Immunizations: controversy or non-controversy?

Recently NPR ran a piece about a woman who asked questions about the safety of vaccinations for her child. She was somehow connected with a leading vaccine "expert" who "educated" her about vaccinations. This physician was well supplied with research data which lent support to the idea that vaccines are both safe and effective. The women told how she went from being skeptical of vaccinations to being militantly against the non-vaccinators in this world, who she felt just freeloaded the benefits of vaccination without going through the trouble of vaccinating themselves or others. My colleague in homeopathic practice, Dr. Jon McGonigle, recently gave a talk at a local hospital in which he presented the case for thoughtful consideration of the safety and efficacy of vaccinations. His opponent, who argued the case for vaccination, attempted to shut down such thoughtfulness by presenting volumes of research data supporting vaccination.

To supporters of vaccination, those who question it must seem like spoil-sports or stubborn contrarians who obnoxiously refuse to accept what is clear and obvious. With such voluminous data supporting the safety and efficacy of vaccinations, who but the most mule-headed could continue to question the wisdom of vaccination? Is there any reasonable basis to doubt the evidence that would seem to make the widespread use of vaccinations a virtual no-brainer?

I do not claim to be an expert in vaccinations, but I have read about the topic and am familiar with the arguments on both sides. As a physician, I find the research evidence compelling, but I also find it impossible to ignore the arguments that have been raised against vaccination. I am not an anti-vaccinationist. Still, reason dictates (to me, at least) that a wiser course of action is to neither blindly accept the vaccinationists or the anti-vaccinationists positions, and to maintain an open-minded attitude about vaccinations. Indeed, you should not allow your minds to be shut to the thoughtful process of evaluation of anything your doctor recommends, and I include myself here, whether it be vaccination or any other medical intervention. Your brain has a purpose: use it!

The research evidence for vaccinations speaks for itself. It uses the instrument of statistics to demonstrate that vaccinations are both safe and effective. The statistics are there and their validity is in general quite impressive. In areas of the world where infectious disease is endemic, research has shown that incidence of these infectious diseases, along with subsequent mortality and morbidity has dropped dramatically and in some cases (polio and smallpox) disappeared entirely (see the National Network for Vaccinations website) with the introduction of vaccination programs. As usual, the problem with statistical methods is not usually in the statistics themselves, but with their interpretation. This is what led Mark Twain to observe that "there are lies, there are damn lies, and there are statistics." Caution in the interpretation of statistics is rarely in evidence in medical journal articles. Indeed it is not uncommon to find unjustified claims of safety and efficacy in the title, abstract or conclusions of a scientific medical research article. These mistakes have led to tragic errors of medical judgment such as with Thalidomide, Diethystilbestrol and Vioxx, to name but a few. Let us therefore survey briefly some of the problems with vaccinations that have been raised for the most part by those who come from the "safety first" camp. Consider the following facts that have been reported in various sources as you evaluate the merit of vaccinations:

1. The incidence of infectious disease began to drop markedly in the early and mid-twentieth century well before the introduction of massive vaccination in the 1950's and 1960's. This has been widely attributed to improvements in public health and greater awareness of hygienic practice. This trend continued after the introduction of vaccinations. Whether the continuation of the trend represents a continued effect of improved public health practices or the effects of the vaccination program, or both has not been proven.


2. There is a well established record of vaccine injuries. Indeed the government established a national vaccine injury compensation program for such people, so even our government acknowledges that vaccines can be harmful. Congress enacted a law in 1986 ("The National Vaccine Injury Compensation Program" (NVICP) in response to information about multitudes of children who had become sick or even died after vaccinations. Some reports have linked vaccinations in infancy to SIDS (Sudden Infant Death Syndrome). These include findings by Australia's Viera Scheibner, PhD, which revealed an increased incidence in SIDS among infants after vaccination. There have been 100's of children whose parents have developed autism within weeks or months after vaccination. Their efforts to obtain compensation through NVICP have, with a few notable exceptions, been rejected because statistics do not support their claim of a cause and effect relationship between vaccination and their children's illness.
   
3. Many people who have been vaccinated fail to acheive immunity (as measured by antibody titers found in their blood) or, for whatever reason, become infected in spite of being vaccinated. Infants in particular, whose immune systems are underdeveloped are prone to this, which is a reason for frequent revaccination during the first year of life. This has also led to the addition of "adjuvants" or immune enhancers to trick the immune system into responding more robustly than it naturally would. By asking the immune system to respond in an abnormal way, it is assumed there is no payback or fallout, but in fact the economy of nature would suggest otherwise (there are no free lunches).


4. For some illnesses, such as influenza, those who would benefit most from the vaccination, such as infants and the elderly, because of their vulnerability to develop more serious and potentially dangerous forms of the illness are also least likely to develop a protective antibody response to the vaccination because of weaker immune function. This is the case with influenza, and possibly some other vaccinations, such as pneumovax. In addition, vaccination for influenza is from last year's strain of influenza (from which the vaccine has been cultured) and may or may not be relevant for the current year's influenza strain, which can not be determined until mass outbreaks occur.


5. There are many case reports in the scientific literature and reported in other journals of children who received vaccinations who developed autism or developmental regression soon after receiving vaccines. While the research has thus far not established a statistically verifiable connection between autism and MMR (the vaccine most often implicated in the development of autism), the parents of these autistic children have repeatedly testified that their children showed dramatic negative changes in their health soon after vaccination and would likely be unpersuaded by (and probably furious with) anyone who tried to tell them that vaccines are safe. Indeed, there are a few reported cases where the government has offered compensation to the parents of children who have become autistic after vaccination, in spite of NVICP's general policy of denial of such suits.


