Posted by: Ticktock | January 1, 2009

Dr. Offit Vs. Dr. Sears – A Copy/Paste Blow By Blow

In the latest issue of Pediatrics, Dr. Paul Offit criticized the Vaccine book by Dr. Bob Sears.  Dr. Sears responded to the criticisms on his own web site.  I recently reviewed Offit’s new book Autism’s False Prophets, which is an excellent explanation and repudiation of antivaccine activism.  I haven’t reviewed Dr. Sears’ Vaccine Book, but my readers may be interested to know that I did follow an uninformed alternate vaccine schedule for my oldest daughter.  I’ve since come to my senses, but I do understand the fear that can drive parents to choose a schedule they prefer.  Perhaps Dr. Sears is doing the world a favor by giving an alternate schedule to parents who are tempted not to vaccinate, but on the other hand, pandering to antivaccine scariness only serves to endorse their misinformation.

I reprint here Dr Offit’s article in Pediatrics alternating with Dr. Sears’ response to the various points in the article.  I do this to make it easier to read the debate.  I don’t expect all my readers to be as interested in this topic as myself, so feel free to skip it.  Hopefully, there will be some of you who will be interested, and I won’t have waisted my time.  I urge you to check out the original articles for footnotes, opening arguments, and closing arguments.  The words in the debate below are not my own; they belong to Dr. Paul Offit and Dr. Bob Sears.

Doctors Do Not Understand Vaccines Dr. Offit

In his preface, Sears writes, “Doctors, myself included, learn a lot about diseases in medical school, but we learn very little about vaccines. … We don’t review the research ourselves. We never learn what goes into making vaccines or how their safety is studied. … So, when patients want a little more information about shots, all we can really say as doctors is that the diseases are bad and the shots are good.” Implicit in Sears’ premise is the idea that doctors do not know much about vaccines and that if parents educate themselves they will know more than their doctors. For some parents, this admission can be quite reassuring, allowing them to negate their doctor’s advice and take control of a worrisome situation. Although Sears is correct that doctors do not often review all of the studies on vaccine science, safety, and efficacy, he ignores the expert committees that do, specifically the Advisory Committee on Immunization Practices, which advises the Centers for Disease Control and Prevention (CDC), and the Committee on Infectious Diseases, which advises the American Academy of Pediatrics. Collectively, these advisory committees and their parent agencies have the expertise in virology, microbiology, statistics, epidemiology, and pathogenesis necessary to review the studies that inform their recommendations. Their advice to doctors has served us well; during the past century, vaccines have helped to increase the lifespan of individuals in the United States by ~30 years, with an excellent record of safety.

Doctors Do Not Understand Vaccines Dr. Sears

I agree with what Dr. Offit says here, except that I think parents want their own personal doctor to have a more thorough understanding of vaccines. Parents are much more likely to accept their doctor’s advice if the doctor has a complete understanding (or nearly so) of all the vaccine issues, side effects, ingredients, safety research, and possible drawbacks to a vaccine. If a doctor can look a patient in the eye and say, “I’ve spent weeks investigating all these issues personally and reviewing all the research myself, and, along with the expert backing of the AAP, CDC, and ACIP, I believe that the vaccines are safe and should be given according to the CDC schedule,” that has much more weight than a doctor simply saying, “I agree with the AAP, CDC, and ACIP that vaccines are safe.” Parents aren’t automatically going to trust such organizations the way we doctors do. They want us to do our own homework. Back in the old days when most patients simply trusted what doctors said, maybe that wasn’t necessary. But today’s parents want more from us. They are asking questions that we, as doctors, should be prepared to answer. If we are caught off guard by a parent’s question, because we aren’t familiar with a particular anti-vaccine argument or a certain vaccine ingredient or side effect, the parent will lose trust in us.

Public Health Agencies and Pharmaceutical Companies Are Not Trustworthy
Sears casts doubt on the reliability and motives of the CDC and pharmaceutical companies. For example, he writes, “Twenty years ago a group of doctors from the CDC, several US medical centers, and two pharmaceutical companies (GlaxoSmithKline and Merck) undertook the task of determining just how common the hep B [hepatitis B] infection was in infants and children. If they found that hep B was very common in kids, it would make sense to begin vaccination of all newborns. … The consensus of the researchers was that approximately 30000 infants and children were being infected with this virus each year.” After taking a closer look at the data, Sears thought that only “about 360 cases [were] reported in kids from birth through age nine each year.” Sears’ implication is clear, that is, to provide a rationale for newborn hepatitis B vaccine, the CDC, in league with pharmaceutical companies, misrepresented the data.

It is not difficult in today’s society to appeal to the notion of corporate or government malfeasance. But Sears’ estimate of the impact of hepatitis B infections is not supported by the facts. Before the hepatitis B vaccine became part of the routine schedule for children, every year ~16000 children <10 years of age were infected with hepatitis B virus after nonsexual, person-to-person contact.2 Given that reported cases might not include subclinical infections, this estimate is probably low.

Public Health Agencies and Pharmaceutical Companies Are Not Trustworthy
Dr. Offit’s words, not mine. I never make this statement, nor do I try to imply it. Most vaccine books are ripe with anti-pharmaceutical company conspiracies. In fact, I tried to steer clear of any conspiracy theories in this book. Now, when reading the quote he offers from the Hep B chapter of the book, in the context of first reading the above heading, I can see how one could read some “mistrust of the system” into my words. But this wasn’t my intent, nor is this impression given when read within the context of my book. In fact, on the next page I state, “These researchers were part of a very well-respected group – the leaders in their field.”

Now, two of the researchers involved in studying Hep B rates in children and helping to create neonatal Hep B vaccine policies did work for Merck and GSK. Anti-vaccine books love to jump all over any researcher who has ties to vaccine manufacturers. But I didn’t. But now that Dr. Offit has questioned this, I will comment. The doctors who worked with Merck and GSK and were part of the research that recommended Hep B vaccination in infants could be the most honorable, dedicated, unbiased doctors in the world. I’ve never met them. But in medical school we are taught to at least briefly raise an eyebrow at research funded by a pharmaceutical company, instead of simply taking it for granted. I will emphasize that while I did that, I didn’t do so based on their pharmaceutical ties. I simply wondered about the findings in the research. While some people might question the motives of and advice given by any doctor with financial ties to the vaccine industry, I refrain from doing so in my book.

