The Fear Industrial Complex

I generally dislike John Stossel's reporting. He's overly simplistic, a bit cruel and supercilious, and like all TV journalists of his type would rather kick you in the groin than tell the truth. But I admit, I enjoyed watching him rake Barbara Loe Fisher and the DTP lawyer Allen McDonnell over the coals on 20/20 on Sunday. To be sure, he rounds off a few facts. It's not true to say that the IOM found no cases of brain damage from the DTP shot. In fact they held that it was likely there were rare cases of brain damage from the shot. Paul Offit disagrees but he's not the only vaccinologist with an informed opinion on the subject.  But as for the autism link, I agree with Stossel--there isn't one. Click here for the URL:

Book tour tales

I have done some stupid things in my life, but I managed to avoid one while in Portland last week on my book tour. I had scheduled a one-on-one basketball game against J.B. Handley, a particularly noxious mercury militiaman. I had impulsively agreed to the match a week earlier, but my wife's better judgement and my own vestigial adulthood eventually kicked in, and I bailed at the last minute...

Library Journal

Vaccines fighting this season's flu strain, cervical cancer, shingles, and childhood inner-ear infections have hit the news, while medical researchers, funded by Gates Foundation dollars, labor feverishly to develop vaccines against the Third World curses of tuberculosis, malaria, and AIDS. The undeniable history of disease prevention via vaccine, however, masks thousands of individual and familial tragedies, the unintended consequences of contaminated vaccines or catastrophic immune reactions. While most parents view routine inoculations as a sacred responsibility, others see a herd of Trojan horses that threaten a beloved child. Noted Washington-based journalist Allen has explored these issues in the New York Times , the Washington Post , and the Atlantic Monthly . Here, he authoritatively and objectively records the miracles, controversies, and tragedies that have accompanied the development of vaccines since Edward Jenner first combated smallpox in the 18th century. A separate chapter explores the alleged relationship between thimerosal, a vaccine preservative, and autism. This compelling narrative of the vaccine's undoubted triumphs and troubling challenges is highly recommended to serious readers interested in medicine and public health. --Kathy Arsenault, Univ. of South Florida at St. Petersburg Lib.

The Oregonian

Over the past two decades, the debate on vaccination has become steadily more rancorous, which is puzzling. After all, vaccines have wiped smallpox from the face of the planet and reduced polio to a ghastly memory. Diseases that once struck fear into every parent's heart -- diphtheria, tetanus, whooping cough, measles -- have become, for most Americans, medical asterisks. But, as Arthur Allen shows in "Vaccine: The Controversial Story of Medicine's Greatest Lifesaver," vaccines are not miracles: They are imperfect drugs with risks and benefits. What's more, he argues, vaccination raises fundamental issues about life, death, illness and the individual's duty to society. Misgivings about vaccines stretch back to 1721, when Cotton Mather, a Boston minister, promoted inoculation (a primitive forerunner to vaccination) to forestall a smallpox epidemic. Opponents denounced Mather as a misguided crackpot who sought to evade God's judgment through unnatural practices. They also articulated the parental dilemma at the heart of every shot: "I should have less distress in burying many children by the absolute acts of God's providence," wrote one opponent, "than in being the means of burying one by my own act and deed." The smallpox vaccine proved remarkably successful, so successful it hatched a swarm of imitators. It is somewhat unsettling to read about the haphazard development of these early vaccines, many produced by "guts and guesswork," and tested on soldiers or schoolchildren. In 1942, for example, the U.S. Army, acting on intelligence that the Axis powers might wage biological warfare, injected millions of GIs with a vaccine against yellow fever that was contaminated with hepatitis B. Some 100 soldiers died and 50,000 others were hospitalized. (Sadly, their sacrifice was meaningless; the intelligence was wrong.) In a similar vein, the polio vaccine developed by Jonas Salk in 1952 was heralded as a triumph of American know-how. Salk described it as "safe, and you can't get safer than safe." Unfortunately, shoddy manufacturing and inept federal oversight allowed contaminated shots to reach the marketplace, crippling hundreds of children before the vaccine was withdrawn. As the last century wound to a close, vaccines were safer and more effective than ever, but the political and moral calculus surrounding them had changed. The diseases they protected against were largely abstract. Cases of severe reaction, though exceedingly unusual, were dramatic and easy to demonize. And the era of trusting experts was long gone. These trends converged in 1982, when NBC aired an expose on the diphtheria-pertussis-tetanus (DPT) vaccine, complete with footage of quadriplegic and brain-damaged children. Overnight, the modern anti-vaccine movement was born. It turns out that the whole-cell pertussis vaccine used in the old DPT shots did indeed cause brain damage in extremely rare instances, and that drug companies had known this for decades but never bothered to introduce a safer alternative. Although the pertussis vaccine has since been replaced, the revelations inflicted tremendous damage to the public trust. Many parents now oppose vaccination in principle and blame shots for a horde of maladies from autism to asthma. "Vaccine" is at least 100 pages too long, and some chapters meander. But Allen really shines with his perceptive analysis of the anti-vaccine movement and his calm examination of the evidence linking vaccines and autism (he is a skeptic). His greatest achievement is to inject a dose of reality into a debate that has become distressingly doctrinaire.  Oregonian, Feb. 18, 2007. By Chris Lydgate.

