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Wednesday, April 2, 2014

Selected works, part III: Anti-vaccine hysteria and the subsequent effect on public health

Class: Eng 101
Assingment: Report the Conversation-- Desribe a topic that is of high discussion in your intened career
Grade: 92/100

The Rise in Anti-Vaccine Hysteria and the Subsequent Effect on Public Health
Joshua A Pillow
Brigham Young University- Idaho
In February of 1998, Dr. A. J. Wakefield was the main author of an early print article in The Lancet that argued for the causative correlation between the Measles-Mumps-Rubella vaccine, commonly known as MMRV, and Regressive Developmental Disorder, also known as Autism-Spectrum Disorders or ASD. (Wakefield et al. 1998) Both within and without the medical community people started questioning the safety of vaccines; this questioning has led to lower vaccination rates, decreased herd immunity and a decreased effectiveness of vaccines. However, not long after the original publication of his findings, Dr. Wakefield’s work was questioned. Two articles were published in The Lancet which pointed out multiple flaws in the original report, including the fact that Dr. Wakefield’s test subjects were possibly self-referred and may not have even had autism, that Dr. Wakefield’s subjects were at an age where ASD symptoms first appear, and that he considered normal digestive behaviors of children to be symptoms of Inflammatory Bowel Disease, or IBD. Eventually, it was found that Dr. Wakefield falsified data in his study to deliberately discredit the MMRV as he was attempting to patent his own MMRV. The Lancet eventually published a retraction of his study, and many of the co-authors of the paper later retracted their statements and findings. While the fallout resulted in Dr. Wakefield losing his medical license, it has also included thousand deaths directly attributed to preventable diseases and massive outbreaks of diseases that were once extremely rare.
            Most of the concerns and controversy around vaccine safety are related to the relationship between the effect of live viruses used in vaccines and Autism-Spectrum Disorders. In the original report that Dr. Wakefield published in The Lancet, Dr. Wakefield argued that the live, though weakened viruses found in the MMRV vaccine were causing gastrointestinal distress, which could cause peptic acid and bile to leak out of the small intestine and into the bloodstream. (Wakefield et al. 1998) He further argued that the digestive enzymes would then travel to the brain, eventually leading to retrograde Autism-Spectrum Disorders and other neurobehavioral issues. This argument was quickly brought under harsh scrutiny; Dr. Wakefield contended no workable model for how digestive enzymes might cause the retrograde neurobehavioral issues. In a 1998 article published in The Lancet in regards to Dr. Wakefield’s original report, it was noted that reproduction of Dr. Wakefield’s study failed to reproduce his findings of MMR vaccine traces found alongside IDB symptoms in young children. The article read that “…other researchers, using more sensitive and specific assays, have not been able to reproduce these findings.” (Chen & DeStefano 1998 p.612) Further on, it reads: ‘There is no report of detection of vaccine viruses in the bowl, brain, or any other tissue of any of D. Wakefield’s series.” (p.612) The article did not argue that Autism-Spectrum Disorder could never be caused by vaccines, but that there has yet to be any reproducible evidence or workable models for how it might work. Another article published in The Lancet in May of 1998 argued in part that the supposed evidences of IBD in the twelve test subjects were not evidence of any form of IBD. It noted that such symptoms as stomach aches, diarrhea and indigestion are quite normal among children. It also notes that evidences collected through colonoscopy are normal for young children. It read that “…lymphoid nodular hyperplasia in the terminal ileum… is not unusual in children. Walker-Smith et al. have described this condition as ‘benign lymphoid hyperplasia’ due to the frequency of its demonstration in asymptomatic children.” (Richmond & Goldblatt 1998 p.1354)  Even though Dr. Wakefield claims that MMRV-induced IBD has happened with children, several physicians argued against him, stating that IBD-like symptoms are not unusual in children and his evidence was in fact not evidence at all; likewise, Dr. Wakefield’s claims of MMRV-induced IBD, and IBD-induced ASD have been thoroughly discredited and repudiated.