Parents look at Hep B vaccination for their newborn and wonder, “Why?” Many pediatricians that I’ve talked to do as well. If Hep B is a potential risk to children through non-sexual casual contact, then vaccination would be a no-brainer. While writing my book I tried to find proof that non-sexual spread of Hep B is a significant risk to babies so that I could advise parents to vaccinate right away. But as a pediatrician, I’ve never seen it occur. And I’ve only heard of one case publicized in the media – an infected child sneezed on a teacher’s hand, and the teacher contracted Hep B through a cut on her hand. I’m sure there are many more such cases. But really, 16,000 kids each year less than 10 year old? Am I the only doctor that wonders whether or not that’s true?

I went straight to the source of disease data – the MMWR 2002 – to see what the actual reported cases of Hep B used to be in children younger than 10 years of age (Reference 1) and found that during the late 80s and early 90s, prior to introducing Hep B vaccine to infants, there was only 1 case of Hep B per 100,000 children age 0 to 9 in the U.S. (see chart at the end of the MMWR report). With 36,000,000 children in the U.S. in that age range, that only comes out to about 360 cases per year. The chart doesn’t differentiate between the perinatal exposures and accidental exposures. I know that some childhood Hep B infections will go unrecognized for many years, but I just can’t believe with such a low number of reported cases that the estimates of 16,000 cases per year can even be close.

The study that Dr. Offit refers to, as well as every other study done during the late 80s and 90s that looked at Hep B in young children, doesn’t actually determine the rate of Hep B by direct study or by reported cases (References 2 – 5). These studies provide estimates using population statistics. They look at adult cases, and estimate what percentage of those may have come from non-sexual contact during childhood, and make a logical guess at what the rate in children might be. Well, in order to really determine the rate of Hep B in children (to see if infant vaccination is warranted), all one would have to do is screen several thousand children for the disease and see how often it shows up. Then repeat the study again with a larger group. That’s what should have been done decades ago prior to introduction of the vaccine. The study could be done today on children who have skipped the vaccine. Why hasn’t anyone simply done that?

I have no doubt that Hep B vaccination is important, especially for pre-teens. And because there may be some small risk of non-sexual exposure to the disease during childhood, vaccinating during childhood may be important as well. I state this very clearly in the book. But does it have to be given right away during the neonatal period? For any family with a Hep B positive family member, yes – each baby should be vaccinated. But for the other 99% of American families, I don’t believe the vaccine needs to be given to young infants, especially in the hospital. Why give a less-than-necessary vaccine to a newborn and risk creating sepsis-like side effects (Reference 6 and 7)? Any family that asks to delay this vaccine shouldn’t be treated like they are crazy. They simply want to give their newborn a break for the first few weeks.

As for the issue regarding parents’ trust in the vaccine manufacturers, that trust was severely shaken when it was revealed in the Los Angeles Times on February 8, 2005, that way back in 1991 a researcher at Merck sent a memo to the president of Merck’s vaccine division stating that they had just realized that the cumulative amount of mercury in vaccines given to infants by six months of age was about 87 times the safety limits set by the FDA. And that information was not revealed to the public until 8 years later. Now I realize that pharmaceutical companies do so much good for our health and the field of medicine, and that such negative occurrences are rare. As a pediatrician I put my trust in them everyday by prescribing their products, including Merck vaccines, to my patients. But I find it surprising that any doctors can fault a parent for not completely trusting Merck after that, or the FDA and CDC departments that were supposed to be overseeing this type of issue.

Vaccine Mandates Should Be Eliminated
Sears thinks that vaccines should be optional. “Only twenty states allow parents to decline some or all vaccines at public school registration on the basis of personal beliefs,” writes Sears. “Parents who decline vaccination in [some] states can have their children taken away from them.” Sears fails to mention that enforcement of vaccine mandates, which were initiated because of measles outbreaks that swept across the United States in the middle 1970s, has dramatically reduced hospitalizations and deaths resulting from vaccine-preventable diseases3,4 or that states with philosophical exemptions have higher rates of vaccine-preventable diseases (such as pertussis), compared with states without such exemptions.5 His claim that unvaccinated children have been removed from the home is alarming and false, only inflaming an already frightened public.

Vaccine Mandates Should Be Eliminated
I don’t make any claim that unvaccinated children have been taken away from the home. I state that I have heard “rumors” of such, but that I don’t believe them. I do believe, however, that some states may actually have that power by law, but I doubt it has ever been exercised. You may recall the recent court battle this year on the East Coast in which parents were refusing the Hep B vaccine for their teenagers. The parents were threatened with jail time if they didn’t either sign the religious waiver or comply with vaccinations. I don’t know if anyone was ever jailed, but that is a really scary thing to have occurred in our free country. I agree with Dr. Offit that in the event of an outbreak that significantly puts the public health at risk, the state should have some authority to step in. But during the normal course of life, I believe that parents should have the right to decline vaccines.

Vaccine-Preventable Diseases Are Not That Bad
In his chapter on pneumococcal infection, Sears tells the following story. “A six-month-old unvaccinated infant had a pneumococcal ear infection that spread to the skull bones behind the ear. She required surgery and IV [intravenous] antibiotics. Afterward, I asked the parents if they regretted their decision not to vaccinate. They said no. They were both well-educated professionals, had done a lot of reading on this issue, and still felt comfortable with their decision.” Sears implies that vaccine-preventable diseases, although occasionally serious, are not really that bad. Before the conjugate pneumococcal vaccine became part of the routine schedule in 2000, however, pneumococci caused ~17000 cases of invasive disease every year in children <5 years of age, resulting in 700 cases of meningitis and 200 deaths.6 The parents in Sears’ story were fortunate that their child did not suffer sepsis, severe pneumonia, or fatal or debilitating meningitis.

Vaccine-Preventable Diseases Are Not That Bad
This is a prime example in which Dr. Offit has taken one statement out of the book and portrayed my viewpoint inaccurately. I clearly state how bad each disease can get as well as the number of yearly fatalities. At the very beginning of the PC chapter I share how serious PC disease is. I also state at the very end of that chapter that I consider PC “a fairly important vaccine.” At the end of each chapter I share any personal experiences I have had as a pediatrician with each disease, and this was the only one I’ve had for invasive PC. At the end of the book I strongly urge parents who are thinking of skipping vaccines to at least consider PC vaccine (as well as a few others). On my website, I dispel a myth that’s been going around that the PC vaccine is no longer important, and is causing other emerging strains, and I urge parents to continue getting the current PC vaccine until an expanded one comes available.

