should not detract from important observations, recall that a farm boy in Idaho actually invented the television.


Those who's salary and departmental funding is tied into the current dogma would consider doing the above study occupational suicide. Looking collectively at these auto-immune diseases in the context of vaccination intensity in childhood is really what is needed as anyone can parse out subtypes of auto-immune disease to the point that it appears there is no connection to vaccines so long as the prevalence of disease is below the threshold of statistical significance in the individual diseases. Group the diseases as variations on the same theme and then things get a bit more illustrative of a connection.


On a more progressive note, hopefully someone will pursue this multi-million dollar concept using the same idea for home pregnancy testing (modified ELISA or EMIT) for checking vaccine immunocompetency: One could simply create test strips for finger prick blood samples to give a "yes" or "no" titer check on all the various pediatric vaccines. This would allow us to easily check the need for various boosters annually without the need for more invasive and problematic phlebotomy. There is a probably a large market for this and the sooner it gets done the more likely it is the we will progress in our understanding of auto-immune diseases that are induced by unwarranted boosters. This approach would clearly be more scientific and evidence based, it may eventually render the current CDC schedule like the tobacco ads I have in my office at the hospital from the early 20th century glorifying the brands of cigarettes that are physician favorites; sadly amusing chaff of an older generation of MD's misguided dogma.


Edward Fogarty, M.D.






HERE's THE ORIGINAL POST:


AND YE SHALL KNOW THEM BY THEIR WORDS

A recent letter to the editor in the Lawrence Journal-World tells us everything we need to know about opponents of childhood immunization, most of whom cling to the discredited notion that vaccines cause autism.The letter contains all the half truths, insinuations, and flat-out confabulations one would expect from a movement that long ago jettisoned science in favor of guerrilla marketing.To the editor:Health of our children under the Centers for Disease Control and Prevention continues to decline. The United States is ranked 41st in infant mortality. Who are the 40 countries that have lower rates of infant death?One in four children has asthma. One in six children has a neurobehavioral and/or developmental disability. Could it be that we inject infants, on their day of birth, with hepatitis B vaccines that still contain up to three micrograms of neurotoxic mercury as well as aluminum?Where are the front page headlines when major autism researchers re-examine their research and say "oops" or when the Department of Justice conceded that thimerosal contributed to a child's autism?Dr. Catherine DeSoto and Dr. Robert T. Hitlan both have a Ph.D. in medicine and had the courage to admit in the Journal of Child Neurology, "We have reanalyzed the data set forth originally reported in 2004 and have found that the original P value was in error and that a significant relation does exist between the blood levels of mercury and diagnosis of an autism spectrum disorder. Moreover, the hair sample analysis results offer some support for the idea that persons with autism may be less efficient and more variable at eliminating mercury from the blood."We are failing our children's health. It is time to help stop poisoning kids.Linda Weinmaster,LawrenceSigh.First, the hepatitis B vaccine does not contain "up to three micrograms" of mercury. From the CDC's own website we learn:All hepatitis B vaccines intended for use in infants and children are free of thimerosal as a preservative, and an adequate supply of these vaccines is available for all infant and childhood vaccinations. This vaccine should be administered to all newborn infants and is a major cornerstone in the prevention of a potentially fatal disease in children and adults.A Google search for "hepatitis B vaccine" +thimerosal yields a bumper crop of quack medical sites, including Mercola.com which tells us Hep B contains up to 25 micrograms of mercury. This is nonsense. Anybody can spin a defamatory yarn, and some will continue to as long as newspapers publish them.Moving on, Dr. Catherine DeSoto and Dr. Robert T. Hitlan are not "major autism researchers", nor were they the authors of the original paper they criticized, as letter's author wants us to believe. DeSoto and Hitlan do not each have a PhD in medicine because there is no such degree. They are PhD psychologists. Why does Weinmaster feel it is necessary to make stuff up? Did she not research her letter first? Or is she relying on fabrications to cover up a lack of evidence for her claims? Falsely proclaiming the two psychologists as medical experts confers a level of respectability that Weinmaster's claims do not deserve. The DeSoto paper does not prove that mercury causes autism. You can read a detailed critique of the DeSoto paper here.Despite what Weinmaster and her fellow travelers tell us, the Department of Justice did not "concede that thimerosal contributed to a child's autism" because there is no sound evidence that mercury in any form causes autism. This slur was lifted from fringe anti-vaccine groups who deliberately misread the respondent's notice in the ongoing Vaccine Court Hearings. The respondents told the special masters that vaccines caused a significant aggravation of an underlying condition in one of the petitioners' test cases. Serious adverse reactions do happen from time to time, which is why the Vaccine Injury Compensation Fund was created 20 years ago.The oft-repeated claim that "one in six children has a neurobehavioral and/or developmental disability," is a self-serving interpretation of normally distributed data on a bell curve. It's akin to saying that half of all children are below average. Here's a graphic explanation of the "one in six" canard.One in six children are below the standard deviation, and one in six are above.Yes, the US infant mortality rate is far too high, but there is no evidence that vaccines are to blame. Infant mortality tends to be a proxy for extreme poverty, and few developed countries with lower infant mortality rates have poverty rates close to that of the US. The best way to combat infant morality is with more prenatal screening and counseling, low cost or free health care, and education. Scaring parents into foregoing vaccinations for their children does not prevent deaths.We are failing our children's health. It is time to help stop poisoning parents' minds with phony conspiracies and fear mongering.

4 comments:

ANB said...

It seems to me that it's futile to reason a person out of a situation she didn't reason herself into. Your proposed study will do nothing to persuade those who value anecdote over science, and conspiracy over logic. That was my point.

Foresam said...

ANB,
Conspiracists do not advertise their dirty deeds. One must think logically to uncover them.
Conspiracists with lots of bucks can sponsor bogus science. Sometimes, anecdotes outweigh science and they always outweigh bogus science. The element of truth is the key ingredient. Your stabs at logical arguments while ignoring truth do not give your position any credibility.

anb said...

John, I'm glad you're posting here. You do more to discredit pseudoscience and quackery than a thousand of my posts ever could.

Do me a favor? Tell us why you think anecdotes are more reliable than science. I'll grab some popcorn and be right back.

EFFIIIMD said...

ANB,

You may be right about trying to persuade people on the merits of ancedote and science, my proposed study is not to persuade frustrated mothers. It is to scientifically test the hypothesis that changing protocols may lead us to showing that a safer vaccination schedule exists without even changing the vaccines themselves. Again, this is the science that vaccine companies, the CDC, FDA and the AAP don't want to see; there undoubtably will be less iatrogenesis in a less intense vaccine schedule that is checked for efficacy by titer levels rather than assumed to need all these money grubbing boosters. Hell, as a parent I would pay 5 times as much for one DTaP vaccine if you could get this study done showing thats all thats needed in 95% of kids for the first 5 years of life.

There IS NO SCIENCE testing protocol variations in vaccination; look at how the oncologists do it time and time again to improve safety and efficacy of treatment of people near death. Millions of kids need more than a white washed, weak-legged epidemiologic cut off of harm at 1 in 200. Just take the 1% of high risk kids out of the program and the side effect rates would plummet even further. I know pediatricians think they are already safe enough, but 1 in 1,000,000 people die from radiologic contrast agents and everyone in medicine is hypervigilant to the problem, we screen for all kinds of risk factors for what we do in radiology because our MD colleagues are our watchdogs. Vaccine companies have a flock of sheep in pediatricians, not watchdogs.