Monday, May 9, 2011

Infant mortality and vaccines

oh goodness, here I wanted to go to bed early and then I stumbled over this latest "peer reviewed" paper in a journal "indexed by the National Library of Medicine" (see the anti-vaccine faction gloating at those fantastic quality indicators) and "proving" with an correlation co-efficient of 0.992 and a p of 0.0009 (so "sciencey") that:

Nations requiring the most vaccines tend to have the worst infant mortality rates

Authors of this little gem, in the journal Human & Experimental Toxicology, with the impressive impact factor of 1.307 and a proud ranking of 58th of 77 in the area of Toxicology (yes, that would put them into the bottom quarter) are Think Twice's own Neil Z. Miller and Medical Veritas' Gary S. Goldman. I wonder why Miller and Goldman didn't publish their paper in Medical Veritas (here is the link to the journal, please don't go blind), seeing that item 7 in their mission is: "Create a movement to address the adverse vaccine reactions and vaccine-related injuries afflicting children and adults". I guess that is because parents have clued in that "peer review" and being indexed on PubMed is a quality measure (although very obviously no guarantee for quality).

In any case - Miller and Goldman took a list of countries and looked at the number of vaccines they schedule for infants and they also looked at infant mortality. And then they correlated one with the other, a fail safe way to find causal relationships: Storks deliver babies p=0.008.

There are a number of things wrong with this procedure - first of all, the way Miller and Goldman are counting vaccines is completely arbitrary and riddled with mistakes.

Arbitrary: they count number of vaccines in US bins (DTaP is one, hib is separate) and non-specific designations (some "polio" is still given as OPV in Singapore), rather than antigens. If they did that, Japan, still giving the live bacterial vaccine BCG, would immediately go to the top of the list. That wouldn't fit the agenda, of course. But if you go by "shot" rather than by antigen, why are DTaP, IPV, hepB and hib counted as 4 shots for example in Austria, when they are given as Infanrix hexa, in one syringe?

Mistakes: The German childhood vaccination schedule recommends DTaP, hib, IPV AND hepB, as well as PCV at 2, 3 and 4 months, putting them squarely into the 21 - 23 bin. The fourth round of shots is recommended at 11 to 14 months, and MenC, MMR and Varicella are recommended with a lower age limit of 11 months, too, which means that a number of German kids will fall into the highest bin, at least as long as you count the Miller/Goldman way.

Then, they neatly put those arbitrarily counted doses into bins. Binning (i.e. grouping numbers before correlating them to something) always makes me suspicious. I don't have the time to check each country's vaccination schedule - I assume there will be mistakes in many claims, but I am guessing that if we plotted the infant mortality against the actual number of recommended vaccines, the correlation would be less good than engineered in this paper, i.e. the dose count above is probably not all that "arbitrary".

Then I noticed that the authors totally ignore historical trends. For example, in the early 1980ies, Germany's infant mortality was about 5 times as high (10000 infants died per year) than it is today (2000 died in 2009 with approximately the same birth rate), however (in Miller's and Goldman's twisted logic), the vaccination schedule contained far fewer vaccines in the first year (essentially just DT and polio, since the whole cell pertussis was not given between 1974 and 1991, the aP not yet introduced, the MMR given in year 2, no hib, nor hepB, nor PCV given either), while Germany was already very much a "developed country".

ETA: a similar point is made by Prometheus on Science based Medicine for the declining infant mortality rate in the US.

If I believed that one factor could ever explain something as complex as infant mortality, I would go and look at the relationship of maternity leave:

Japan, for example, generally gives 14 weeks at an average of 40% of a woman's salary and mothers are also entitled to childcare leave for their new baby's first year. Childcare laws dictate that in the first year of her baby's life, a mother may take two 30-minute breaks per day to care for her child (anyone else think breastfeeding?). She may also take time off any time during the baby's first year with one month's notice.

In Sweden, all working parents are entitled to up to 16 months of paid parental leave, Norway is similarly generous. Read the table and weep, US American parents!

In the bottom countries, the USA gives 0 months of parental leave, the FMLA offers some (up to 12 weeks) generally unpaid leave under very specific conditions. Heck - Botswana and Chad have better rules. Australia has 18 weeks (not months, like Norway) at minimal wage, but then, Canada, third worst in infant mortality has up to a year of parental leave at almost $2000 a month and that is where my crude correlation fails (although, if I binned some countries...a cunning plan).

ETA: Dr. Gorski picks up on some other flaws of this study - read his post.

In general, several large studies/meta-analyses NOT cited by Miller and Goldman, have indicated that if vaccines have anything to do with infant death, then as a protective factor, as this German study and meta-analysis and this large study from the UK.

To prevent SIDS (specified 10 May after comment):

put your baby "back to sleep"
do not smoke
breastfeed if at all possible (easier in countries with 18 months of paid maternity leave)
avoid loose bedding and soft mattresses or sofas
do not bed share when intoxicated, or smoker, or taking medicine that may make you drowsy, but keep your baby in your room
keep the sleep environment cool and don't overdress your baby

That is it.

