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The good, the bad, and the ugly

December 6th, 2007 · 24 Comments · Narrative

Science writing, like autism, exists on a spectrum. First the good, from Heritage Newspapers in Washtenaw County, Michigan:

Addressing common myths of the flu vaccine, Crowe said most rumors are unfounded.

“Some people worry that they will get sick after being vaccinated. If they get sick, it’s only by coincidence,” she said. “The flu virus is not a live virus when it is used in the vaccine. There are no indications that it has caused people to suddenly fall ill.”

In addition, concerns that the use of thimerosal, a mercury-based preservative found in most childhood vaccines, is linked to autism have not been proven, she said.

“There is thimerosal in some flu vaccines, but all-in-all, I believe it’s safe,” she said. “The benefits outweigh the reactions to it.”

Got that? Unfounded beliefs are myths. Coincidence creates an illusion of causation. The virus contained in a flu shot is not dangerous. I’m not crazy about the lukewarm thumbs up for thimerosal – it would be far better to state unequivocally “There is no credible evidence that the small amount of thimerosal present in a flu shot is dangerous.” But what do you do? Dr. Patricia Crowe, center medical director for Concentra Urgent Medical Care Center in Brighton, might be concerned that anti-vaccine activists could follow her home after work. Regardless, editor Daniel Lai deserves major props for some solid reporting. Would a follow up story about the dangers of vaccine scaremongering be too much to ask? Email Daniel at dlai at heritage.com and encourage him to keep up the good work.

Moving on to the bad, KOMU-TV in Columbia, MO is posting a spectrum of viewpoints on its blog, Thrashing Autism to Within an Inch of its Life and Tossing it from a Moving Vehicle From Within. Viewer “Rachel”reminds us why a little knowledge is a dangerous thing:

I started researching vaccines when I was pregnant. My mother in law told me that she had heard that autism might be linked to them since they are giving so many now. When I found out that they were trying to convince me that the chicken pox was a “deadly” disease that we had to vaccinate against, red flags went up… you’re SUPPOSED to get chicken pox as a kid! I was also astounded that we needed to give a hepatitis B shot at birth. I don’t claim to be a professional in the medical field, but I am certainly no dummy. I know a thing or two about a few diseases, and I know that hepatitis B is a blood infection that is transmitted by IV-sharing individuals, prostitutes and homosexuals. NOT newborns in sterile hospital nurseries. I thought the medical community had lost their minds when they said they NEEDED to vaccinate at birth for hepatitis B. That seemed OUTRAGEOUS to me!

Huh? Chickenpox, can lead to secondary infections and death, especially in some high-risk groups. Serious complications occur via bacterial infection of the skin, but pneumonia and inflammation of the brain (encephalitis) also occur. Researchers in Ireland recently looked at children hospitalized with chicken pox over a 13 month period, and found that “bacteraemia/septic shock was observed in 30 children, pneumonia in another 30, en­cephalitis was seen in 26 of the cohort, while 25 children had ataxia. Toxic shock syndrome or toxin-mediated disease occurred in 14 children. Fifty-one per cent of cases had additional bacterial or viral infections and six deaths were reported, including one intra­uterine death.”

In a devastating Wall Street Journal op-ed, Dr. Ari Brown, an Austin pediatrician took Rachel, KOMU and their fellow travelers to task with this tale from the trenches:

I was the senior pediatric resident on call in the Intensive Care Unit. Cradled in the arms of her parents, a seven-year-old girl was brought to the emergency room at Children’s Hospital Boston. The girl had come down with chickenpox a few days earlier – she had a fever and hundreds of itchy skin lesions. That night, she had taken a turn for the worse. Her fever shot up to 106 and she became confused and lethargic. She was unresponsive and limp in her mother’s arms.

The ER doctors suspected that her open sores allowed Strep bacteria to get under her skin and rage through her bloodstream. Now she was in “multiple system organ failure” – every square inch of her body was shutting down all at once. IVs were placed into her veins to start fluids, antibiotics and medications to stabilize her heart and blood pressure. She was placed on a ventilator machine to breathe. Then she was brought to the Intensive Care Unit.

By the time I met my patient, she had tubes coming out of every opening and weeping skin lesions all over her body. I was used to blood and gore, but it was hard to look at her and not cry. Imagine how her parents felt when they saw their once-beautiful little girl in this grotesque state, struggling to survive.

My attending physician told me to grab dinner. This child would need me for the rest of the night. I returned to the ICU to find that my patient had gone into cardiac arrest and died. I watched, helplessly, as the nurses placed the little girl into a body bag.