            Many medical professionals question Dr. Wakefield’s findings because it is unclear whether or not his test patients actually had ASD, and if they did have ASD, was it caused by the MMRV? In a correspondence published in The Lancet in May 1998, A. Rouse of the UK Department of Public Health questioned Dr. Wakefield and the credibility of his test subjects. He writes that there is a questionable relationship between Dr. Wakefield and an autism advocacy group referred to as the Society for Autistically Handicapped, writing that “…information from parents referred in this way would suffer from recall bias” (Rouse 1998 p.1356) Dr. Wakefield denied any connection between his research and the society, claiming he never heard of the society. (Wakefield 1998 p.1356) Dr. Wakefield refused to state form where the children were referred. In his original paper Dr. Wakefield noted that all of his test subjects were tested by a psychiatrist who confirmed their diagnoses (p.1356); however, ASD diagnosis can be difficult, and the DSM-IV used at the time did not include as wide of criteria for ASD as is currently included under DSM-V. In order to give a definitive diagnosis, a therapist, either psychiatrist or a psychologist, must spend a significant amount of time with the child and get to understand him or her. Without definitive sources of referral, Dr. Wakefield had failed to prove beyond any doubt that his twelve test subjects actually had ASD, by either DSM-IV standards or DSM-V criteria.
Another area that has been a hot-topic in the arena of vaccine safety is between Thimerosal and ASD. Thimerosal is an organic compound that contains mercury and is an effective antifungal and antibacterial. Because it was considered safe in small doses, it was used in vaccines for the purpose of preservation until 2002 when it was recommended that Thimerosal be removed from all childhood vaccines. The recommendation came after multiple studies failed to definitively prove that trace amounts of mercuric compounds are completely safe. (Grinker 2005 p. 545) Many people, including Robert Kennedy Jr., have claimed that these studies and subsequent recommendations on Thimerosal are proof that the government knew Thimerosal caused autism, stating that there are supposedly hundreds of scientific studies claiming causative correlation between mercuric compounds and ASD (Kennedy 2005); however, there has never been cited any peer-reviewed study showing causative coloration between mercuric compounds and ASD. In fact, there have been many reports showing that there has been no connection between Thimerosal and ASD. Despite the removal of Thimerosal from childhood vaccines and declining vaccination rates, multiple scientific studies have shown increased ASD diagnoses, suggesting there is no correlation between vaccination and ASD. (Gerber & Offit 2009) Despite this, the myth of vaccine-induced ASD continues. In a report on Paul Offit’s book Autism’s False Prophets, Richard Grinker writes “[it] is as if these reports never happened.” (Grinker 2005 p.545) Richard Grinker writes that many people ignore the evidence that is around, instead choosing to lie and support a debunked mentality that vaccines and Thimerosal are causing ASD. Even with mounting evidence that Thimerosal is not connected to ASD, many still believe and push the idea, leading to a disturbingly large cleavage between what is supported by scientific evidence and what is perpetuated by popular media.
One of the more ignored facts in the vaccine debate is that many of the supporters of the pseudo-science that pushes the idea of vaccine-induced ASD have been found to have ulterior motives, most usually financial gain. There is a lot of money to be made from fear mongering and scaring people away from truth. Jenny McCarthy, who has no formal scientific training, has become one of the most outspoken opponents to vaccination in the last several years. She claimed in her book Louder than Words: A Mother's Journey in Healing Autism, that her child was given a vaccine that then caused the child to develop autism, but is now claiming her child is okay—she claims that methods of questionable scientific value have cured her child’s autism. (McCarthy 2007) Many in the medical community believe that her child’s diagnosis of Autism was inaccurate as the symptoms he showed, such as sudden-onset seizures, are not symptoms of autism, but actually Landou-Kleffner Syndrome, which is often mistaken for ASD. Despite her obvious lack of scientific credibility, the doubt around her story’s validity and a preponderance of evidence against her claims, many in the popular media continue to give her credence in her claims. What is often not mentioned is that the methods used to “cure” ASD are often extremely expensive, sometimes costing over ten thousand dollars. Many in the anti-vaccine camp actively attack “big pharma” for being profit-driven, although this is easily repudiated, as the evidence shows vaccination is a low-profit area for everyone involved. (Paul 2009 p.693) Ironically, many of these alternative practitioners who are against “big pharma” stand to make massive profits themselves. (This is similar to the workings of the overall natural health industry, which is its self a multi-million dollar industry.) There is a vast network of people, mostly alternative practitioners like Traditionalist Chiropractors and Acupuncturists, and even a few Osteopathic and Allopathic physicians who, despite well-established evidence against it, practice therapies that are intended to cure Autism. This is considered by some in the medical field to be a violation of the Hippocratic Oath, as it is understood in the medical community that there is no cure for ASD; further, many of these treatments can be painful and traumatizing for young children. Still, many practitioners continue with these controversial treatments. Still, physicians such as Robert Grinker do not necessarily blame the parents of autistic children, noting that for many parents, it’s difficult to simply sit and wait, and pseudo-cures may be very psychologically comforting. (Grinker 2008 p.546) In his paper, Robert Grinker notes that many of the physicians who work to support anti-vaccine theories and their subsequent cures are being paid for their activities by those who profit from the supposed cures. Robert uses the example of Mark Geier, who he notes is not an expert in either autism or vaccination, who does research in his basement, funded by two anti-vaccine activists, an anti-vaccine lawyer (who uses Geier’s findings in his arguments), and a “business partner” of Geier who profits from Geier’s work. (p.545) The idea that ASD is curable stands in direct contrast to the current scientific understanding. While a few fringe practitioners peddle the idea that ASD is curable, usually for financial gain, those who stay within the bounds of reason and science do not peddle what is often called pseudo-science.
