Your freedom of choice - somebody else's baby

I am having discussions with my non-vaccinating friend at the moment, who describes herself as "pro-choice" when it comes to vaccination. What seems absolutely impossible to grasp for vaccine refusers is that their choice makes other parents' children ill, and, potentially, kills them. The parents whose babies contract measles did NOT get a choice, NO say in their children's infection. That is the effect of vaccine refusal:

The below is Mobius - there are 24 hours between those pictures - the photographer, a friend of Mobius' family, Donavan Freberg, describes their feelings (shared from Refutations against Anti-Vaccine Memes page with kind permission of Mobius' mum):

This is Mobius Loop. He is the son of my dear friends Ariel Loop and Christopher Loop. He has measles. It was just confirmed. This is real, this is awful and these two photos are 24 hours apart. The good news? He's getting better. Quarantine ends tonight and the baby seems to be recovering well. The bad news? This was caused by one thing only, total and complete ignorance and selfishness of the anti-vaxxers. Because of people not vaccinating their kids (and when I say "people", I mean much of the upper crust westside of Los Angeles) this little sprout (who was too young to be protected) fell sick to a HIGHLY CONTAGIOUS epidemic that up until recently, had been a thing of the past. This is infuriating, sad and worst of all, needless. The Loops are dear friends, long time photo clients and informed, smart people. Ariel is a nurse. You don't just vaccinate your kids to protect them, you do it to protect other's who are too wee to get the shots. You are doing it as a selfless act. Please send good thoughts and prayers to this little muppet and to his parents, who are truly some of the best people I know.

Side note: I was scheduled to photograph this sweet everlasting gobstopper, but then this happened. I intend to photograph him the moment he has fully recovered and will be donating 100% of my shoot fees to charity to raise awareness of the necessity of vaccines. As a photographer, I must do everything within my power to document this and see that the awareness of this spreads faster than the disease in question. To all people reading this and for those who may be on the fence about vaccinating your kids, please, for Mobius and for all those who are affected by this terrible and PREVENTIBLE disease, DO IT. Vaccinate!!!! Don't even think twice. Just think.

ETA: Mobius' mum, Ariel, also weighs in:

I have a lot of mixed feelings right now, but ultimately I'm relieved that Mobius is doing so well. The horrific cough aside, he's doing way better than anyone expected at this point.
However, I'm furious that we're now part of the problem. While he's up to date with his vaccines, at 4 months he isn't old enough for the one that should have made this whole outbreak almost impossible. During the four days he was contagious before his rash appeared, we went out to eat twice, ran countless errands, and have potentially infected other kids who are too young to have to go through this. That kills me. And might kill one of them.

I understand that vaccines are scary. Having to hold him tight while a stranger hurts him is hard. Having three people hold him still to get the blood to test him for measles, however, was infinitely harder. Even at the time I had this passing thought of, "Am I being paranoid? Am I putting him through more trauma while he's sick for no reason?" I found myself almost hoping it was measles then so at least having to torture him would be "worth it."
It isn't, though. He shouldn't have had to go through any of it. I shouldn't have had to set alarms for myself in the middle of the night to make sure he was still breathing. It's bittersweet--I can't be as comforted by his recovery as it is clouded with guilt and fear that we might put another family through this.
Please, don't put other families through this.

Routine vaccination leaves man quadriplegic? Open Letter to Channel Nine

Like several other outlets, Channel Nine News reported the story of Ben Hammond, a Western Australian father of five, who came down with a debilitating episode of what is purported to be ADEM after a whooping cough booster. Now the Northern Rivers Vaccination Supporters have written an Open Letter to Channel Nine, which I am reposting here with kind permission, since it is, in contrast to Channel Nine's piece, evidence based and factual and important.

AN OPEN LETTER REGARDING A RECENT CHANNEL NINE NEWS STORY, THEIR INACCURATE PORTRAYAL OF VACCINE RISK, AND THE IMPORTANCE OF THE ADULT WHOOPING COUGH BOOSTER.

A news story that aired nationally on 2nd and 3rd June, 2014 on the Channel Nine News network and the Today Show was inaccurate and grossly irresponsible.

The story featured Perth father Ben Hammond, who received a Diptheria/Tetanus/Pertussis booster, and became seriously ill eleven days afterwards. Ben’s condition was said to be ADEM (Acute Disseminated Encephalomyelitis), a rare auto immune condition. This disease lead to Ben becoming quadriplegic for several months.