9 comments:

  1. Another small point. Co-sleeping is officially only rooming in, which is encouraged by the AAP for the first 6 months. Bed sharing is not encouraged, and definitely shouldn't be done when there are any complicating factors, like substance use (including pharmaceuticals that may affect sleep), sleep apnea, or other sleep issues.

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  2. Gary S Goldman is not only the author of the above mentioned article but also the chief editor of medical veritas- the "obviously" only medical journal telling the truth (or as he claims "the only honest health science journal").

    In the latest issue you can read the artcle "Whats wrong with vaccines" from CJ Frompovich.

    http://web.me.com/len15/WHATS_WRONG_WITH_VACCINES/Catherine_J._Frompovich.html

    She claims-as do many of the antivaccine movement- that there are toxic ingredients in vaccines.

    Let us have a look on her findings:

    Aluminium would be an metallic aluminium- this is wrong aluminium salts but not Al-metal is an adjuvant.

    Then she comes to ASO3 this is a reletively new adjuvant from GSK consisting of vitamin E, sqalen (a cholesterin precursor), and polysorbate 80.
    But for the author ASO3 is arsenic(III)oxide - so wie are poisoning our children with arsenic according to medical veritas, the only honest..... bullshit journal.

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  3. Germany was a developed country in the 80's was it.... should have left the wall up

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  4. Do you doubt that Germany was a developed country? The numbers were for West Germany, I should have maybe specified.

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    Replies
    1. the former GDR had a vac obligation ;) would that be such a bad idea?

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    2. if things continue downhill in Germany, I think we will find out.

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  5. We have provided all the data that we utilized for the analysis of IMR and vaccine doses--so there is transparency in our study, allowing any and all individuals to do the analysis completely independently--using appropriate/valid statistical techniques. Epidemiologists and biostatisticians agree that nations reporting just a few infant deaths should be excluded since this translates into extremely wide confidence intervals and IMR instability. Health department policies typically include cautions concerning the use of such data. Please divide the data about the mean IMR value and mean (or median) number of vaccine doses and perform an odds ratio analysis and see if the trend is not confirmed. Please feel free to perform any longitudinal analyses as well and expand the selection of countries if desired.

    For example, one researcher wrote the following:
    "I found data on
    (1) child poverty rates,
    (2) low birth weights,
    (3) breast feeding rates,
    (4) teenage fertility rates,
    (5) births out of wedlock rates,
    (6) age at first marriage,
    (7) percent of divorces with/without children involved,
    (8) total fertility rates,
    (9) pertussis incidence rates, and
    (10) the mother's index
    on many of the same nations that are given in your article. When I controlled for each of these factors, none of them lowered the partial correlation below 0.62 even though child poverty rate, pertussis vaccination rate, and teenage fertility rate were significant predictors of IMR. This confirms your study's findings very strongly!"

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  6. Peter Abay et al. has definitively shown mortality rates jump in the first six months after D,P,or T, or any combo of them (worse for girls) and after polio vaccines. While the WHO sent numerous researchers to discredit him or his findings, they could not. here is a published article:http://ije.oxfordjournals.org/content/33/2/374.full
    and the graphs of mortality rates of all infectious diseases including those we vaccinate for was in its steep decline decades prior to vaccine introduction
    anyone who understands regression analysis or has common sense can see that our current m&m rates for "preventable diseases" were reached prior to introduction of the vaccines. THis is why pediatrics journal stated mortality rates were from improved nutrition and non-medical public health measures not anything else:PEDIATRICS Vol. 106 No. 6 December 1, 2000
    pp. 1307 -1317
    (doi: 10.1542/peds.106.6.1307)

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  7. Peter Abay et al. has definitively shown mortality rates jump in the first six months after D,P,or T, or any combo of them (worse for girls) and after polio vaccines. While the WHO sent numerous researchers to discredit him or his findings, they could not. here is a published article:http://ije.oxfordjournals.org/content/33/2/374.full

    No Toni, no they don't "jump" and nor was there any statistical significance for mortality rates. There were severe limitations to this study as A.) They could not identify vaccine manufacturer, B.) Counted children who obviously died of other causes and C.) Had an undetermined drop-out rate.

    anyone who understands regression analysis or has common sense can see that our current m&m rates for "preventable diseases" were reached prior to introduction of the vaccines. THis is why pediatrics journal stated mortality rates were from improved nutrition and non-medical public health measures not anything else:

    I'm sorry Toni but what is this supposed to be an argument for? It's okay to allow children to die of VPDs just because some were spared by non-medical interventions? This is supposed to be common sense? How about the thousands of children who died each year due to Hib prior to the vaccine? This disease mortality has absolutely nothing to do with sanitation and improved nutrition and now virtually no deaths since the introduction of the vaccine.

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