A word of thanks to Dr. Offit on this issue for pointing out that I could perhaps improve on my disease descriptions in the book. In the next edition I am planning to add a section on each disease that paints a picture of “a typical course of this disease”, then a “worst case scenario of the disease.” Dr. Offit is absolutely correct. Parents should know how bad each disease can be.

Hide in the Herd
Perhaps the most disingenuous comment in the book is directed at parents who are afraid of the measles-mumps-rubella (MMR) vaccine. “I also warn [parents] not to share their fears with their neighbors,” writes Sears, “because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.” In other words, hide in the herd, but do not tell the herd you’re hiding; otherwise, outbreaks will ensue. Sears’ advice was prescient. Recent outbreaks of measles in 15 states, caused by an erosion of herd immunity in communities where parents had chosen not to vaccinate their children, were the largest in the United States since 1996.7

Hide in the Herd
I agree with Dr. Offit here. Herd immunity is very important. I state the argument in the book that “the good of the many outweighs the good of the few.” Nowhere in the book do I encourage parents to “hide in the herd.” Again, Dr. Offit’s words, not mine. I clearly state (as Dr. Offit quoted) the danger to our country if too many people don’t vaccinate. My comment on “not sharing your fears with your neighbors” was an attempt at humor, while trying to teach a very important point.

Natural Infection Is Better Than Vaccination
Sears describes the value of chickenpox parties. “Some parents… may purposely get their child exposed to get the disease over with,” he writes. “If you’ve ever been invited to a ‘chickenpox party,’ you’ll know what I’m referring to. Having the disease in most cases provides lifelong immunity (better immunity than the shot provides), so there is practically no worry about catching the disease as an adult.” Sears’ concern that immunity to chickenpox will fade, only shifting the burden of disease from children to adults, fails to take into account decades of experience with other live viral vaccines. Although measles, mumps, and rubella infections are often more serious in adults, widespread immunization of children has not shifted the burden of disease; rather, it has reduced dramatically or eliminated these infections. Furthermore, although Sears is correct in stating that natural immunity is generally better than vaccine-induced immunity, the high price of natural immunity, that is, occasionally severe and fatal disease, is a risk not worth taking.

Natural Infection Is Better Than Vaccination
Again, what book is Dr. Offit reading? Not mine. I describe chickenpox parties in the book, but I certainly don’t recommend them. Notice the “. . .” in Dr. Offit’s quote here. The entire quote is “Some parents actually want their kids to catch chickenpox. They may purposely get their child exposed to get the disease over with.” I’m simply stating what some parents do. Not what I think they should do. As for the risk of acquiring natural immunity to a disease, I agree with Dr. Offit. It is a risk. And I clearly state what that risk is for each disease.

A very popular anti-vaccine argument is that childhood diseases are healthy. They exercise the immune system. Other authors encourage parents to allow their kids to catch many of these diseases. I couldn’t disagree more. My book tries to dispel that myth. No one wants to exercise their baby’s immune system with meningitis or hep B, or most of the other vaccine-preventable diseases.

Vaccination Has Eliminated Infectious Diseases at the Price of Causing Chronic Diseases
Sears writes, “When I reviewed numerous studies, I did find some that show a possible link between a vaccine and a chronic disease. Examples include the Hib [Haemophilus influenzae type b] vaccine and diabetes, the hep B vaccine and multiple sclerosis and rheumatoid arthritis, and the MMR vaccine and eczema.” Sears fails to point his readers to the clear body of evidence that has exonerated vaccines as a cause of these disorders (reviewed in ref 8).

Vaccination Has Eliminated Infectious Diseases at the Price of Causing Chronic Diseases
I never even come close to saying any such thing I my book. Allow me to quote from page 178: “Critics [of vaccines] worry that many chronic diseases and other physical and mental problems like ADHD, chronic fatigue, diabetes, allergies, asthma, learning disorders, and autism are triggered by vaccines. I haven’t found any solid research to support this contention.” Interestingly, this is the very sentence that precedes Dr. Offit’s quote here. As Dr. Offit points out, I go on to say I found studies that show a “possible link,” but that’s it. I actually go out of my way to debunk the myth described in the heading above. By the way, the peer-reviewed journals that discuss “possible links” include Revue Neurologigue, Rheumatology, British Journal of Rheumatology, Journal of Rheumatology (that’s a lot of rheumatology!), Lancet, Neurological Science, Scandinavian Journal of Rheumatology, Acto Dermato-venereologica, Autoimmunity, Journal of the American Academy of Dermatology, and Clinical Rheumatology, Journal of Allergy and Clinical Immunology. See References 8 through 19.

Vaccine Safety Testing Is Insufficient
Sears writes, “A new medication goes through many years of trials in a select group of people to make sure it is safe. … Vaccines, on the other hand, don’t receive the same type of in-depth short-term testing or long-term safety research.” On the contrary, vaccines are tested in larger numbers of children for longer periods of time than drugs. For example, the human papillomavirus vaccine was tested in 30000 women,9 the conjugate pneumococcal vaccine in 40000 children,10 and each of the current rotavirus vaccines in ~70000 children before licensure.11,12 No medication receives this level of scrutiny. Furthermore, safety mechanisms such as the Vaccine Adverse Event Reporting System (VAERS) and the Vaccine Safety Datalink Project are model systems for detecting rare adverse events after licensure. Drug surveillance would benefit from mimicking these vaccine catchment systems.

Vaccine Safety Testing Is Insufficient
I don’t say that safety testing is insufficient. Again, Dr. Offit left out some of the words in his quote. I start this particular chapter with a discussion of the extensive short-term research that is done with each new vaccine, describing the research in a similar way that Dr. Offit states here in his article. As for his quote from my book, the entire text reads: “A new medication goes through many years of trials in a select group of people to make sure it is safe. These subjects undergo extensive blood testing and physical evaluations over many years. If nothing severe or common shows up, the medication is then released for general use. Vaccines, on the other hand, don’t receive that same type of in-depth short-term testing or long-term safety research . . . Their blood isn’t tested to check for internal toxic effects. Doctors don’t do physical exams to look for problems.” My point here is that the short-term research could be more hands-on, instead of simply by parent questionnaires.