First of all, we wish to express our sorrow and sympathy for everything this man and his family have been through. By all accounts they have suffered a great deal physically, emotionally, and financially.
We are not writing to challenge or diminish what has happened to the Hammonds. This family deserves the support and generosity of the public to help them get back on their feet. We support a full investigation into the cause of his illness, so there is transparency on the facts of whether the vaccine caused it and the risks.
However the story breaches the Australian Communications and Media Authority Code of Practice (1):

• Section 4.3.1: The article was not factual or accurate and did not represent
  viewpoints fairly. It did not state:
    o How rarely, if ever, it has been shown that ADEM can be
       caused by vaccination
    o Any evidence to support this allegation
    o Why adults require the Whooping Cough (pertussis)
       booster
    o The relative risk to babies of whooping cough, versus
        the risk of the alleged vaccine reaction
• Section 4.3.2: It could cause public panic about vaccines and place
  newborn babies at risk

Why adults require Whooping cough boosters:
The Hammonds were offered a free booster during the time that Australia was experiencing the world’s largest Whooping Cough epidemic. This peaked at 38,500 cases in 2011. In response to thousands of babies being hospitalised and tragically over ten babies dying nationally, State governments have distributed millions of doses of the vaccine for free to new parents since 2009. Without the program, the number of grieving families would have been significantly higher.
Our group includes families whose babies have died from Whooping Cough, and who have worked hard to raise awareness of the need for adult boosters. This has saved lives, particularly of vulnerable premature babies.

Adults need a booster because of waning immunity, this happens both after the vaccine, and following ‘natural’ infection. Recent research has shown that this can occur as quickly as after four years(2). Unfortunately, nationally, less that 12% of adults have had a Whooping Cough booster (3). This means if there is an outbreak, an adult is susceptible to catching the disease, and passing it on to others. For most adults, this causes an irritating coughing illness that can last for months and lead to rib fractures and pneumonia; in young infants it can be deadly. Babies cannot have their first dose of protective vaccine until they are 6 weeks to 2 months old, so these very young babies must rely on adults being up-to-date with their boosters to be protected (4).

Risk of whooping cough to babies:
The story did not state the relative risk of acquiring ADEM after a vaccination, when compared to the risk of a baby catching whooping cough.

   • Nearly all babies that catch whooping cough require care in hospital.
   • It tragically proves fatal in 1 in 200 who catch it (5).
   • There is no cure for whooping cough. Babies face months of disease, and once it takes hold, the only treatment is supportive, with oxygen, and for critical cases, ventilation and ECMO (life support that, at best, also carries a very high mortality) (6).

Thankfully new research has shown that if a woman gets vaccinated when pregnant, this may halve the risk of the baby catching whooping cough (7). However, we are concerned your program will negatively impact on the uptake of this vital public health measure.

The facts about ADEM:
The news story should have featured a medical expert, to provide some facts about ADEM. Without the context of how rarely ADEM occurs after a vaccination, this omission could greatly damage public confidence in the vaccination program.

The alarmist headlines used such as “Routine vaccination almost fatal” “Vaccine danger” “Man becomes quadriplegic following routine vaccination” “One shot left him crippled” “Destroyed his life” and “Vaccination nightmare” were not counterbalanced with any information portraying the real-life risk of developing ADEM. Instead, we were solely given the Hammonds' own assertion of it’s cause.

ADEM may or may not be associated with some vaccines. We know that it occurs at such an extremely low rate it is impossible to determine causality with any scientific accuracy.
Indeed it is so rare the risk is something like 8 out of 1 million risk to the general population. Out of those cases, less than 5% follow immunisation, and it is much more likely to follow infection by one of the vaccine preventable diseases (8). There are many common and not-so-common bacteria and viruses that induce ADEM at much higher rates than those associated with vaccination.
The only vaccine proven to induce ADEM is the Semple form of the rabies vaccine. Other vaccines have all been implicated, most commonly the MMR vaccine, but the majority of the studies that correlate vaccination with ADEM onset use small samples or case studies (because there are so few cases to begin with). Large scale epidemiological studies have not shown an increased risk of ADEM following vaccination.

Also misleading was the implication Mr Hammond had “no immune system" and “no kidney or liver function” from the vaccine. ADEM should not cause organ dysfunction or immune suppression (although medication used to treat it can), and the paralysis it causes is usually temporary.
We take vaccine safety and transparency about that safety very seriously, and support the Hammond's use of the media to highlight the rare possibility of adverse vaccine reactions. The family deserves respect, and privacy, and we understand their need for financial assistance. We hope Ben’s case highlights the importance of a no-fault vaccine injury compensation program in Australia, for when adverse reactions to vaccines do occur.

However, unnecessarily scaring people away from vaccination programs such as against whooping cough could deter adults from having a booster, and place vulnerable newborns at high risk. News reports regarding vaccination should be clear and balanced. They need to present the relative risks of an adverse reaction to a vaccine when compared with the risks from vaccine preventable diseases. The media’s role in public perception of healthcare, risk of disease, and vaccine safety should not be underestimated, nor the responsibility taken lightly.


