Skeptics bat-signal

[liv]

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?

Comments

[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.

[jack]

*hugs*

Ouch. I really *should* be able to explain this better, but I doubt I can do very well, (and I imagine you can certainly do better). I'm basically 100% convinced, mostly based on the fact that the more I hear about any particular anti-vaccine reason, the more it tends to be traced back to something originally spurious, which gives me no reason _to_ think that.

Conversely, the reasons _for_ vaccines seem overwhelming. People used to die of measles all the time. Now they don't. I don't think anyone is really arguing against that, except that few people have a personal experience with the diseases vaccinated against. And those diseases are coming back, it's not an imagined danger.

But that's all based on very nebulous "my intuition says this evidence is convincing", it's very scary how much I can absorb certainty from people around me, without absorbing sufficient facts :(

[ceb]

To answer the literature question, Cochrane reviews. Someone else has already done the hard work of reading through all the literature and summarising it and keeping the results up to date. For instance here's the most recent Cochrane review on MMR vaccine: http://summaries.cochrane.org/CD004407/using-the-combined-vaccine-for-protection-of-children-against-measles-mumps-and-rubella

Also as marymac says, we dismiss measles as "just childhood illness" but it's a serious business. It can kill or cause permanent disability. Here's a quick summary of complication rates:
http://www.medinfo.co.uk/conditions/measles.html
and this page has a comparison of complication results after vaccination compared to after disease:
http://www.medinfo.co.uk/immunisations/mmr.html

[ironed_orchid]

Jabbed - Love, Fear And Vaccines

This documentary recently aired in Australia and while they do talk to some family members of the very rare cases where there is a bad reaction to vaccines, as well as families affected by lack of vaccination, doctors, and scientists. They do try to leave it as a matter for people to make up their own minds, but it comes down pretty firmly on the side of vaccination.

I'm not sure if it will play at that link outside Australia, but it is on dvd and there maybe pay for streaming options.

Disclosure: the producer is related to some of my friends

Addenda: she received death threats from Anti-vaxxers before it even aired.

ETA: Here is a review by a population health professor.

[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!

[liv]

Yes, I think this is part of the problem. Lots of people hold it as an article of faith that vaccines are good, and they haven't really examined even a summary of the evidence for why this is the case. I have read more primary evidence about vaccine safety than you have, but that does depend on me taking it as a given that the scientific establishment is basically sound. And there are valid, non tinfoil hat conspiracy, reasons to doubt the scientific consensus.

[ceb]

Oh, and re herd immunity, their child may be OK for now, but we've been having increasing numbers of outbreaks of measles &c. due to reduced herd immunity at later ages, e.g. in university students. It is much more serious for adults to catch measles and rubella than for children, and can pass consequences on to the next generation. We may or may not eventually discover whether MMR causes autism at a very low rate, but congenital rubella syndrome very definitely does cause autism, along with a whole host of other unpleasant stuff.

[liv]

I have been jumping up and down saying Cochrane reviews ever since we started having this discussion. When my friends started specifically worrying about thiomersal, I couldn't find a CR on that particular additive. But the CR on MMR itself is recent and includes some seriously enormous studies, so that should be a very good start, thanks for the link.

For these particular people, being unaware of the seriousness of measles is I think not the main problem. They're not thinking, oh, we won't bother vaccinating, if the kid gets measles it'll just be a rash and a fever. They're thinking that the vaccine itself may have risks which are under-reported due to Pharma corruption of reporting safety studies.

The Medinfo page looks really useful; I at least find it helpful to have numbers on the actual risks of fits caused by MMR. But I don't know how to get my friends to believe that 1 in 1000 number. Also, it doesn't solve the problem that the risks aren't really comparable. There might be a 1 in 200 risk of convulsions for someone who catches measles, but the risk of an unvaccinated child catching measles is itself fairly low (due to herd immunity), almost certainly less than 1 in 5. Which means that on some level the MMR vaccine is more likely to lead to severe fits than not having the vaccine.

[jjhunter]

If you need a money quote, the supposed ‘autism-vaccine’ link was itself the wholesale invention of a now widely discredited British gastroenterologist, Andrew Wakefield, as part of a deliberate conspiracy to drum up millions in yearly sales of a related fake medical test (link goes to CNN). (Compare / contrast to Maurice Hilleman, M.M.R. Vaccine's Forgotten Hero.)

If they need more, I would recommend your friends check out the book The Panic Virus by Seth Mnookin:

In The Panic Virus, Seth Mnookin draws on interviews with parents, public-health advocates, scientists, and anti-vaccine activists to tackle a fundamental question: How do we decide what the truth is? The fascinating answer helps explain everything from the persistence of conspiracy theories about 9/11 to the appeal of talk-show hosts who demand that President Obama “prove” he was born in America.

