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.
References
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 http://www.robertfkennedyjr.com/articles/2005_june_16.html
Center
for Disease Control (2014) 2014
Recommended Immunizations for Children from Birth through age 6 Retrieved
from http://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0-6yrs.pdf
Center
for Disease Control (2014) Morbidity and
Mortality Weekly Reports for 1 Feb 2014 Retrieved from
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6305md.htm#fig1
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