I agree that vaccine safety testing is very extensive, and in my mind it is very adequate. What we could improve is the long-term safety research. Dr. Offit points out how VAERS and VSDP are model systems for detecting rare adverse events. A few paragraphs down, however, under “Risks From Vaccines,” he states (somewhat contradictorily, if that’s a word) “VAERS is a passive surveillance system and cannot be used to determine the true incidence of adverse events, which can be determined only by using control groups.” I couldn’t agree more. We need a large placebo group of voluntarily unvaccinated kids to compare to the vaccinated population. I think that we will see that in the upcoming National Children’s Health Study.

But back to “insufficiency” of safety research. In the book I refer to a statement made by the Cochrane Collaboration in Vaccine 2003 (Reference 20) regarding a review of 22 studies on MMR vaccine safety: “the design and reporting of safety outcomes in MMR vaccine studies, both pre-and post-marketing, are largely inadequate.” Their words, not mine.

Public Health Officials Make Recommendations for the Public and Not for Individuals
Sears writes, “Obviously, the more kids who are vaccinated, the better our country is protected and the less likely it is that any child will die from a disease. Some parents, however, aren’t willing to risk the very rare side effects of vaccines, so they choose to skip the shots. Their children benefit from herd immunity… without risking the vaccines themselves. Is this selfish? Perhaps. But as parents you have to decide. … Can we fault parents for putting their own child’s health ahead of the other kids’ around him?” Sears’ argument represents a fundamental flaw in logic. For example, Sears states that the polio vaccine, which prevents a disease that has not occurred in the United States since 1979, is given to protect the population and not the individual. “[Polio] doesn’t occur in our country,” he writes, “so the risk is zero for all age groups.” Although it is true that polio has been eliminated from the United States, it has not been eliminated from the world. The disease is still prevalent in India, Africa, Southeast Asia, and the Middle East. Because international travel is common and because only 1 of every 200 people infected with poliovirus exhibits symptoms, it is likely that people who are unknowingly shedding poliovirus come into the United States every year. An unimmunized child would be particularly susceptible if an outbreak occurred. Furthermore, the unimmunized child might later travel to a country where polio is endemic. Therefore, every individual benefits from receiving polio vaccine.

Public Health Officials Make Recommendations for the Public and Not for Individuals
I’m pouring through the book right now trying to find where I may have made such a statement, and I just can’t find it. Hmmm. What I do believe is that Public Health Officials view vaccine issues from two sides – the risk to individuals as well as the risk to our nation as a whole. Parents, on the other hand, tend to make decisions based on their own individual child, without considering the public’s benefit. I also state in the book that such a decision is perhaps “selfish.”

As for the polio vaccine, Dr. Offit fails to include other quotes from the book that state the importance of the polio vaccine: “I consider this vaccine very important from a public health viewpoint. Until the whole world is polio free, ongoing vaccination will help keep our nation protected . . . (page 79).” Because there haven’t been any cases of polio in the U.S. for decades, I do believe it is correct to say that we don’t use this vaccine to protect each particular child from catching the disease (as compared to every other vaccine we use). Rather, we use it for herd immunity. I agree with Dr. Offit that “every individual benefits from receiving polio vaccine.” There is no “flaw in logic” here. We are both saying the same thing.

Decision-Making
Sears wants parents to use the information he has provided to make their own decisions about whether to vaccinate their children. “I have offered you all the information you need to make this decision,” he writes, “but I have held back from actually telling you what to do. I want you to formulate your own decision without letting my opinion sway you one way or the other.” Unfortunately, Sears, who wants parents to make informed decisions, has written a book that will largely misinform them.

Decision-Making
You know, I do suppose it was a little presumptuous of me to state that “I have offered you all the information you need to make this decision.” That would imply by book is 100% complete. No book is. I should have said, “I have given you almost all the information . . .” As for misinformation, I’m still waiting for some here.

Distinguishing Good Science From Bad Science
At the end of every chapter describing individual vaccines, Sears includes sections titled “Reasons to get the vaccine” and “Reasons some people choose not to get the vaccine.” In the latter sections, Sears often takes the position that, if parents think that a vaccine is problematic, then the vaccine is problematic. He believes that parents’ fears should be indulged by offering alternative schedules, not countered by scientific studies, and he fails to explain that good science is the only way to determine whether a vaccine causes a particular adverse event. Instead, Sears alludes to evidence on both sides of any issue, failing to distinguish studies on the basis of their quality, internal consistency, or reproducibility and failing to distinguish those that are accepted by the scientific community from those that are not.

Distinguishing Good Science From Bad Science
Because the science on vaccine safety is not complete, and never can be, I didn’t undertake the very tedious task of detailing every scientific study there is. Who would read such a book? This is a book for the general public. Where I state “Reasons some people choose not to get the vaccine,” I clearly state the risks that such parents are taking.

I will take this opportunity for the second time to state my appreciation for an oversight pointed out by Dr. Offit. I really should have delineated which studies come from a peer-reviewed (mainstream) journal and which do not. This is very important, so parents can decide whether or not a particular study holds any weight. This will be corrected in the next edition of the book.

Risks From Vaccines
In chapters describing individual vaccines, Sears lists side effects found in product inserts and VAERS reports. Weighing the risks and benefits of the conjugate pneumococcal vaccine, he writes, “In the first two years of Prevnar’s use in the United States, about 32 million doses were given, and about 4100 adverse reactions were reported to VAERS. Most reactions were fairly mild, but about 15 percent (around 600) were considered serious. This means that for every 53000 doses, one serious reaction occurred.” Like many parents who are concerned about vaccines, Sears thinks that reports to VAERS represent an accurate profile of a vaccine’s side effects. However, VAERS is a passive surveillance system and cannot be used to determine the true incidence of adverse events, which can be determined only by using control groups (not provided by VAERS). For this reason, VAERS reports often represent coincidental and not causal associations. Furthermore, the source of VAERS reports can be misleading. For example, many of the recent VAERS reports of autism after receipt of vaccines came not from parents, doctors, nurses, or nurse practitioners but from personal-injury lawyers.13 Finally, pharmaceutical company lawyers often list in product inserts all adverse events that occurred after receipt of vaccines even if those events occurred at rates similar to those found among placebo recipients.