1: http://tinyurl.com/ltbyrl4
2: Wendelboe, A. M., Van Rie, A., Salmaso, S., & Englund, J. A. (2005). Duration of immunity against pertussis after natural infection or vaccination. The Pediatric infectious disease journal, 24(5), S58-S61
3: http://www.aihw.gov.au/publication-detail/?id=10737418409
4: http://www.chainofprotection.org/adultimmunisation
5: http://tinyurl.com/pwfthsw
6: http://tinyurl.com/msyg6pg
7: http://tinyurl.com/k3rp7t3
8: Huynh, W., Cordato, D. J., Kehdi, E., Masters, L. T., & Dedousis, C. (2008). Post-vaccination encephalomyelitis: literature review and illustrative case. Journal of Clinical Neuroscience, 15(12), 1315-1322.

Insolent demands and reality

There is a measles outbreak in Wales. 1181 cases of measles have been reported since 1 November 2012. Quite impressive for a small country (Wales has about 3 million inhabitants). Public Health Wales have done a stellar job in reporting numbers, breaking them down into the different Welsh regions and they run a Facebook page on which you can ask questions and will get them answered. Countless weekend and in-school clinics were run to get the Welsh youth protected (a lot of teens did not get their MMRs/or MMR booster in the wake of Wakefield's manufactuversy).

Despite PHW's fabulous work, the pro-disease faction have been up in arms. First of all, they abused the fact that not all cases were laboratory confirmed to claim that there is no outbreak, it is fabricated, all to cause panic to increase vaccine uptake (like good vaccination uptake was a bad thing). Never mind that laboratory confirmed cases are catching up with the reported numbers (like they should, those tests take some time to come back); that is part of the conspiracy, too (lowers voice "they noticed that numbers don't match, so they are making new numbers up" - really).

Equally suspicious, according to the anti-vaccine-critical, is that the vaccination status of reported cases is not reported in real time. PHW quite clearly stated on their web site that they'll publish a full report after the outbreak:

and explained on their Facebook page (multiple times) which cases were tested:

many anti-vaccine posters still insist that the delayed publication of numbers was fishy (after all, GPs should know whether their patient has been vaccinated or not) and continually allege that real time reporting was somehow important for their decision.

I call bullshit - there is nothing unique about the Wales outbreak. Last year, just north east of Wales, the Merseyside measles outbreak saw 359 confirmed measles cases, of which, not surprisingly, only 12 (3.3%) had received 2 MMRs. Those hugely relevant numbers (the two outbreaks within a year and 150 miles of each other) are convincing truly hesitant parents:

Meanwhile, I received the following letter from my Health Board:

It seems that although we have been registered with the same GP for many years, and said GP should have all of our children's vaccination records, and I have in writing that they are up to date, their Child Health System has our son down as "not [having] completed the full course of 2 doses of MMR". Obviously, ascertaining vaccine coverage is not quite as trivial as some think.

Thank you PHW for checking before publishing data on vaccine coverage without verification.

Now if you or your child really have not had 2 MMRs - go get them now. MMR is highly effective in protecting you and your loved ones from measles.

Fear mongering and responsibilties - UK private vaccine clinic fuels MMR fears

Wales is currently heading the leader board, unfortunately not in a good way (like for rugby), but for measles infections in the Western hemisphere. Since February, Wales has had nearly 900 reported measles cases, 80 of them hospitalised, and, as feared, now the first suspected death, 25 year old Gareth Colfer-Williams. A lot has been written about responsibility. Obviously, Andrew Wakefield came up as the main culprit, who in turn blamed the government for the outbreak, which they rejected. To be honest, to solely blame Wakefield for the MMR mess would be too much credit to the man. The MMR mess is a media manufactuversy as beautifully summarised by Ben Goldacre. And the greed for the headlines has not stopped, and Wakefield is still given front page coverage by irresponsible papers.

Meanwhile, clinics providing single vaccines for measles and rubella are having a field day. Under the guise of "we are just responding to parental fears" one private provider of single measles vaccines, the Children's Immunisation Clinic (CIC), is advertising their services (£ 50/~US$ 75 registration plus £ 110/US$ 165) playing on the MMR-autism lie, while making totally untenable claims. This starts off with:

A high percentage of the children we vaccinate also have allergies and excema which indicate they may not have a perfectly functioning immune system – and even so we have no recorded adverse reactions.

Wow - that is impressive. I wonder how they do that, given that the Rouvax for example, one of the vaccines that CIC is offering, has the following adverse effects (my bold):

The most common side effects (in more than 1 in 10 subjects vaccinated) seen in clinical trials were irritability/agitation and rhinopharyngeal catarrh.
Other side effects that occurred in more than 1 in 100 subjects vaccinated in clinical trials were fever >38°C, injection site reaction, rash/cutaneous eruptions, conjunctivitis, nausea, vomiting, abdominal pain, diarrhea.

They then post a google link to Hannah Poling:

In October 2008 Hannah Poling an autistic child won a huge payout from a triple vaccine manufacturer, who said that she had a DNA genetic predisposition to become autistic given the MMR vaccine More Info…

 and concluding with this beauty:

In 2009 a Dr Walker in the USA has studied 275 autistic children and found in a large percentage of the cases that these children had the live Measles virus living in their gut after vaccination with the triple MMR .You can see more about this on the Daily Mail online. We do not use the same MMR or Measles virus vaccine in the vaccine we have chosen to use.