The Panic Virus is a riveting and sometimes heart-breaking medical detective story that explores the limits of rational thought. It is the ultimate cautionary tale for our time.

[liv]

Thanks for that link. I do think it's important to acknowledge that vaccines do sometimes have serious side-effects, and not to dismiss valid anxieties about that. It looks like we can't see the documentary outside Australia, unfortunately, but the review itself is a good start.

[kaberett]

Bad Science, for all my many problems with Ben Goldacre, contains a really good section on how vaccine panic (about any given vaccine) tends to be restricted to a single country (or language-group); he gives an example of a vaccine in France no-one in the UK is the tiniest bit concerned about. And he & other doctors - like, the ones on the national stage talking about why pharma suppression of results (and it's not just pharma, of course, as you know...) - who engage critically with this stuff, etc, are all still firmly in favour of vaccinations. Which is appeal to authority rather than data, but...

[liv]

Yeah, it's a real negative spiral, isn't it, the more people think they can just rely on herd immunity, the less effective herd immunity actually is.

I think it's extremely unlikely we will ever discover that MMR causes autism, basically. I mean, it's hard to think of any supposed correlation which has been so thoroughly investigated on such an enormous scale, with consistently negative results. Especially considering that the original study showing a correlation was fraudulent, really, if there isn't even a correlation you can be pretty damn certain there's no causal link!

I am quite surprised to hear that rubella can be linked to autism; I thought the consensus was that autism is congenital and isn't caused by any (known) external event. In any case, I just want to note that there are autistic people reading this who are somewhat uncomfortable with autism being linked to "other unpleasant stuff". I know what you mean; if the MMR vaccine did cause autism that wouldn't otherwise have appeared, that would be a side-effect whose risk would have to be evaluated. But hopefully it's possible to talk about that without positioning autism as a terrible bad monster.

[liv]

In lots of ways I'm glad that Wakefield turned out to be evil rather than just a bad scientist. Because it's a lot easier to explain to lay people, look, this guy completely fabricated the data in order to sell stuff to gullible parents, than, well, he did one small-scale study which turned out to have been over-interpreted and wasn't reproducible. The latter makes it sound like there's still some kind of controversy, there's evidence on both sides that has to be weighed up. So I've already said, the MMR-autism thing was completely made up and fraudulent and there is absolutely no basis to it. I think the next step is convincing my friends that the thiomersal-behavioural issues thing is just a mutated version of the MMR-autism thing, it's not actually a new risk or a new controversy.

The Mnookin book sounds like it could be really well worth recommending, because they are definitely grappling in general with issues of how to sort out truth from propaganda.

[liv]

I was hesitating whether to recommend Goldacre. Because he does have kind of a personal crusade against Wakefield, which I think in this case is justified, he was the original investigative journalist who exposed Wakefield's fraudulent scheme and the effort he put into doing that was a great public service. But it's a bit too easy for the anti-vax conspiracy theorists to claim that it's just a personal grudge on the part of Goldacre, that he's put too much effort into discrediting Wakefield to be wholly credible himself. But I think the fact that he's a qualified doctor himself, and that he is very much directly grappling with the issue of, what if the safety data is corrupt because of the Pharma industry pursuing profit over human concerns, does make him someone worth listening too.

[ironed_orchid]

That's a shame, but I know how that works when they are trying to sell it to overseas TV networks. I looked at the facebook page, and there's discussion of it being picked up by a US network, but no news yet about the UK.

[marymac]

UK vaccine-related fatalities? None in the last twenty years. None in the twenty previous, from what I can see, but I don't have a cite for it.

The Green Book link - https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/147868/Green-Book-Chapter-8-v4_0.pdf

The anaphylaxis thing is not the vaccine itself - generally what children are reacting to is the egg proteins in the medium. That's something you're only going to find out about when they're exposed for the first time - that child is a time-bomb. Not vaccinating them doesn't improve their chances, in fact, if you're going to find out your child has that kind of allergy reaction the GP's office is one of the better places to find out about it.

I have very little patience with the fuzzy logic of anti-vaxxing parents, mostly from knowing absolutely nobody with adverse effects from being vaccinated and several with severe disabilities from the diseases in question - one friend is profoundly deaf due to measles and a dear family friend had lifelong disability from polio and died from post-polio syndrome. Why the hell do you want to risk that? I will take behavioural issues over dying young any day of the week.

Morally, unless your kid is already otherwise compromised or allergic, they're not at risk from vaccines. They're at risk from the diseases we vaccinate against and if they don't get vaccinated you're putting your own and other people's children at risk. That lack of concern for the rest of society looks kind of fundamentally amoral from here.