As the debate around vaccines has evolved, many in the anti-vaccine camp have questioned the overall effectiveness of vaccines and have questioned if they are even necessary. For many people, it doesn’t seem inherently safe to put live viruses into a human body, and many question whether or not it is necessary. This mentality that has been beneficial to anti-vaccine camp, giving them a flammable fuel they can use to further their ideologies. Most of the questions however come from a lack of proper education on vaccines to the parents. First, while many vaccines do contain viruses, some do not. For example, many influenza vaccines do not contain actual influenza viruses; instead, they contain inert microorganisms that have been modified to mimic the surface protein structure of the influenza virus, which in turn causes the immune system to treat it as the disease and create antibodies.  Second, the argument against so many vaccines is also scientifically flawed, as the human body is not overwhelmed by vaccines, and even a newborn’s immune system can handle hundreds of pathogens at once (Gerber & Offit 2009 p.459) While the body does have a small immune system at a young age, immunity is only available from exposure. The Center for Disease Control recommends 14 vaccinations for children beginning at a few months and progressing to the early teens. (Center for Disease Control 2014) This is because disease is non-discriminatory—it can affect anyone at any age. President Franklin Roosevelt had Polio (one of the 14 diseases children should be vaccinated against) as a child, which led to his inability to walk as an adult. In a report for The Journal for Specialists in Pediatric Nursing, Dr. Lisa Miller, MD and Joni Reynolds, RN write that “Infant immune systems are capable of responding to these routine exposures… Infants and children build effective antibodies to vaccine antigens and are then able to develop internal defenses against a variety of infectious diseases…” (Miller & Reynolds 2009) Immunizations give the body a safer way to be exposed to disease antigens, which in turns protects the body from these very diseases. As more people become immune to diseases, those diseases become less prevalent. Vaccinations work over 99% of the time, making it one of the most successful medical procedures ever. The most striking example is Smallpox. Smallpox was once one of the most deadly disease found in the human race until the 1970s. After a world-wide immunization blitz, Smallpox was totally eradicated, with the exception of a small sample that is kept in a secure lab.  Because these vaccinations give the body exposure to disease antigens without the inherent risk associated with direct disease exposure, the body is capable of building a strong defense against the antigens, therefore proving the necessity, usefulness and effectiveness of vaccines. Because vaccines give the body a means of safe exposure, their effectiveness is evidenced in such things as the eradication of Smallpox, and near-eradication of Polio.