San Francisco Chronicle

At first glance, the title of Arthur Allen's "Vaccine: The Controversial Story of Medicine's Greatest Lifesaver" seems a little contrived. I mean, how controversial can vaccines really be? A few Band-Aids and lollipops when we're kids, and polio disappears. But in this far-reaching work, Allen, a Washington journalist who has written about the subject for the New York Times, the Washington Post, the New Republic and the Atlantic, shows that those tiny syringes actually represent centuries worth of science, religion, politics and war.

In a world of hyper-specialized medicine, Allen's account of the early days of vaccine discovery has an enjoyable, "greatest generation" feel. He dusts off characters from grade-school history class to conjure a time when giants roamed the earth and wiping out all disease was seen as a noble and attainable goal. Unfortunately, the nostalgia is quickly replaced by the disquieting knowledge that the good old days weren't that good.

"Vaccine" is an exhaustive, and at times exhausting, account of seemingly every religious figure, scientist, politician, school principal and anti-vaccine activist who ever held an opinion on the matter. The book's real value lies not in its details, however, but in the difficult philosophical questions it raises, questions as relevant today as they were when Benjamin Franklin fought over them almost 300 years ago.

What is the individual's duty to society? As Allen points out, vaccination is the first obligation the state imposes on our children; unless a legal exemption is obtained, they can't enter school without them. Most people would agree this is a good thing -- that the individual risk of vaccination is small compared with the overall improvement in quality of life it provides. But, in order to help your neighbor, should the government pressure you to ingest a substance to which you may be morally opposed?

And does immunization constitute an attempt by the government to influence our morality? This question recently came to the fore with the U.S. Food and Drug Administration's approval in June of a vaccine against human papilloma virus -- a sexually transmitted virus with certain subtypes causally linked to cervical cancer -- but it was also an issue when the government was deciding whether to make the vaccine against hepatitis B -- a virus linked to liver cancer that is also spread through blood and bodily fluids -- part of the required schedule of vaccinations.

The argument that a teen girl should not be given a simple shot that may prevent her from getting cervical cancer later in life because it might promote promiscuity is as absurd as saying seat belts should be removed from vehicles because they promote reckless driving. But what if the government made the vaccine, or a similar one, mandatory for people based on sexual orientation? Or a woman was told she couldn't receive government assistance without receiving it?

Like most topics having to do with health and behavior, there are no easy answers. Allen clearly doesn't have much patience for the pseudoscience and predatory zeal with which many anti-vaccine activists use grieving parents of autistic children to push their agendas, but he presents a fair analysis of why the anti-vaccine movement has been so successful.

He rightfully points out that mainstream medicine doesn't do a good job of giving meaning to illness, something people desperately need when there is no explanation or cure. As a mother of a child who died of sudden infant death syndrome says, "If someone dies, there's a reason," and the holistic approach of anti-vaccine proponents provides that reason. Whether or not the trace amounts of mercury in vaccines contributed to her child's death, her conviction that it did has a real impact on the health of her community when she persuades others not to get vaccinated.

"Vaccine" makes it painfully clear that science is very malleable and that people tend to shape the facts to conform to their worldview rather than the other way around. Is President Bush's making a photo op out of getting vaccinated against smallpox in 2002 -- thereby using dubious germs of mass destruction to support his case for war against Iraq -- any more or less shameful than the people in Colorado who frame their anti-vaccine beliefs as a simple "alternative lifestyle choice" while they trigger pertussis (whooping cough) outbreaks that kill children?

Odds are that you'll finish "Vaccine" with more questions than answers, but Allen's detailed lessons in history, statistics, immunology and cultural theory will give you the tools to tackle them. Even more important, they'll cause you to ask some new ones you've never thought of before.

--John Vaughn is a writer and physician in Columbus, Ohio.

Washington Post

"Vaccine is two books, really. The first is a historical account of experiments with vaccination from the early 18th century, when Cotton Mather tried to inoculate his neighbors in colonial Boston against smallpox, through the peak of vaccine development in the 1960s. Written in a straightforward fashion, this book offers few surprises to students of vaccine history, but it does deliver a very accessible account of American (and, to a lesser degree, European) scientific discoveries, public health campaigns and their controversies. The take-home message: Though vaccines have clearly saved lives and stopped epidemics, the practice of immunization has always been controversial, with organized skeptics claiming that vaccines would anger God, kill children, cause innumerable diseases, worsen epidemics and produce defective offspring.