At this point already, I know I am never going to entrust my child to this clinic. The Daily Mail as a source for medical information? Honestly? The article they mean is the one previously bemoaned by Liz Ditz to have been posted without time stamp. Everything else is false, too.

Steven Walker's work was presented as a poster at the IMFAR conference in 2006, so no "study", not in 2009 either.

The abstract reports on results of 82 kids, 70 of them supposedly had measles vaccine virus in the gut. They tell us they have samples of >275, but have not analysed them all. Also, we know since Dr Bustin's testimony to the Autism Omnibus proceedings and Hornig et al that measles virus has not and cannot been found in the guts of > 80% of autistic children.

I think this claim "We do not use the same MMR or Measles virus vaccine in the vaccine we have chosen to use" is a lie. We already know that the clinic have not looked at Walker's data, since they misrepresent his findings. There is actually no way the people at the clinic can know what vaccines the children Walker looked at had received, because it is not reported in the abstract and a full paper has not been published since 2006. Given that Arthur Krigsman is the senior author of the abstract and children have been flown to him certainly at least from the UK, it is not clear which measles vaccine strain they had been vaccinated with. The French Rouvax, CIC are offering contains the Schwarz strain, which is also the measles strain used in GSK's Priorix, often used in Europe, the Indian Sii M-Vax, also on offer at CIC contains the Edmonston-Zagreb strain, also contained in the Swiss MMR-Triviraten (Berna) (CIC also import vaccines from China and Russia, if someone knows what vaccine strain is in those, email me).

Now, tell me how you can interpret the above facts and let the clinic appear in a good light. At best, their research was irresponsibly shoddy and they conveniently believed the Daily Mail. At worst, they are intentionally fuelling parental fears to sell their singles with false claims. It gets worse though - on the side bar, on the lower right, the clinic claim:




No Autism in over 10 years and amongst 18000 Patient Record Cards?! That is an outstanding record and it sounds dangerously like a "warranty" (I am not a lawyer, but a lawyer friend of mine pointed this out). Absolutely amazing, especially given that autism/ASD prevalence in the UK has been published to be 1 in 67, so they should be looking at about 282 patients on the spectrum, give or take a few. The reason for their "Clinic Highlight" might be their rather unorthodox method of assessment...  "We [the clinic] ask you [the patient] tell us if you have an adverse reaction within a few days of the vaccine."


They are obviously way out of their depth now, because it is all fine and well to make exaggerated claims when it is "only" about people's money. But now Wales is steering towards breaking the 1000 mark of measles cases (probably by next week), children and young adults are very very sick and one might have died, and the tolerance wears thin. While CIC is still keeping up appearances for the BBC, they seriously lost it in response to a short article in last week's Sunday Times and in the middle of a massive rant (which they really want you to read in its entirety and not quote out of context, so they mention it twice, probably because they know how tedious their rant is) about "offering singles will increase herd immunity" and "not politicising the issue" slip in this paragraph (all typos are [sic]):

9) CIC is not judgmental about parents’ choice of vaccine (any vaccination ,generally ,is better than none) nor does it have any preconceived ideas as to the causes, be they single trigger(s) or perhaps even several different combinations of triggers.
Anecdotally though,  that portion of the parents who tell us their stories , all confirm that there was a dramatic change in behaviour, either with their child ,from their circle of friends , neighbours or work colleagues; and these families make up a significant minority proportion  of our population,
The emotional and financial burden on the family, the limited funding of the UK’s Health sector all point to potential benefit of further timely research into those specific cases which may then be identifiable as being preventable An unencumbered choice for either single or multivalent MMR vaccine options would do less harm  than the current situation of a large portion not willing to engage in any vaccination programme.

Goodness, somebody save them from themselves. CIC are in a hole, they should stop digging. If they wanted to keep up the illusion that they are there "to help" instead of setting up shop in Swansea in the middle of an outbreak and charging full price for their services, maybe they should have offered their singles at cost? Just to maintain the illusion that they weren't hell bent on keeping the MMR autism lie alive for their own business interest? Just an idea.

Don't panic at CDC's new autism numbers

The CDC has released the new autism numbers (Reuters, full report pdf) and the new prevalence is 1 in 50, or as Seth Mnookin tweeted earlier "1 child per school bus". My first thought, just like Matt Carey's over at LBRB, was that the removal of thimerosal seems not to have stopped the "autism epidemic". This seems to have escaped Dr "vested interest" Bob who is asking why nobody (but him, of course) is alarmed (especially not the CDC).

Meanwhile, the fabulous Emily Willingham, PhD explains the reasons behind the apparent increase. Read her post. Understand. Don't panic. As Emily says:

...if you look at the numbers and the report itself, you’ll see that overall, the numbers of people born with autism aren’t necessarily increasing dramatically. It’s just that we’re getting better and better at counting them. The next step is getting better at accepting autistic people, seeing their potential, and ensuring the supports and resources they need to fulfill that potential.