6. It is known that infant's immune systems are immature, yet it is considered without substantial risk to embark upon a course of extensive vaccination for them. Children may be vaccinated within hours of emerging from the womb. Hepatitis B vaccination is usually begun within hours of birth, and while it appears to have led to a reduction in the incidence of Hepatitis B, there have been reports of immune and immunologic damage following Hepatitis B vaccination. This may be because the infant's immune system is not prepared to handle foreign proteins injected internally.


7. The incidence of autism, asthma, ADHD, allergies and other chronic illness is rising with no credible reason offered by the medical profession. The development of chronic illness when acute illness is suppressed is consistent with the homeopathic concept that suppression of illness tends to lead to the development of more serious and more chronic illness. Indeed, the costs of health care in the United States are growing by leaps and bounds, so while we may celebrate the decreased incidence of infectious disease, we can not necessarily conclude that we as a society are healthier as a result of vaccination. Many have argued that there is a price to good health, but the reverse logic is equally credible -- namely, that the healthier we are, the less health care we should need.


8. There seems to be no limit to the number of vaccinations our children can be given without raising questions about their benefits. While each individual vaccination comes with its body of research evidence, no concerns ever seem to be raised about the number of vaccines we subject ourselves and our children to. The more, the better seems to be the underlying assumption. This raises the question whether the actual risk may be greater than the sum of each individual risk -- a synergism of multiple vaccinations. It is well known to be the case with medications, where polypharmacy is regarded in most medical circles as a dangerous practice, or at least one best avoided if possible. During the first year of life, the CDC recommends a total of 7 different types of vaccines, given a total of 18 times. Over the first 15 months of life, there are 12 different recommended vaccines, given a total of 27 times. Gardasil is now being considered as another mandatory vaccination. (Since I first posted this blog one month ago, 2 rotavirus vaccines in the first 8 months of life have been added to the list of recommended vaccinations by the American Academy of Pediatrics.) Where do we stop? Nowhere, or only when it is clear we have gone too far, when the damage is widespread and irreversible?


9. We have been given reassurances many times about the safety of medical treatments that seem to challenge common sense, only to find later that the data had been misinterpreted, or methodologically flawed. In addition to misinterpretation, research data may be fudged, suppressed, used in restricted population groups which don't relate to the public in general. The dangers of long term effects may not be apparant in short term or even extended trials, only to raise their ugly heads later, after many have died or been permanently maimed. Medical research has emphasised efficacy over safety for centuries. Hahnemann warned of this back in the early nineteenth century, when he referred to primary and secondary effects of medicines: the good effects came first, and the heavy price often came second. In short, research data can no longer be trusted the way it once was. People have been killed or maimed too often by treatments which the government, medical researchers, and physicians themselves have calmly and self-confidently proclaimed to be entirely safe.


10. There is increased evidence that we must try to live in harmony with nature, not try to master it. The triumph of vaccination has helped to eliminate illnesses that were once the scourge of humanity: polio and smallpox for example. But now new infectious agents arise that are proving even more challenging, such as AIDS, MRSA, and possibly new strains of influenza (bird flu). Humans have tried to master nature for their safety, pleasure and comfort. We have found however, that our use of fossil fuels, commercial agriculture, and technology has proven imprudent. We did not forsee the problems of pollution, such as global warming, toxins in our food, in the toys of our children, in the water we drink, and in the air we breath. We did not forsee the effects of commercial agriculture on the quality of our food, which has now affected the quality of our health. Thinking that we can ride roughshod over mother nature has proven to be misguided. The use of antibiotics has led to the appearance of MRSA, clostridium difficile, pseudomonas, and resistant strains of tuberculosis. Antibiotic use can also lead to fungal infections, and to the selection of multiple antibiotic resistant bacterial strains. As we continue to make "progress" technologically, we wipe out species of plants and animals. When do we stop to consider the possibility of living harmoniously with nature, rather than destroying, in General Sherman-like manner, every part of it that lies in our path?


11. Some may say that one can't live harmoniously with small pox, plague, polio or leprosy. Homeopathy is able to prophylax against most infectious disease with some success (albeit possibly with less overall efficacy than vaccination). It can also treat most acute infectious illness including viral illness, again with considerable, but not total success. Homeopathic treatment virtually never results in any serious morbidity or mortality. It also provides a means of living harmoniously with nature. It does not have dangerous or lethal side effects. The worst that can be said about it is that it is not perfect. It does not wipe out infectious organisms or the diseases they cause. But it also does not cause holes in the ecosystem which later may be filled by even more pathogenic organisms. It does not pollute or destroy the environment. It does not suppress acute illness and in the process create chronic illness. It is a reasonable alternative to vaccination for many or most infectious illnesses, but it may not alway confer the degree of protection we would like to have.

In sum, vaccination has been shown by numerous studies to be effective in reducing the incidence of certain infectious diseases, but it has not proven to be equally effective for all, and it has a compromised safety record. It is touted as being a wise choice without sufficient regard for the long-term and short-term risks, both to ourselves and to the ecosystem. It is difficult not to succumb to the temptation to protect ourselves and our children from frightening diseases. But we must remember that while we protect with one stroke, we may be opening ourselves up to other dangers with another. We simply do not know the long term consequences of vaccination. Vaccination should be considered a useful option, probably some vaccines more than others (Diphtheria and Tetanus appear to be among the safest), and particularly in situations where epidemics are present or threatening, but it may or may not be a wise choice as routine treatment for ourselves or our children. It is not the no-brainer choice that it has been held up to be. It warrants careful thought, and much further research. This research will not occur as long as there is blind acceptance of the safety and efficacy of vaccines and as long as an attitude that discourages thoughtful reflection upon the research data persists in the medical community.