Risks From Vaccines
Once again, I am respectfully thankful for this constructive criticism. Dr. Offit is right. We shouldn’t view reported reactions in VAERS as actual vaccine reactions, and I shouldn’t have used such numbers to determine statistical risks. I do, however, point out in the book that we don’t know that VAERS reports are actual vaccine reactions. The problem is, that’s the only system I have to try to determine what the risk of a vaccine reaction might be. I think parents deserve to know that. Until we have an active surveillance system, instead of a passive one, we won’t know what that risk is. I could also add that VAERS only contains reactions that are reported. Many reactions go unreported. So, even if only some of the VAERS reactions can be attributed to the vaccine, not all such reactions are actually reported. So, my numbers may reflect something close to reality. But that’s not scientific. We really need to take a better look at this.

Risks From Vaccine-Preventable Diseases
Sears often counters data on the national incidence of specific infectious diseases with personal experience. For example, in the section on pneumococcal disease, he writes, “I’ve seen only one serious case of [pneumococcal] infection in my office in my ten years of practice.” Regarding meningococcal disease, he writes, “I saw one case during my medical training, and I haven’t seen it since.” Because Sears works in a private practice and not a hospital, he is unlikely to see serious infectious diseases commonly. His individual experience should be enriched by his knowledge of published studies, however, and not used to negate them. This see-no-evil approach only misinforms his readers.

Risks From Vaccine-Preventable Diseases
Wow. I am now convinced that we are not talking about the same book here. I not only make it very clear what the risks are from each disease, allow me to quote from the meningococcal vaccine chapter’s list of reasons to get this vaccine: “Obviously, meningitis is devastating. Getting the shot during the early teens protects a child . . . the chance that a college freshman in a dorm could catch it is something to consider. In the chapter’s conclusion: “No one can argue that MC disease isn’t a horrible thing to see, much less to actually catch.” That sentence precedes the one quoted by Dr. Offit here. Yes, I do comment on the GBS issue, as that was brand new information when the book came out. I state “If experts can determine that the risk of GBS is negligible, the shot will likely become more widely accepted.” I also predicted that it will become approved for two-year-olds, and state “this will become a very important vaccine, since the disease is more common in younger children.” I comment on GSK’s combo of HIB and MC vaccine for 2, 4 and 6 month olds (currently undergoing trials) and state “this vaccine will provide much-needed protection during infancy, when MC disease is most common.” I also describe MC disease (page 137) as “. . . extremely serious. This is probably the single most serious and potentially deadly of all vaccine-preventable diseases.” I go on to describe in detail the likely ICU course, with organ failure and likely permanent disability. Even though I fortunately don’t get to “see much of this evil”, I certainly describe it in the book.

Animal Products
Sears explains that some vaccines are made by using fetal bovine serum, raising the specter of mad cow disease. “All animal and human tissues are carefully screened for all known infectious diseases,” he writes. “Some vaccine critics are still worried, however, that there may be other viruses or infectious agents (called ‘prions’)… that are much smaller than viruses and that we don’t yet know how to screen for.” Sears fails to mention that prions propagate in the nervous system and not the bloodstream, that they do not grow in the mammalian cells used to produce attenuated viral vaccines, that they have never been found to contaminate fetal bovine serum, that mad cow disease is not a human health problem in the United States, and that studies found no increased risk of mad cow disease in children who did or did not receive vaccines in the United Kingdom, where mad cow disease was a problem (reviewed in ref 14). Rather, in keeping with his theme that parental fears trump scientific studies, he concludes, “If exposure to animal tissues worries you, you may want to choose the brand that doesn’t use cow extract.”

Animal Products
I didn’t raise the specter of Mad Cow Disease. That’s a ploy found in many anti-vaccine books, and I state that this is an issue the critics often bring up. Dr. Offit is right, I should have mentioned that we don’t use “mad cows” in the U.S., but I though everyone already knew that.

Dr. Offit failed to mention the one time when a viral disease did contaminate a vaccine. And this was no small deal either. I open Ch. 16 with this info. In August of 2002 and February of 2003, the pediatric newspaper Infectious Diseases in Children published reports of SV-40 viral contamination of millions of doses of polio vaccine due to the use of monkey kidney tissues used to make the vaccine. It was estimated that almost 30 million people were injected with vaccines containing this virus between 1955 and 1963. Also, in 1980, 150 newborns were given an experimental Hep A vaccine that was contaminated with SV-40 virus. This virus has been linked to several human cancers, although fortunately the people injected with this virus haven’t been found to have higher than expected rates of cancer. Now we know to screen for this virus.

I find it peculiar that Dr. Offit portrays my book as raising the specter of mad cow, but completely leaves out the SV-40 virus problem. It’s not a problem anymore, but I use it as an example of what happened in the past. I state that vaccine critics worry that “unknown infectious particles or . . . foreign DNA in [human and animal] tissues may cause problems . . .” I end the section with “At this time, I can’t offer any good evidence to support these worries . . .”

Thimerosal
Sears does not take a clear stand on this issue, writing, “Do I think mercury is harmful? Yes. Do I think the amount in the old vaccines caused harm? I’m not 100% convinced one way or the other.” It is hard to imagine a better conceived, better designed study on the subtle effects of mercury poisoning than that performed by Bill Thompson and colleagues at the CDC and published in 2007.15 The study carefully identified the quantity of mercury exposure from thimerosal before birth (from RhoGam; Ortho Diagnostics, Raritan, NJ) and after birth (from vaccines) for >1000 children. Researchers then subjected the children to >40 neurologic, psychological, and developmental tests and found no significant differences for those who received greater or lesser quantities of mercury. By choosing not to evaluate the quality of the scientific findings on this issue, Sears again fails to educate his readers.

Thimerosal
Actually, the whole point of my two-page discussion on thimerosal is that it has been removed from virtually all vaccines, so you really don’t have to spend hours researching whether or not it is harmful. I save the parents’ time by making it a non-issue. Going back and reviewing all the research is a moot point for parents deciding about vaccines today. I actually thought that I was doing a great service by dispelling this myth. I guess not?