^ That.

Tetanus in an Unvaccinated Boy in NZ

It happens - unvaccinated children do contract tetanus (as we had reported before). It doesn't happen very often, but when it does, it is incredibly cruel. Alijah, a 7 year old Auckland (NZ) boy cut his foot (as children will do) and developed tetanus. The NZ Herald provides a harrowing description of what that means:

Within 36 hours, the 7-year-old Auckland boy was crippled by body spasms, unable to swallow and racked with pain.

"He was screaming in agony," mother Linda Williams said.

.../...

"It was hideous. He was spasming every three minutes. He was biting his tongue and bleeding. His arms were spasming and he was arching his back and his whole face and jaw was completely locked."

Alijah was admitted to a ward but 24 hours later he was moved to intensive care, put into an induced coma and paralysed by drugs to prevent the spasms and relieve the pain.

His breathing had to be monitored because the muscle contractions could close the airway, and later a tracheotomy tube was inserted in Alijah's throat to help him breathe.

Luckily, Alijah survived and could leave the hospital after 26 days, although he now faces a year of rehabilitation to relearn how to eat and walk. The parents are blaming themselves for their son's horrific ordeal and have since vaccinated their other children and asked other parents of unvaccinated children at their son's school to reconsider. Although both hold degrees in the science/health field, they had fallen for the anti-vaccine misinformation. Alijah's dad says:

Parents like us make the decision to not vaccinate on very little factual information about the actual consequences of the diseases - massive pain, disability and death - and a lot of non-factual, emotive information from the internet stating inflated figures on the frequency and severity of adverse reactions and conspiracy theories about 'evil' doctors, governments and drug companies.

.../...

Believing myths about vaccines is not the same as getting the facts. And that is the core problem.

We hear from more and more parents who are regretting their non-vaccine decision (e.g. against pertussis) and maybe it is about time more parents spoke about vaccinating. Currently, the discussion seems to be dominated by a very vocal minority, which, despite being on the very fringe manage to endanger children's lives.

ETA: a bit more info and renewed self awareness here.

Chalkboard is the New Comic Sans

It seems that Chalkboard is replacing Comic sans as the font of choice for woo. This image is popping up on all sorts of Facebook pages:

Not once? Nope, every time a new vaccine is licensed, it is tested against the current schedule (and the old vaccine against the same disease, if there was one). We had previously addressed this anti-vaccine lie - here is the list, by no means exhaustive, as a reminder:

Hexavac with Hepatitis A

Hexavalent vaccine with Rotateq

DTaP with Hib

PCV-13 with all infant vaccines

MMR and Varicella

PCV-7 with MMR, Hib and Varicella

Pediarix with Hib and Infanrix-hexa

New Hib with all infant vaccines

MMR with Varicella

MMR-V with Hib-HepB

MMR-V with all infant vaccines

Meningococcal-C with Hep B and Pentacel

Pentacel with PCV-7

Lies do not become "truer" when you use chalkboard - take the course if you don't believe us.

ETA: ohh look, the Skeptical Raptor has expanded on the links, so you don't have to click on every one of them.

Oh, Pout, *I* Was Going to Tackle This One Next and Orac Scooped Me

I was going to pitch it under the "concern troll" heading, but Orac saved me the work - please go and read

Respecting parental concerns versus pandering to antivaccine fears

It summarises my thoughts on "anti-vaccine wolf" in "concerned citizen sheep" skin just beautifully :)

much ado about timing of measles shot

A newspaper snippet is making the round on the interwebz...

Timing of measles vaccine questioned Quebec had a large outbreak of measles in 2011, with more than 700 cases reported. Surprisingly, a number of the teenagers infected had received the recommended two doses of vaccine. A study De Serres did last year showed those who got their first shot at 12 months of age were three times more likely to get infected than those who got their first shot at 15 months of age; his new study put the risk at six times more likely.

We know what will become of this in the claws hands of anti-vaccine vaccine-critical folk. "An outbreak in Quebec where 700 vaccinated teens got measles proves that current vaccination schedule makes teens six times more likely to contract measles". So let's look at the actual study: It analyses measles cases in one high school in Quebec with 1306 students. The index case was a teacher, who imported the measles. This teacher had been vaccinated once. Passive and active surveillance identified 110 students with measles in the following outbreak - I'll bold the notable passage:

Of the 110 student cases identified, 98 were therefore classical (23 laboratory confirmed) and 12 were attenuated (Table 2). Attenuated cases were only found in 2-dose recipients, none of whom had been revaccinated as part of outbreak control.

So out of 1306 pupils, 110 got sick, 12 of them mildly. Mild cases had been vaccinated twice. Have a look at this handy little table:

The overall attack rate among unvaccinated students was 82%,
the overall attack rate among vaccinated students was 4.8%.

