liv | Skeptics bat-signal

Some friends of mine have a young baby who is just about approaching the age where the NHS starts its vaccination schedule. They've been reading anti-vax stuff on the internet and it's scaring them.

I have told them that vaccination carries much less risk than the diseases it prevents, and that such risk as there is is about acute adverse reactions to the vaccine, not long-term vague "developmental / behavioural issues", which is a lot of what the scaremongers are talking about, I think partly because that kind of thing is difficult to comprehensively disprove. And most certainly not autism. I have linked to what I consider to be accessible lay information, and to technical research findings from impeccable scientific sources, backing up my view that vaccination is extremely safe.

My friends are not completely convinced because they say that the pharmaceutical industry is motivated by profit rather than health. They are aware of stories of negative trial results being suppressed, of contaminated vaccines and of testing unsafe vaccines on vulnerable populations without proper consent. I can't deny that those things have happened and continue to happen. I've resorted to saying, look, the entire scientific and medical consensus is that vaccines are safe, nobody in the mainstream doubts that at this point. If you're going to doubt extensive peer-reviewed research evidence because Big Pharma and profit motives might have corrupted the hospitals and universities carrying out the research, why pick on vaccines? That line of argument means that no possible medical treatment whatsoever is safe.

I know that a lot my skeptic-inclined friends make a hobby of marshalling arguments against the anti-vax conspiracy theorists. Here's your chance to actually put this into practice in real life. Can you help me save a tiny baby's life by reassuring its parents about their anxieties?

These people are not stupid or ignorant or religious fundamentalists. They have emphasised several times that they are not in principle anti-vaccination and generally support science and evidence-based thinking. An argument based on mocking them for not being as knowledgeable about technical topics as you are is not going to go anywhere (and I am not going to pass on any such arguments). They are quite reasonably concerned about long-term health and psychological consequences for their firstborn child. They are not afraid of inflicting the physical pain of injections on their child, or at least, they are afraid, but they're willing to overcome that for the child's long-term good. They understand the principles of how vaccination works and accept that this method is a good protection against infectious diseases.

They have a real problem which shouldn't be dismissed out of hand, which is that they don't have a way to evaluate all the safety evidence that exists in favour of vaccines. I mean, they can read scientific papers ok, as educated lay people, but they don't have the skills or the time (it's probably a Masters worth of work) to survey absolutely all the literature and come to an overall conclusion about safety. And yes, some of it is very small studies and some of it is paid for by the companies that are trying to market the vaccine. It's very hard to know, even for me working in this field, whether there are more damning studies out there which ended up never getting properly published because they would cut into drug companies' profits.

They're particularly worried about that favourite of anti-vax conspiracy theorists, thiomersal / thimerosal, the mercury containing preservative which always gets blamed for nebulous bad consequences of vaccines when arguments about the actual antigens are thoroughly debunked. Some of the anti-vax sites have overwhelming lists of mainstream scientific papers with toxicity data about thiomersal. I mean, I can say that the fact that toxicity data exists doesn't mean that the compound is particularly high risk. I can say that this list of large-scale and long-term clinical studies saying the compound is safe outweighs this list of studies which mostly show things like, if you pump lots of thiomersal into cells or mice you get toxic effects. But I'm not sure that's going to be really convincing; arguing like that is almost buying into the paradigm that there's a balance of evidence on both sides and people have to make up their minds which evidence is most compelling. Whereas the reality is that there is overwhelming evidence that thiomersal is safe and no substantial or meaningful evidence that it causes any harm.

I also don't want to over-state the case: sometimes children are in fact harmed by vaccines, and I don't think it's helpful to gloss over that or pretend it isn't true. Sometimes well-intentioned medical professionals prescribe treatments that are in fact dangerous, because they are unaware of dangerous side-effects for any number of reasons. That's most likely to be because the dangers haven't been discovered yet, or because the practitioners aren't properly aware of the latest evidence, but it could be because of corruption and suppression of unwanted data as well. I keep coming back to the idea that even taking into account all these issues, vaccines are far less dangerous than remaining unprotected against diseases. The problem with that argument is that this isn't really the right direct comparison; there's a good chance that herd immunity would protect an individual unvaccinated child, so even though not vaccinating is far worse on a population scale, a specific child is highly likely to get away with not being vaccinated.

Help?

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From:

marymac

Have you tried pointing out their logical failure/hypocrisy in being willing to accept the benefits of herd immunity while not actually contributing to it? There's no causation between vaccines and autism (most of the correlation is from autistic syndromes being diagnosed more broadly in the last ten years, not an overall increase, cf: my family, of the seven youngest grandchildren, only the 14-year-old has an autistic diagnosis. All of us have the same traits, some to far greater extents. Three of us had the old single-vaccine regimen, four had MMR).

What there is is a really good causation between non-vaccination and death.

Therefore, you may want to remind them that the usual vaccines given in childhood by the NHS have not, so far as we have records, killed anyone in the last couple of generations. Measles and whooping cough, though, will kill several children this year and disable a significant number more. So it's basically down to whether they fancy their chances and can live with the guilt when their non-vaccinated child hands on their diseases to someone immune-compromised.

Resident pharmacologist sez: The vaccinations of early childhood are tested in one end and out the other, regulated into oblivion and really don't make much money for pharmaceutical companies because they're all long out of patent and the NHS does not do brand-name where it can do generic. There's very little incentive to hide anything regarding childhood vaccinations because everything is out there and has been for a long time. The last really problematic vaccine was the old polio one.

ETA: They may also want to consider that herd immunity in the under-15s in large parts of the UK is basically broken, due to so many parents not getting their kids the MMR. Not getting the MMR is not only putting their firstborn at risk, it's placing a significant risk on their hypothetical second-born, because the outcome of rubella in pregnancy is not great.

Edited Date: 2013-10-23 12:08 pm (UTC)

From:

liv

I have told my friends that the MMR-autism link is absolutely and comprehensively debunked, and told them about the consequences that Wakefield has faced for his unethical experiments and falsified data. The problem is that the anti-vax people have now moved on to saying that thiomersal causes "behavioural issues", which is almost certainly equally untrue but there isn't such a huge weight of evidence as there is showing that the triple vaccine has no effect on autism risk. I've also told them about correlations, improved diagnosis and the fact that austistic traits tend to show up at around the time vaccines are given, which is a complete coincidence.

Are you absolutely sure that no child has died from vaccine side effects in generations? Do you have a citation for that? I'm sorry to be picky about that, but it seems likely to me that perhaps one or two children do die in a given decade from vaccine-related anaphylaxis or from seizures and extreme fevers. That's still obviously much much rarer than deaths from measles and whooping cough, definitely. But I don't want to make a claim that vaccines are absolutely never fatal unless I can back it up.

I think the moral argument for not contributing to herd immunity is difficult. I agree it's kind of hypocritical, but the thing is, I don't want to make the case: you have a moral obligation to put your child at risk in order to protect immune compromised people. I want to make the case: the risks to your child are extremely minimal, so there's no reason not to do the right thing, both for the child and for society. The interests of society at large and the interests of your child coincide, it's not a matter of making sacrifices.

That's a really helpful point that most vaccines are generic and out of patent. I think that will really help to assuage their fears about Pharma industry corruption of the safety data. Plus of course the fact that nearly all children are vaccinated and have been for decades, so there's a real wealth of data available!

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