Aluminum
Sears’ main argument for spacing out vaccines is to avoid giving infants too much aluminum at one time, writing, “When a baby gets the first big round of shots at two months, the total dose of aluminum can vary from 295 micrograms… to a whopping 1225 micrograms if the highest aluminum brands are used and a hep B vaccine is also given. … These doses are repeated at four and six months.” Extrapolating studies of patients undergoing hemodialysis and severely premature infants to healthy newborns, Sears claims that these quantities might be unsafe. However, Sears fails to put aluminum exposure in context. By 6 months of age, infants typically ingest ~6700 µg of aluminum in breast milk, 37800 µg in infant formula, or 116600 µg in soy-based formula.16 Furthermore, Sears fails to describe scientific studies that led the National Vaccine Program Office to conclude that the amount of aluminum contained in vaccines did not warrant changing the vaccine schedule.17

Aluminum
Ok. Aluminum is a very complicated issue. It really deserves its own article. In order to provide you with a full discussion on aluminum, I am posting that section from the book on my website in the FAQ section on the right. I ask you to not pass judgment until you’ve read the whole thing. I don’t use the 2002 Vaccine study in my book. Instead I use the 2004 Lancet study from the Cochrane Collaboration for a thorough review of aluminum (Reference 21). For those of you who don’t read the entire aluminum section of the book, here is the bottom line. We know aluminum is a neurotoxin. We also know that humans can ingest huge amounts without harm, since 99% of it passes out through the stools. I’m sure Dr. Offit knows that, so I’m curious as to why he’d use the “babies ingest tons of aluminum anyway” argument. I would also point out that the conclusion of the study that Dr. Offit refers to doesn’t say anything about proving that aluminum is safe. It simply concludes that the amount in vaccines didn’t warrant changing the schedule. Those are two completely different statements.

I’ve been searching and searching for human infant studies that determine what a safe level of injected aluminum is, including looking at all the studies used in the article quoted by Dr. Offit, and I can’t find a single one. There is a lot of animal research, a lot of studies that use theoretical mathematical models, and one human adult study, but not a single human infant study (see Resources 22-30). As a precaution, I show worried parents how to take precautions to limit their baby’s aluminum dosing during vaccinations. This allows these parents to vaccinate, instead of declining them all.

Other Vaccine Ingredients
Sears claims that the MMR vaccine contains human albumin purified from human blood. “The human and cow blood products used in manufacturing may also concern some parents,” he writes. However, the MMR vaccine contains genetically engineered human serum albumin, a product that is not derived from human blood, as a stabilizer.

Other Vaccine Ingredients
Up until December 2007, the albumin used as a growth medium for the MMR viruses was human albumin filtered out of human blood. The PI described how the human albumin is screened for the absence of adventitious agents, and processed using the Cohn cold ethanol fractionation procedure. In December 2007, the MMR PI changes its description of the albumin to recombinant. Dr. Offit makes it sound as if I’m misleading my readers and printing false information, when in fact my information was correct in October 2007. I appreciate him highlighting this change, however. It’s good to see Merck moving away from using a human blood product. Not that this was a problem – the albumin was carefully screened and filtered. Reference 31.

MMR Vaccine and Autism
Sears writes, “Some doctors and researchers who suspect the MMR vaccine may play a role in autism also feel it is safer to give the three injections separately, spaced out one year apart. I can’t find enough research to determine if this precaution is justified, but in theory it does make sense.” For this reason, Sears recommends that the measles, mumps, and rubella components of MMR be administered separately. Sears fails to mention the many epidemiological studies that showed that the MMR vaccine did not increase the risk for autism1824 or to note that the theory that measles-containing vaccine causes intestinal inflammation has been thoroughly debunked.2527 Worse, Sears takes the discredited notion that measles vaccine causes intestinal disease one step further, recommending that “the MMR vaccine not be given when a child is suffering from diarrhea or has taken antibiotics in the past few weeks. This vaccine may cause more reactions when the intestines aren’t at peak health.”

MMR Vaccine and Autism
Actually, in the book I describe in detail six studies that showed no link between MMR and autism (References 32-37). As for the MMR vaccine/intestinal inflammation/autism theory being debunked, I would now agree with Dr. Offit. At the writing of my book, however, no one had yet repeated Dr. Wakefield’s work to prove him wrong. As of this year, a very well done study by Harvard, Columbia, Mass General, CDC, and the AAP has (Reference 38). I have written an update to this effect on my website. My initial worries about the MMR and intestinal inflammation are probably unfounded.

Coincidence Versus Causality
Sears’ general theories of science and medicine are often poorly reasoned or illogical. Sears writes, “Sometimes infants and children develop medical problems… within days or weeks of a vaccination. Although it can be highly suspected that the vaccine was the cause, it can’t be proven. I’m sure the truth of the matter is somewhere in between causality and coincidence.” Epidemiological studies, which are the single best way to determine whether a vaccine is associated with an adverse event, have shown consistently that vaccines cause certain problems, such as measles-containing vaccine causing thrombocytopenia28 and diphtheria-tetanus toxoids-pertussis vaccine causing seizures.29 Some studies have failed consistently to find an association, such as thimerosal in vaccines causing autism.30,31 In all of these cases, it can be said that a truth has emerged. There is no middle ground between coincidence and causality; a vaccine either causes a problem or it does not.

Coincidence Versus Causality
Again, it sounds like myself and Dr. Offit mostly agree here, although for some reason my agreement with him would be viewed as “poorly reasoned or illogical.” One can’t simply group all reported reactions into two groups: either proven to be caused by a vaccine or proven to not be cause by a vaccine. There are so many reported reactions that haven’t been proven one way or the other through scientific study. This is a third category, and as further research is done we will place each reaction in one of the first two categories. But until that is done, parents can only view these reports as somewhere between coincidence and causality.

Scientific Proofs
Sears has a poor grasp of the scientific method. “Some studies have been published in recent years that have failed to show statistical proof of a relationship between vaccines and autism,” he writes. “However, by the same token, it is also difficult to prove that there is not a connection.” Using the scientific method, investigators form the null hypothesis. Good epidemiological studies are powered to reject or not to reject the null hypothesis. However, the scientific method does not allow investigators to accept the null hypothesis. Said another way, scientists can never prove never. The most that scientists can show is that 2 events are not associated statistically; scientists cannot prove that the events can never be associated statistically. In stating that it is “difficult to prove that there is not a connection,” Sears is suggesting the impossible.