Vaccine efficiency was 95.9% for one dose of MMR. It was 95.5% against classical measles and 94.1% against any measles in the 2x vaccinated group. The authors then analysed the 2x vaccinated students to see whether vaccine protection waned with age. That was not the case. Instead they found that for students who were vaccinated at 12 months, vaccine efficiency was 93%, whereas in students who had had their first MMR, it was 97.5%. When you compared those two groups with each other, the relative risk of the 12-months-at-first-vaccination to contract measles compared to the 15 monthers was about 4.35x higher, which was borderline significant (p=0.04). That bit made the news. The fact that measles vaccination offered highly significant protection against measles somehow didn't. Well, now you know.

5 Minutes with Ben Goldacre on what is "bad science" and what is "good science"

Those of you who don't know Dr. Ben Goldacre - go and buy and read his book "Bad Science", now. It may be a bit Britain focussed for the non-Brits out there, but it is a great introduction on how the media and snake oil salesmen and -women take advantage of us and reading the book and understanding its principles will protect you, your health and your wallet. Ben Goldacre takes on the great manufactroversies, like the one about MMR on his blog, his book, in talks he gives, in wonderful short films on health (for example placebo) and in testimony to the British Parliament, and so his debunking work is directly linked to public health (and vaccines). The BBC have interviewed Ben Goldacre in their "5 Minutes with... series" - have a look at the author (and go get the book if you haven't).

Oh, and should you be tempted to comment "pharma shill" or something the like, read one of the below (paperback out on 27 September 2012) on an empty stomach and call me in the morning...

"Spot of bother" as The Sun reports on measles

The English Sun tabloid has a short piece on the rise of measles cases in the UK, which is a masterpiece in media accuracy, or rather, lack thereof.

It starts with the picture used:

which is indeed a "spotty" child, however, this child clearly has chicken pox, not the measles.

The teaser is more of a political statement than a summary (also reflected in the link text http://www.thesun.co.uk/sol/homepage/woman/health/health/
4523220/Spot-of-bother-as-UK-catches-the-measles-from-London-2012-Games.html):

The number of measles cases here in Britain has almost doubled after a surge of visitors arriving for the Olympics and Paralympics.

Well, no, actually, the measles numbers reported here by the Health Protection Agency are for the period of January to end of June 2012. The Olympic Games didn't start until the 27th of July and visitors have nothing to do with the rise in measles cases. The Sun goes on:

Tourists from other countries, including the United States, have been warned to have a vaccination before arriving in the country to avoid creating an epidemic in other parts of the world.

Yes, spot on - the UK might export the measles, and has not imported them through Olympic athletes or spectators. Why didn't you write that in the teaser or link?

The subsequent image is titled "Failure... parents have neglected to vaccinate their kids" 

Holy cow - if the MMR came in such a huge syringe with such a big fat needle, I would have hesitated too. In fact, only about 1/6th of what is shown in that image (0.5ml instead of the visible 3ml) are injected. That is about 1/10th of a teaspoon full of fluid.

The Sun is reasonably good about describing the symptoms of measles, however they are, unfortunately, wrong about this:

The last UK death was a two-year-old child in 1992.

The last UK death was a 13 year old boy in 2006. 

The Sun is also overly optimistic when it comes to treatment options for the measles. While 

Children may be treated at home with pain and fever-reducing syrups such as paracetamol and they need plenty of fluids.

will be true for the milder cases, this:

Hospital treatments, with antiviral drugs, may be needed in more serious cases.

is actually not possible. A recent publication on measles control states very unambiguously:

Currently, no therapeutics for the treatment of measles are available.  

so that hospital treatment for serious cases means ventilation for respiratory distress, antibiotics against opportunistic bacterial infections and general life support in the case of encephalitis/coma.

At least they get the last bit right:

What can I do prevent it? UK kids are offered vaccination against measles as part of the MMR vaccine, which is given to them between 12 and 15 months of age.

They then have a booster before they start school, between the ages of three and five. 

Is the vaccine safe? Yes. The original paper suggesting a link between MMR and autism was discredited and its author had his licence to practise as a doctor removed.

Since his flawed publication, there has been lots of scientific evidence to prove that MMR does not cause autism.

It is a bit disappointing to see perfectly correct recommendations follow a piece riddled with errors. Hopefully, the inaccurate ideas about imported measles and treatment options for complications won't stick, while immunisation recommendations will.

Australian Anti-Vaccination Network AVN pwned by stopAVN statistician at their own seminar

Since we didn't post anything yesterday, here's a quick post to celebrate Stop the AVN's Scotty Harrison's beautiful talk at the Australian Anti-Vaccination Network's seminar "Vaccination and health - your right to choose" held in Armidale NSW a couple of days ago. I think the audience and organisers were expecting a slightly different take on the issue than they got - have a look and hear the guffaws about 3 minutes in as the penny drops:



Rather small-mindedly, the organisers turned down Scotty's generous offer of coming back for the next seminar the next day to provide some balance. Pwned - just beautiful - cheers mate!