So why does KOMU solicit and publish demonstrably wrong information? To present all sides, of course! But the station has really crossed a line with Rachel. Letting an unqualified viewer tell us that chicken pox is benign is reckless. A recent study in Pediatrics reports that autistic symptoms lessen with fever. Will Rachel recommend induced bacterial infection to recover children with autism? I know a TV-station that will give her a platform.

And finally, WLNS in Lansing, MI, serves up a steaming pile of ugly in a story about the state’s proposal to mandate insurance coverage of the treatment of autism:

Mara Husband, mother of autistic child: “It’s a constant battle between what’s the right thing for your whole family in the future, you know, do we risk the chance of maybe having to move in with his mom because we lose our house? That’s what we’re facing, so it’s very overwhelming.”

Overwhelming because, without treatment, there’s little hope for autistic children.

Without daily doses of critical thinking, there’s little hope for local TV news coverage of autism. What exactly is the evidence that autistic children face bleak, hopeless futures unless they receive anything more than the love, acceptance, and nurturing afforded their neurotypical peers? Repeat after me: autism is a developmental disorder. There is no cure, no magic bullet, but pretending there is can make matters much, much worse.

That’s the story.

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24 responses so far ↓

  • 1 Kate // Dec 6, 2007 at 9:54 am

    Hepatitis B is also transmitted through the birthing process; from mother to child. This is why infants are vaccinated within 12 hours after they enter this world. Additionally, Hepatitis B is an extremely hardy virus that lives outside of the body for a period of 4-7 days- unlike other viruses like HIV that are killed upon contact with the air. Once contracted, especially at such a tender age, the likelihood of acquiring liver cancer increases exponentially. As evidenced in places like China. Food for thought…

  • 2 Schwartz // Dec 6, 2007 at 7:54 pm

    It’s interesting that you rail all over anecdotal stories in the previous post, and then turn around and praise a different example of the same thing.

    I believe that’s called inconsistent application. I also find it interesting that the Crowe who is quoted, is actually technically wrong. People do get sick due to flu vaccination (there are published side effects, including common ones).

    The accurate statement should have been that you can’t get the Flu from the Flu vaccine because it’s an inactivated virus. You can certainly get sick.

    So given the blatent inaccuracy of the statement, combined with the noted lukewarm statement on Thimerosal, I find your choice of good journalism a bit lacking.

    Some more inconsistent application?

    Even better, why don’t you address the question of Flu vaccine efficacy? You’ll note that most of the recent evidence based studies of flu vaccine (including some independent meta-studies by the cochrane group) concluded that there is no proof of efficacy? Where is the reporting on that?

  • 3 Schwartz // Dec 6, 2007 at 7:56 pm

    Kate,

    Very true, so children who have parents that are Heb B positive should get the vaccine. As for the vast majority of the other children? Sounds like both an unnecessary risk and expense. Given the significant immaturity of the immune system at that birth, I wonder if the efficacy trials have been done to see how long the protection even lasts when given at that age.

  • 4 isles // Dec 6, 2007 at 10:26 pm

    Schwartz, the unfortunate truth is that hospitals don’t always test mothers for hepatitis B, and that when there was a brief recommendation to suspend use of the birth dose of hepatitis B vaccine, there is at least one known case of a child born to a HBV-positive mother failing to be vaccinated and contracting the disease. The birth dose is important as a failsafe against this kind of error.

    It also protects against avenues of transmission we don’t even understand yet. A significant percentage of hepatitis B cases are not traceable to known blood-blood contact, so the children of the antivaxers who sniff “well, MY baby won’t be shooting drugs or having sex” are not as safe as they think.

    As for “the significant immaturity of the immune system at birth,” that’s EXACTLY WHY infants need to be protected. The earlier a person is infected with hepatitis B, the worse the prognosis.

  • 5 Schwartz // Dec 7, 2007 at 12:03 am

    Isles,

    Sounds like a good reason to re-direct 99% wasted money and improve pre-natal care and testing. This is especially important since the US has one of the highest infant mortality rates compared to comparable first world countries. Somehow I doubt that’s going to be solved with more vaccination since the US probably has the highest number of recommended vaccines.

    This is a classic example of poor return on investment.

  • 6 Schwartz // Dec 7, 2007 at 12:05 am

    Isles,

    “It also protects against avenues of transmission we don’t even understand yet. A significant percentage of hepatitis B cases are not traceable to known blood-blood contact, so the children of the antivaxers who sniff “well, MY baby won’t be shooting drugs or having sex” are not as safe as they think.”

    Listen to your argument here. You’re claiming we should spend millions of dollars on vaccinating 99% of babies (and risking known side effects) who don’t need it for some unspecified mode of Hep B tranmission. Why don’t you provide some hard numbers on how many 6 month old babies contracted Hep B from an unknown source before I invest my millions of dollars?