Scientific Proofs
I agree. This is not a sound scientific argument. I just really wish we could prove a vaccine doesn’t cause a particular reaction. Parents could then worry a lot less. Although we can’t prove a negative, we can improve the long term safety research of vaccines so parents can be more confident.

Context
Sears argues that elements such as mercury are neurotoxins and the presence of mercury in thimerosal makes some vaccines (such as multidose preparations of inactivated influenza vaccines) dangerous. However, Sears never discusses the fact that mercury is present on the earth’s surface and that, like aluminum, children ingest mercury in breast milk and infant formula at levels that often exceed those contained in vaccines.32 Sears also fails to explain that small quantities of heavy metals such as cadmium, beryllium, lead, and thallium, which can be toxic in large quantities, are present in everyone who lives on our planet. By creating the notion of zero tolerance, Sears fails to educate his readers that the dose makes the poison, that it is the amount of a potential toxin and not its mere presence that counts.

Context
We’ve already covered this. As for the flu shot, here’s my opinion. Because mercury is a known neurotoxin, all the science in the world won’t convince many parents to give their baby a mercury-containing flu shot, especially when they have the option to get a non-mercury version. I completely agree with Dr. Offit’s statement that the science shows no evidence that the amount of mercury in a flu shot causes any harm. But I just don’t think that parents believe it.

Understanding Risk
Sears does not recommend the meningococcal vaccine for teenagers because of the possible risk of Guillain-Barré syndrome. Indeed, the most recent estimates are that the conjugate meningococcal vaccine might cause Guillain-Barré syndrome for ~1 per 1 million recipients.33 However, the risk of meningococcal disease for a child who is not vaccinated is ~10-fold greater than the possible risk of Guillain-Barré syndrome for a child who is vaccinated. Furthermore, the high rates of death and permanent sequelae caused by meningococci make the choice not to be vaccinated an illogical one. By failing to weigh the relative risks of the disease and vaccine side effects accurately, Sears again misinforms his readers.

Understanding Risk
I understand the risk of MC disease as well as any doctor, and I very clearly recommend this vaccine in my book: “Obviously, meningitis is devastating. Getting the shot during the teen years protects a child through high school and college . . . There are about 250 teen and college-age cases each year. The ingredients are among the purest and simplest of all vaccines . . .” I do discuss how the reported GBS reactions may worry some parents, and may cause dome parents to delay the vaccine. But never do I say not to get the vaccine: “. . . this vaccine is an important step in eliminating or at least minimizing the disease among our nation’s teens . . .” I also give a very strong recommendation in favor of its use in younger children if it becomes approved for that age group. I don’t understand how Dr. Offit could misconstrue my statements to say that I don’t recommend this vaccine. I agree that the risk of GBS is much smaller than the disease risk.

The Harm

For parents who are worried about vaccines, Sears offers 2 alternative schedules. One, titled “Dr Bob’s Selective Vaccine Schedule,” is for parents who want to decline or to delay vaccines. Children whose parents choose this schedule might not be receiving the measles, mumps, rubella, varicella, and hepatitis A vaccines and will not be receiving the polio and influenza vaccines or a booster dose of pertussis vaccine.

The other schedule, titled “Dr Bob’s Alternative Vaccine Schedule,” is written for parents who worry that children are receiving too many vaccines too early. Children whose parents choose this schedule will not be receiving the influenza vaccine until 5 years of age (which is unfortunate, given that tens of thousands of children <4 years of age are hospitalized with complications resulting from influenza every year),34 will not be receiving the hepatitis B vaccine until 2.5 years of age, will not be receiving measles vaccine until 3 years of age, and, to space out vaccines so that children do not receive >2 shots at 1 visit, will be visiting the doctor for vaccines at 2, 3, 4, 5, 6, 7, 9, 12, 15, 18, 21, and 24 months and 2, 2.5, 3, 3.5, 4, 5, and 6 years of age. Increasing the number of vaccines, the number of office visits, and the ages at which vaccines are administered will likely decrease immunization rates. In addition to the logistic problem of requiring so many office visits, Sears’ recommendation might have another negative consequence; recent outbreaks of measles showed that several children acquired the disease while waiting in their pediatricians’ offices.7

At the heart of the problem with Sears’ schedules is the fact that, at the very least, they will increase the time during which children are susceptible to vaccine-preventable diseases. If more parents insist on Sears’ vaccine schedules, then fewer children will be protected, with the inevitable consequence of continued or worsening outbreaks of vaccine-preventable diseases. In an effort to protect children from harm, Sears’ book will likely put more in harm’s way.

The Harm
In my selective schedule, I don’t tell parents not to get the MMR, VZ, Hep A, Polio, and Flu shots. That’s their decision. This schedule is designed to encourage non-vaccinating families to at least get their baby the DTaP, Rota, PC, and HIB vaccines, and their teens the HPV and Hep B vaccines.

Dr. Offit makes an incorrect statement regarding my alternative schedule. He says that children using this schedule won’t be getting a flu shot until age 5. On page 236, the flu is very clearly listed as a recommended vaccine starting at 6 months and continuing through to age five, so I’m not sure exactly what book Dr. Offit was looking at. Not mine.

My alternative schedule isn’t necessarily what I recommend parents do. In the book (page 235), I encourage parents who trust in our country’s vaccine system and safety, as recommended by our nation’s top medical experts and almost every doctor, to go ahead with the regular vaccine schedule. “I recommend that you trust your doctor’s advice, and your own intuition, and go ahead with vaccination.”

The alternative schedule is designed for parents who are worried about grouping so many shots together. That is the single most common worry I’ve heard from parents over the years. They want to fully vaccinate, they just want to do it at a slower pace. But up until now such parents haven’t had any guidance on how to do this. These are parents who otherwise may not be vaccinating, or if they do they are cringing and scared about doing it. Parents should feel secure and confident in their vaccine choices. Yes, this schedule is a lot more time consuming and more work for the parents and the doctor’s office. It certainly wouldn’t be a reasonable or practical vaccine schedule for our country as a whole. Babies would fall behind on their shots, compliance would wane, and some could be susceptible to what should be a vaccine-preventable disease. I agree with Dr. Offit there. My alternative schedule is simply an option for parents who want to take the extra time and effort. It’s just an option. I worry that if doctors don’t offer an option like this, some patients will go unvaccinated, and that’s not good. I believe this schedule will increase vaccination rates among non-vaccinating families.