August is National Immunization Awareness Month

The title says it all, tomorrow, National Immunization Awareness Month starts and Just the Vax will support vaccination awareness by blogging daily on vaccine related issues. Since a daily blog is about 30x the frequency of our usual activity, some posts might just be a "read this today" reference to other people's blogs. So let's warm up with this post by Orac over at Respectful Insolence, who today exposes Joe Mercola's typical anti-vaccine cherry picking and distortion of data:

Joe Mercola attacks vaccinations again. Film at 11.

and as a reminder why immunization awareness is really important - pertussis soars in the UK with 5 dead babies this year to date:

Whooping cough outbreak spreads to very young babies

Support Libel Reform

Bloggers in the Health Field are often threatened with legal action. This is a problem especially in the UK because of their plaintiff-friendly libel laws. The Libel Reform Campaign lobbies for changes in law with some success, which is not comprehensive enough, though. I can't go to the below, so if you are in the UK, please have a read of the following and consider becoming a

Dear Libel Reform Supporter,
On 27^th June, we will be part of group who will present the petition you have signed to No.10 Downing Street. We will be asking for a Defamation Bill that will make the libel laws fairer, more accessible and in the public interest. Will you help us and let MPs know that the Defamation Bill currently passing through Parliament is still inadequate?
For example, the Bill lacks a public interest defence, which is what those writing on matters on public interest desperately need. The unfair libel cases (Singh, Goldacre, Wilmshurst, etc) that sparked the Libel Reform Campaign could all happen again without a public interest defence.
In this final push for a truly fair and effective Defamation Bill, you can do your bit in three simple ways in three minutes: 

1. Please send an email to your MP if you have not done so already last week. You can find a template email and instructions for contacting your MP here http://www.libelreform.org/news/527-write-to-your-mp2. Please tweet: “Support #LibelReform by signing the petition http://bit.ly/8gJQ7w - if you’ve signed already, click http://bit.ly/LvOqrG to remind your MP”3. Please forward this email to 5 people who you think care about free speech and ask them to write to their MP and tweet. 

Finally, please  join us all at the Houses of Parliament on 27th June at 10.30am immediately before the delivery of the petition to Downing Street. A large show of support will impress upon MPs that many people are committed to winning the battle for a fairer defamation law. You can find details of what to do and where go here.  Let Mike and Síle know if you can come at news@libelreform.org so we can save you a space.
Brian Cox 

Dave Gorman 

Dara Ó Briain

Sue Reid propagates MMR Manufactuversy in the Daily Mail

MMR does not cause autism. There is no controversy about this. Medical experts agree. There is no epidemiological connection between MMR and autism (in Denmark, England, Japan, Japan, Japan, Poland, and the United States), papers alleging a connection have been retracted, no one has ever reproduced the "MMR measles virus infiltrates gut, causes autism" claims of Andrew Wakefield and the largest court hearing, the Autism Omnibus trials in the US, has denied all three test cases and appeals for the various "autism is caused by vaccines" hypotheses. The media hype, largely responsible for the drop in MMR uptake in the UK and subsequent mumps and measles outbreaks has died down, parent confidence is rising, and MMR coverage rates are picking up.

It seems this is not common knowledge across Europe though. This March, a provincial court in Rimini, awarded a family €140000 for their son's autism "caused by the MMR". A quick glance at the plaintiff's side reveals an anti-vaccine "dream team":

Their lawyer, Luca Ventaloro, is a well known Italian anti-vaccine advocate (seen here on YouTube explaining how to legally avoid compulsory vaccination). And while their doctor, Massimo Montinari (misspelled as Montanari in the court decision), has no proper biomedical research papers on autism or MMR or vaccines in general, he authored the book "Autismo: i vaccini fra le cause della malattia" and sells his own autism "cure" protocol. Why the defendants, the Italian Ministry of Health, apparently did not present any of the huge body of evidence against any association between MMR and autism is not clear. Ironically, the Cochrane Team reviewing the MMR is Italian. After the ruling, horses bolted and all, it appears that this decision will be appealed. Already, the Italian Federation of Pediatricians has protested and pointed out the poor factual basis on which the court's decision was made.

Now, the lack of evidence-based information in the Italian decision and the bias in the parents' team should be blatantly obvious to anyone with a keyboard and access to the internet. Nevertheless, the Daily Mail, not entirely innocent in the original media campaign against the MMR, joined the ranks of the usual anti-vaccine activists (no links to those guys) and published a sensationalist article:

MMR: A mother's victory. The vast majority of doctors say there is no link between the triple jab and autism, but could an Italian court case reignite this controversial debate?

What they obviously mean is "let's help them reignite the debate, so our web site gets clicks and our paper sells copies - yeah". That kind of fear mongering is highly irresponsible in the light of the lack of evidence for a connection between MMR and autism (see above - interestingly, Autism Omnibus verdicts never made the Daily Mail) and record measles outbreaks across Europe and the UK. A fellow blogger, equally astonished about this inflammatory piece of poorly researched journalism, now revealed the Daily Mail author's motivation. Sue Reid is just simply anti-vaccine minded, conspiracy theories, pharma shill allegations and all, although she seems to recognise that this is not popular and threatens libel action. If the comments are correct, she is no stranger to controversial reporting based on fabricated evidence either.