Then, in what feels like a separate book, Allen offers his own analysis of the current state of anti-vaccine sentiments in the United States. This section alone is well worth the price of admission. With genuine panache, Allen describes the "legislative jihad against vaccines" led by Rep. Dan Burton (R-Ind.), as well as the mind-boggling array of political and religious forces that have, over the last decade, claimed child vaccination to be responsible for everything from brain disorders and autism to causing the very diseases the products are designed to prevent."
--Laurie Garret, Feb. 11 Washington Post Book World

"Vaccine" Correction/Clarification

On page 253 of my book, there is an error pertaining to Barbara Loe Fisher, a vaccine skeptic and vaccine safety advocate. I stated in my book that her son had a reaction to his third DPT shot, when in fact it was his fourth shot, when he was two and a half years old. In addition, the book inadequately described the symptoms Fisher witnessed her son experience after his fourth DPT shot:

A more complete, substitute description follows:

Rotateq trouble?

The AP and Reuters are reporting tonight that the FDA has issued guidance asking pediatricians and parents to be on the lookout for cases of intussusception--a paintful twisting of the bowels--in infants who receive Mercks' Rotateq vaccine. 28 cases of intussusception have been reported over the past year to VAERS, the Vaccine Adverse Events Reporting System, which is run by the CDC and FDA. Intussusception can be deadly; in 16 of the 28 cases children had to be hospitalized for surgery following the obstruction, which occurs when a part of the bowel telescopes into another. It's believed to be caused by viral infections, and the Rotateq, like all rotavirus vaccines, is a live viral vaccine that's given orally. The previously marketed rotavirus vaccine, Wyeth-Ayerst's Rotashield, was withdrawn from the market in 1999 because it caused the bowel problem--at a rate, studies later determined, of about 1/20,000.

The wire stories failed to record a key point in the FDA letter, which is that the 28 cases post-Rotateq are below the expected background rate of 18-43/100,000 cases in an unvaccinated population. 3.5 million doses of Rotateq have been distributed in that year. Though not all of them have been used, if only half had been given to children, 28 intussusceptions would still be far lower than one would expect in an unvaccinated population. On the other hand, VAERS is generally considered to underreport reactions associated with vaccines. This may be why FDA has asked pediatricians et al to look more carefully for intussusceptions. Merck and the CDC have been conducting post-marketing safety studies of Rotateq since it was licensed in 2005.

I have a slight conflict of interest in reporting this issue, which is that Paul Offit, one of the inventors of the Rotateq vaccine and a champion of the need for a rotavirus vaccine for American and the world, is a friend of mine and blurbed my book. I obviously hope that eventually his vaccine's name is cleared. If it isn't, I won't hesitate to report on it. I don't imagine that Paul will shirk the evidence either. Maurice Hilleman, the world's leading vaccine maker (at Merck) before his death a few years ago, use to say that he was never sure one of his vaccines was really safe until it had been given to 3 million children. Vaccines are a tough business. But since rotavirus kills hundreds of thousands of children each year, mainly in the Third World, and hospitalizes thousands of American children, it's obviously worth having a vaccine to prevent it.

HPV? Yes, But Don’t Rush Me

Sometimes, good policy is a question of good timing. The HPV vaccine, which Texas mandated for its 6th grade girls last week, is a good example. I've written and spoken in favor of mandating this vaccine, but consistency, as they say, is the hobgoblin of small minds. And I've recently learned from some public health contacts that the push to mandate HPV vaccine may be misguided. Hence the following, a version of which appeared in today's Dallas Morning News:

2007 Nominations for the next Vaccines-Cause-Autism theory....

Barbara Loe Fisher's National Vaccine Information Center is a resource center for people who think that their children were injured by vaccines as well as others who think vaccines are harmful for one reason or another. I subscribe to her listserv, which is always on the 'qui vive' for bad news from the vaccine front.

Today, however, she reports the latest autism statistics from California, with an observation that will not be cheering to Safe Minds, Generation Rescue and others who blame mercury in vaccines for the "autism epidemic." Most scientists and others who understand how autism diagnosis and reporting have changed over the past three decades see the steady increase of autism reports as largely an artifact of new discovery methods. But nevermind them -- let's say there is an epidemic. It doesn't take a toxicologist to observe that the numbers from 2002 to 2006 completely overturn the thimerosal thesis. Over a period in which thimerosal in vaccines was at levels lower than in the 1960s, the number of diagnoses grew from just over 20,000 to just under 33,000, with the sharpest increase in the 3-5 year olds, the group that got those largely thimerosal-free vaccines.