[liv]

That's beautiful, thank you. Sorry for being pushy on that; I believed your statement but the problem is that I'm already convinced, so I wanted more evidence to be able to show to my worried friends. The Green Book is a really useful source. Apart from the clear data about the extremely low rates of anaphylaxis and the zero fatality over a long time period from that cause, it also notes that no routinely used vaccines in the UK even contain thiomersal. So whether or not I can convince my friends that thiomersal is safe, they may be reassured to know that it's a non-issue because their child will not in fact be exposed to it. Cool.

The thing is that these people are not anti-vaxxing parents. They've just read a bunch of scare-mongering information put out by the morally bankrupt anti-vax movement, and I need a way to debunk that. I need to break out of the cycle of just stating that the anti-vax talking points are made up by people with a profit motive, because the anti-vax crowd will equally well say that the scientific consensus I'm relying on is if not outright made up at least corrupted by the pharmaceutical industry who also have a profit motive.

[ceb]

Congenital rubella syndrome is a result rubella infection in utero, very early in development, and can screw up all sorts of things. A lot of early trimester rubella infections lead to miscarriage or stillbirth. http://www.biomedcentral.com/1471-2458/11/340 for an example of the rubella/autism literature (and see references therein). It's rarer these days as rubella is rarer.

Autism's not awful, at least not for most people living with it. Being born deaf and blind and with defects to internal organs is pretty awful, though, even if the people this happens to live with it as normal.

[forestofglory]

Is thiomersal still used in vaccines? I remember my mom saying they phased it out in the US. Wiki says it is not used in the EU, but I can't access the source they cite.

[ceb]

Oh, not directly relevant, but did you know we're very close to eradicating polio? Down to the low hundreds of cases annually worldwide, and only remains endemic in 3 countries. http://www.polioeradication.org/

[wild_irises]

It was in the flu vaccine shot I had three weeks ago in the U.S.

I am not a scientist (though I am an intelligent lay reader of science) and I don't have a lot of data on this. The thing I would say is that if you have your child vaccinated and something awful happens, you will feel terrible and you will know why. If you don't have your child vaccinated and something awful happens (like Rubella Syndrome), you will spend the rest of your life wondering if you made a terrible mistake, but you won't know, which is vastly more painful.

[marymac]

It's a generational effect - there are studies about it, I haven't access at work, but the upshot is that as things pass out of living memory, their risks become less real to people.

Because my grandparents were all born before WWI, at 30 I personally know people of my parents' generation who were severely disabled by polio, and measles, and rubella. There isn't even a full generation between me and the last children of my family to die from epidemic disease in Ireland. That kind of thing is pretty concrete. Any child of mine that can be vaccinated, will be vaccinated, if only for fear of Patsy coming back to haunt me.

[wendylove]

Is it so difficult to acquire thimerosal-free vaccines in the UK? I thought they'd become pretty standard in most cases. (In the US, everything except some flu shots is now typically TM-free, and even then parents can opt for a TM-free version: http://www.cdc.gov/vaccinesafety/Concerns/thimerosal/thimerosal_faqs_availfree.html).

For my part, the fact that millions of first-world children have gone through the same basic vaccine schedule as my children (if anything with rather fewer combined vaccinations) makes for a convincing longitudinal cohort study. Here in the US, the vaccines are taxed for a fund from which families may draw if they are able to prove injury due to vaccine (this includes adult vaccinations such as influenza and pneumococcus). In 25 years of vaccinations, there have been fewer than 3400 successful claims (see http://www.hrsa.gov/vaccinecompensation/data.html), of which over half come from DTP -- specifically, the whole-cell pertussis vaccination that's not standard for kids here anymore, we go with acellular instead -- and from seasonal influenza, where there are numerous choices and variables that don't affect children. I can't find exactly how many total US vaccinations produced those less-than-3400 confirmed damange claims, but it's got to be a very tiny percentage. (As someone pointed out above, I would also prefer to find out if my kid has some sort of anaphylaxis-inducing drug allergy in a fully equipped health-care setting designed for pediatric patients.)

As someone who wanted two kids and had the second a standard 2-3 years after the first, I also felt that it was especially important to get my first child vaccinated in a timely fashion so that she couldn't pass anything on to her infant brother. Herd immunity is an important abstract concept; not endangering immunocompromised people in your immediate family is a little less abstract.

[pretty_panther]

Oh wow. I have no idea what you can say. *supports*

[marymac]

No, it's good that you're doing it! I just basically lose my mind on this topic because as I said below, children who died from epidemic disease in living memory in my own family - my older aunts can tell you about more cousins than my mum can.