  • 7 Schwartz // Dec 7, 2007 at 12:07 am

    Isles,

    “As for “the significant immaturity of the immune system at birth,” that’s EXACTLY WHY infants need to be protected. The earlier a person is infected with hepatitis B, the worse the prognosis.”

    You seem to be missing the point here. How effective do you think the vaccine is going to be if the immune reaction isn’t satisfactory? Again, did they study the efficacy of the Hep B vaccine when delivered at birth?

  • 8 _Arthur // Dec 7, 2007 at 10:45 am

    As for the chicken pox, even if it was true that _most_ *healthy* children recover easily, when chicken pox strike a children that is already frail or sick, for whatever reason, the outcome is another matter.

    That why the vaccine. The chicken pox vaccine doesn’t only protect us when we’re at our most healthy, but also when we are sick.

  • 9 Patrick // Dec 7, 2007 at 3:23 pm

    “You’ll note that most of the recent evidence based studies of flu vaccine (including some independent meta-studies by the cochrane group) concluded that there is no proof of efficacy? Where is the reporting on that?”

    Can we get some links or study titles to look at? or maybe the search terms that get them on pubmed hits?

  • 10 Marla // Dec 8, 2007 at 7:19 am

    I like your last point.

  • 11 Schwartz // Dec 10, 2007 at 12:18 am

    Patrick, here are some recent ones:

    “Summary points

    Public policy worldwide recommends the use of inactivated influenza vaccines to prevent seasonal outbreaks

    Because viral circulation and antigenic match vary each year and non-randomised studies predominate, systematic reviews of large datasets from several decades provide the best information on vaccine performance

    Evidence from systematic reviews shows that inactivated vaccines have little or no effect on the effects measured

    Most studies are of poor methodological quality and the impact of confounders is high

    Little comparative evidence exists on the safety of these vaccines

    Reasons for the current gap between policy and evidence are unclear, but given the huge resources involved, a re-evaluation should be urgently undertaken”

    http://www.bmj.com/cgi/content/full/333/7574/912

    At the conclusion it is stated:
    “The optimistic and confident tone of some predictions of viral circulation and of the impact of inactivated vaccines, which are at odds with the evidence, is striking. The reasons are probably complex and may involve “a messy blend of truth conflicts and conflicts of interest making it difficult to separate factual disputes from value disputes”22 or a manifestation of optimism bias (an unwarranted belief in the efficacy of interventions).23

    Whatever the reasons, it is a sobering thought that Archie Cochrane’s 1972 statement that we should use what has been tested and found to reach its objectives is as revolutionary now as it was then.”

  • 12 Schwartz // Dec 10, 2007 at 12:19 am

    The following article documents many issues that exist in determining the efficacy of universal flu vaccine application. He also expresses concerns regarding the safety of universal application given the lack of data.

    http://www.cmaj.ca/cgi/content/full/164/1/38#R10-22

  • 13 Schwartz // Dec 10, 2007 at 12:20 am

    This very recent review finds serious problems with the studies used to justify vaccination of the elderly and is unable to determine any benefit from the data:

    http://www.thelancet.com/journals/laninf/article/PIIS1473309907702360/abstract

  • 14 HCN // Dec 10, 2007 at 10:07 am

    http://www.amcp.org/data/jmcp/pages%2012-15.pdf

  • 15 Schwartz // Dec 11, 2007 at 2:41 am

    HCN,

    I’m not sure why you posted that, but it contains no data at all on the flu vaccine. The influenza vaccine in this paper is referring to HeB which is a childhood vaccine. They don’t even discuss it in the body of the paper.

    I also note that a lot of the references here come from industry funded studies which the Cochrane report (a semi-independent group) has clearly stated are filled with bias and design flaws.

    This paper was specifically written to promote widespread usage of the HPV vaccine.

    So far that’s 7 recent references to show lack of efficacy of the flu vaccine. That represents a huge cost benefit problem.

  • 16 passionlessDrone // Dec 11, 2007 at 10:54 am

    Hi Schwartz -

    I love you.

    - pD

  • 17 Schwartz // Dec 13, 2007 at 8:43 pm

    This cochrane review finds some efficacy when used in the elderly although they caution that the studies that showed this had potential bias. This review was performed before the Lancet study was available (from above):

    http://www.cochrane.org/reviews/en/ab004876.html

    This quote from the first article is interesting:

    “The large gap between policy and what the data tell us (when rigorously assembled and evaluated) is surprising. The reasons for this situation are not clear and may be complex. The starting point is the potential confusion between influenza and influenza-like illness, when any case of illness resembling influenza is seen as real influenza, especially during peak periods of activity. Some surveillance systems report cases of influenza-like illness as influenza without further explanation. This confusion leads to a gross overestimation of the impact of influenza, unrealistic expectations of the performance of vaccines, and spurious certainty of our ability to predict viral circulation and impact. The consequences are seen in the impractical advice given by public bodies on thresholds of the incidence of influenza-like illness at which influenza specific interventions (antivirals) should be used.”