            For many of the pro-vaccine camp, the trend of decreasing vaccination rates have been disturbing. Because of the decrease in vaccination rates, the heard immunity effect is being lost. This is evidenced in the trend of disease outbreaks that were only recently considered rare. According to CDC statistics, In Idaho alone there have been 77 confirmed cases of whooping cough since 2007, with two already this year. In Europe, there have been tens of thousands of cases of Measles; there have been over ten thousand cases of Rubella in Western Europe. This is not random. During the aftermath of Dr. Wakefield’s studies, MMRV rates dropped significantly worldwide. Not long following this drop came an increase in Measles and Rubella cases, focused mostly in Europe. One of the biggest issues faced is that those who under immunize their first child are more likely to under immunize subsequent children. An article in Pediatrics finds that the 18% of under immunization is parental beliefs against vaccines related directly and solely to safety. (Gust et al. 2004) Because heard immunity depends on a vaccination rate above 90%, this puts those who are under vaccinated at greater risk. In a report published by The Lancet in January 1998, it’s noted that in Hungary, where immunization rates have stayed over 95%, there has not been a confirmed case of Pertussis since 1975. (Gangarosa et al. 1998 p.357) This stands in sharp contrast with the US, where vaccination rates have dropped off under 90%, and Pertussis has increased from 1.2 per 100,000 to just over 2 per 100,000, (p.357) which in medical terms is a large enough increase to cause concern. There are even more grizzly statistics: according to the CDC, there have been over a hundred thousand infections leading to over a thousand preventable deaths from under immunization (CDC 2014) Even though those who are immunized themselves are in little harm from outbreaks; there is a large portion of under immunized who are at an increasing risk of disease as the number of preventable diseases continues to rise under the influence of the anti-vaccine movement.
            As the anti-vaccine debate rages, there are those who align themselves with science, and there are those who align themselves with hysteria. While the evidence has conclusively proven time and time again that vaccines are safe and do not cause ASD, there continues to be a loud minority who claim to know better. Many times, the popular media lends ear to the latter group, leading many in the public to be misinformed and weary of what is a safe and many times life-saving treatment, the effect of which causes those who cannot be vaccinated at all to be put at higher risk. The outlook does seem bright, however. Slowly, vaccination rates are continuing to increase, reaching closer to the threshold of heard immunity. Many people are learning to trust their doctors and learning to recognize legitimate scientific inquiry. The debate is slowly shifting, and will continue to shift away from ASD and towards other minor concerns, such as the right to religious refusal of immunizations. Hopefully, there will be a time when the anti-vaccine movement is lowered to a point where it loses its influence completely. That certainly seems the path it’s taking now, and in the minds of many experts, that is the path it should take.

Autism, inflammatory bowel disease, and MMR vaccine. (1998). The Lancet, 351(9112), 1355.
Chen, R., & DeStefano, F. (1998). Vaccine adverse events: Causal or coincidental? The Lancet, 351(1903), 611.
Freed, G. L., Clark, S. J., Butchart, A. T., Singer, D. C., & Davis, M. M. (2010). Parental vaccine safety             concerns in 2009. Pediatrics, 125(4), 654-659. doi:10.1542/peds.2009-1962
Gangarosa, E., Galazka, E., Wolfe, C., Phillips, L., Gangarosa, R., Miller, E., & Chen R. (1998). Impact of anti-vaccine movements on pertussis control: The untold story. The Lancet, 351, 356-361.
Grinker, R. R. (2009). Offit paul: Autism's false prophets: Bad science, risky medicine, and the search for a cure. Journal of Autism & Developmental Disorders, 39(3), 544-546. doi:10.1007/s10803-008-  0679-y
Gust, D. A., Strine, T. W., Maurice, E., Smith, P., Yusuf, H., Wilkinson, M., . . . Schwartz, B. (2004). Underimmunization among children: Effects of vaccine safety concerns on immunization status.    Pediatrics, 114(1), e16-e22. doi:10.1542/peds.114.1.e16
McCarthy, J. (2007). Louder than words: A mother's journey in healing autism (Reprint ed.). New York City: Penguin Books USA.
Miller, L., Joni. (2009). Autism and Vaccination—The current evidence. Journal for Specialists in Pediatric Nursing, 14(3), 166-172. doi:10.1111/j.1744-6155.2009.00194.x
Plotkin, S., Gerber, J. S., & Offit, P. A. (2009). Vaccines and autism: A tale of shifting hypotheses. Clinical             Infectious Diseases, 48(4), 456-461. doi:10.1086/596476
Wakefield, A., Murch S., Anthony A., Linnell J., Casson D., Makil M., . . . Walker-Smith, J. (1998). Ileal-            lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The Lancet, 351(9103), 637.
Kennedy, Robert Jr. (2005) Dangerous Immunity Retrieved from
Center for Disease Control (2014) 2014 Recommended Immunizations for Children from Birth through age 6 Retrieved from

Center for Disease Control (2014) Morbidity and Mortality Weekly Reports for 1 Feb 2014 Retrieved from