In any case, the ruling is unlikely to stand very long - the inflammatory language used in the Daily Mail piece is likely to cost some children their health. The current measles outbreak in Merseyside has well over 300 patients, with a hospitalisation rate of 18%. Well done, Sue Reid and the Daily Fail.

Measles in Europe: personal stories about coma, SSPE

Euronews has uploaded a video on measles in Europe, including the stories of Nastasia, a French teen who spent 12 days in a coma, needed 4 months of physiotherapy to learn to walk again and still suffers from a weak bladder, due to the muscle loss. Her mum believes in "building natural immunities" and in "treating with homeopathy". Max, a German boy, caught measles when he was 6 months old in his older sibling's kindergarten. SSPE caught up with him in 2006 - the family's life is centered around care for Max, who is a wake coma and needs round the clock care until he dies. Watch until the end... (and sorry for the annoying YouTube ad at the beginning)...

Letters: Dear Doctor - Dear Parent

The Thinking Moms' Revolution blog (not to be confused with the very useful Thinking Person's Guide to Autism) is written by a number of mothers who strongly believe in "healing" their children's (vaccine-induced) autism. Overall, they seem to be very angry, which is beautifully reflected in a recent post - "The letter I wish I could send to my old pediatrician". There is, of course, no reason why the poster could not send that letter, although her chances of the pediatrician actually reading it might go up, if she find another address than "Dear Dr. Asshat". Orac does a good job in taking the fallacies in the letter down, however, as often the case, one of the commentators takes the cake with a response letter, which deserved to be showcased:

Dear Ignorant Parent:

We are well aware that you pulled your child out of our practice, since we've seen a marked decrease in the volume of ignorant questions that our nurses have had to answer as of late. Trust us, you won't be missed.

Will we lose an ounce of sleep over you deciding the vaccines are wrong for your child? No. However, if your young, and unvaccinated little one comes down with measles, mumps, whooping cough, polio, or rubella then we would wager that you will. We've treated all of them in our tenure as doctors and be assured, while modern medicine can reduce the risk to your child after infection, the results can still be daunting.

Blindness, paralysis, deafness, and even death are some of the results of not vaccinating your child from diseases that once killed millions around the world. By not allowing us to vaccinate you are saddling your child with plenty of risks, none of which he should or need bear.

We all understand that the internet is a treasure trove of information. The problem with that is that not all the information is correct. Certainly you can find information claiming vaccines cause autism and a host of other developmental problems. Guess what else you can find? People that believe the earth is flat and that nobody has ever been to the moon. You claim there's evidence to support your claim? How nice. So do the people that believe the earth is flat. A cursory internet search on vaccines being bad does not make you an expert. Years upon years of medical training does, and that learning process is ongoing.

If you thought we were curt with you when you started asking these questions then it's most likely because we've been inundated by questions from you. Asking the same thing a hundred times but slightly changing the wording isn't going to get you a different answer. You decided long ago that vaccines were evil and now you simply want to try to get us to go along with you. We aren't going to. When we rolled our eyes at you for citing a study that was twenty years old it was because there was twenty years of newer information that supported our point of view.

Your claims that we broke your child are ludicrous. When you showed us an outdated study that linked autism with vaccination we showed you a dozen that did not. Our data was somehow tainted in your mind because you believe that we're all in the pocket of some shadowy conspiracy group. We aren't. Your claims that we're running a business and that we make money off vaccinations are also completely unfounded. Be assured that treating a child who has contracted the mumps is going to be a lot more lucrative than simply vaccinating against it. Yet, that's what we do. The Hippocratic Oath says do no harm, you like to say that, but there is another important part of that oath you missed, where is states that prevention is preferable to cure. In our tenure as medical professionals we have come to believe in that statement after treating scores of children permanently harmed by diseases the should never have been stricken with but for their parent's misguided good intentions.

We wish you the best of luck with your family and hope only for the best for you all. We also hope nothing bad comes of your decision.

I am not sure that time could mend the communication breakdown between mothers who think of their doctors as "asshat" and doctors who think of their patients' mothers as "ignorant", but lack of communication is one of the main reasons why parents take their children (or adult patients themselves) to charlatans. We know that time with the patient/parent influences continuity in care (i.e. how long the patient will stay with a health care provider), there are good recommendations in the literature how to address the concerns of parents who refuse vaccination, which also have time as an essential component to build trust and establish and maintain communication channels. More and more physicians dismiss non-vaccinating parents from their practices. They perceive the risk for their other patients as too high. This does mean though that the children of these parents are likely to end up in suboptimal medical care reinforcing their unrealistic views of vaccine dangers. Do you think an insurance-reimbursed hour per new child in a pediatrician's practise would be a solution?