    Please note that you won’t find any evidence to confirm the CDC’s death rates from Flu that they publish every year. Those numbers are used to justify the vaccine, but are almost certainly overestimated due to the inability to seperate flu vs flu-like illness. (let alone the lack of evidence of efficacy in many of the populations the flu vaccine is given to).

  • 18 autblog // Dec 14, 2007 at 7:16 am

    Cochrane says:

    In children and adults the consequences of influenza are mainly absences from school and work, however the risk of complications is greatest in children and people over 65 years old.

    Another consequence is a worldwide pandemic similar to the 1919 Spanish flu outbreak that killed tens of millions.

  • 19 Prometheus // Dec 21, 2007 at 1:20 pm

    The CDC makes a distinction between “influenza-like illness” (ILI) and influenza in its reports. If you would like to see the current report, go to:

    http://www.cdc.gov/flu/weekly/index.htm

    In these reports, they list pediatric deaths from laboratory-proven influenza, as well as nation-wide deaths attributed to pneumonia and “influenza”. The reported pediatric deaths are definitely caused by influenza.

    Last influenza season (which runs from October to May), there were 68 deaths of children under 18 years of age that were from laboratory-proven influenza.

    Since there were a little over 74 million children under the age of 18 in Jan 2007 (rough middle of the “flu” season), that works out to a shade under one in a million. Not bad odds, I suppose, unless it’s your child.

    Of course, the hospitalization rate was higher than the death toll. In the same influenza season, a little over 7,000 children aged 0 – 4 years were hospitalized with laboratory-proven influenza.

    And last season was a mild one. In the 2003 – 2004 influenza season, there were 152 deaths of children younger than 18 and almost 24,000 children 0 – 4 were hospitalized.

    I suppose it all depends on whether you’re willing to take the risk.

    It’s also worth considering the impact of vaccination on the deaths and hospitalizations. If there is a reasonable “herd immunity”, the people with poor immunity and those who aren’t vaccinated are safer.

    Prometheus

    Prometheus

  • 20 whoAREu // Jan 7, 2008 at 11:22 pm

    Who are you? Your ‘About’ page isnt working? I have been reading many of your threads here, and I am wondering, do you live with Autism each and every day? Does someone you love live with Autism? When you talk about ‘the debates’ between the possible link between Vaccines and Autism, I really can NOT believe you are stating what you are stating, I mean, you sound just like the people who are ‘naive’ to think that there could possibly BE a link..oh wait, you must not be one of those silly Moms who want ‘something to blame’…really…COME ON! You CAN not possibly 100% believe that there is NO connection between Autism and Vaccines? Especially since all of the wonderful TRUE studies you site all say that they have NOT found the cause of Autism…so if THEY cant say 100% that there isnt a link, then how can you? And if they say that they dont know the cause, then how can THEY say without a doubt that there is NO connection?
    Going back to the start of my post, IF you ARE living with ASD or love someone on the spectrum, then share your story, maybe if you can personalize these very judgemental and NAIVE statements, I can understand where you are coming from. If you are not personally affected, well, I guess I am just going to assume that you are just an angry person searching for someone to bash and call stupid….and if you arent THAT person, then, which pharm. company are you working for?

  • 21 HCN // Jan 8, 2008 at 8:00 pm

    ANB is a parent of an autistic child. He also posts as Heraldblog elsewhere.

    Speaking of news, have you seen this:
    http://www.sciencebasedmedicine.org/?p=14

    Also, for a collection of blogs of autitistic adults, parents of autistic children and those who work with autistic people go here;
    http://www.autism-hub.co.uk/

  • 22 MomNOS // Jan 19, 2008 at 6:05 am

    Hey whoAREu –
    Whats with the yelling? Im not hearing much well reasoned discourse from you. There is no link.

  • 23 Lucia // Mar 3, 2008 at 10:59 am

    I am doing a term paper for my english class on the contraversy of immunizatons and whether they are safe, effective, and neccessary. A major portion of my research deals with the link of vaccines to autism. Does anyone have facts or info pertaining to this subject?

  • 24 autblog // Mar 3, 2008 at 11:24 am

    Lucia:

    You can email me at ken@autismnewsbeat.com

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