The only vaccines that my alternative schedule delays to any extent are polio (until 9 months of age), Hep B (until 2 ½ years) and Measles (until age 3). This is virtually no risk involved in delaying the first two, but I agree with Dr. Offit that delaying measles vaccine is a risk, especially for a child in daycare or with older siblings. On my website, I encourage such families, and any family who is worried about measles exposure, to vaccinate for measles sooner.

About these ads

Responses

  1. That was an interesting read. It actually make Dr. Sears sound quite reasonable. But, (having not read any of the cited books or literature), it also sounds like Dr Sears’ book is misleading or trying to be persuasive.

  2. Sears, like his father, uses a lot of literary devices to convey a given message in a way that gives him plausible deniability. When you read the passages in context, however, it’s clear both Searses are pushing the reader (usually a credulous, not scientifically literate one) towards a certain conclusion. Which is one of the reasons I dwell on them so often on my own blog…

  3. “At our April 6 autism hearing, Dr. Paul Offit disclosed that he holds a patent on a rotavirus vaccine and receives grant money from Merck to develop this vaccine. He also disclosed that he is paid by the pharmaceutical industry to travel around the country and teach doctors that vaccines are safe. Dr. Offit is a member of the CDC’s advisory committee and voted on three rotavirus issues – including making the recommendation of adding the rotavirus vaccine to the Vaccines for Children’s program.”
    So, is anything he says valid?

    • Maybe you should attack his specific arguments rather than raising the specter of Conflict of Interest, of which he admits in every book or paper that he writes. Either his arguments are wrong or they are correct. As you can see from the debate above, several of the points that Offit made were accepted by Dr. Sears, who agreed to update his book in later editions. So, yes, there are things that he says are valid. The antivaccine movement has their own conflicts of interest… such as books and lawyers… that can be used against them too. So, the best way to shake out the truth is to directly challenge the arguments and the science. That’s the best thing about the scientific method; one can replicate the studies that Offit mentions and can compare the results.

      • However Offit accuses Sears of misleading readers by offering half-truths and misinformation; however its pretty clear in this copy-paste version he is doing the exact same thing. He continually misquotes Sears and selectively quotes sections out of context to support his argument.
        While some of his arguments are valid, as Sears recognizes and addresses, his creditability went out the window when he sat on the board that voted in his vaccine. As a blatant conflict of interest he should have recused himself from that vote to dispel any questions as to his motives. Instead, he participated in making his vaccine part of the normal schedule that every child receives thus profiting immensely from its sale.

      • He disputes the claim that he sat on the board that voted on his own vaccine. According to him, this simply is not true.

      • That Dr. Offit was not on the ACIP when RotaTeq was voted in can be verified just by looking at the records. A quick search on the CDC website for ACIP documents finds a 2005 draft version of ACIP minutes where Dr. Offit is a presenter, and not a committee member. RotaTeq was approved in 2006, Dr. Offit was no longer an ACIP member.

        Actually the ACIP minutes where RotaTeq were voted in are also online, the Feb. 2006 ACIP meeting. The rotavirus discussion starts on page 34, with a vote several pages later, I cannot find Offit’s name.

        Dave, why should you believe such whoppers as “he participated in making his vaccine part of the normal schedule” when there is easily accessible public records that show exactly the opposite?

      • Does Dr. Offit not profit from the sale of his patented vaccine?

        I think its pretty clear in the above articles that Offit does the exact same thing he accuses Sears of; He spins words and misrepresents what the book is attempting to accomplish. If you read Dr. Sears book he states numerous times that he is FOR vaccine

      • Not anymore. He and his co-inventors sold the rights several years ago. He got a total of $6 million, explained here. Even Dan Olmsted of AoA now admits it.

        Why do you think someone should be denied compensation for twenty years of work? Do you have something against people getting paid for their efforts?

        You sound just like some of my 9th grade classmates. I once spent my own money for a pattern and supplies to create a stuffed lion for a school project (a prop for a poem), something I spent hours doing (check out the chickenpox article on this site for an example of the skills I have learned starting with the toy lion, Aslan, and I still have it). Sure enough, several of my classmates asked if I could make one for them, without offering to pay (one did borrow the pattern, and never returned it!).

        You should read Offit’s book Deadly Choices, there is a whole chapter on Dr. Bob (oh, and be like me and check it out of your local library). He responds to each of Sears’ arguments.

      • I’m sorry, where did I say he should be denied compensation for his work? Great spin though, are you a Fox News commentator?

        You do seem very proud about your stuffed lion, congrats on that!

      • You implied it by going on by claiming he got “millions for a patent.” Except you forgot the last part of the sentence which would make more truthful: “for something he worked on for twenty years.”

        You were using a common cry and whine posted on several anti-vax sites. You started with Bad Argument A, “He voted to the vaccine on the schedule.” But when you found out that was patently false you fell back to Bad Argument B, “he got paid for his patent!.”

        Now come up with something original, like the use of real data and evidence.

        And yes, I am proud of my stuffed lion. As a fourteen year old kid I learned lots about sewing, and how there are selfish unthinking people. And not all of them are still fourteen years old.

      • Wow! Look at you go!! I guess the career in the textile industry didn’t pan out?

      • Actually being an aerospace engineer did pay much better. Your point?

  4. Listen, if the “herd Immumity” theory made any sense, than maybe I could understand the argument of why mandates are enforced on vaccinations.

    But, if you believe an unvaccinated child is a danger to yours, then so are your parents, grandparents, older aunts and uncles and society in general. Why? Because what is being vaccinated for now, wasn’t then, so they are not part of the ‘herd immunity’ either. Besides, the chances that they get boosters are low, and even if they did, how do they know they are really ’protected’, as not all vaccines will produce immunity in all people.

    Also, Offit and other authoritaive types never seem to recognize what years of sanitation, clean water and improved living conditions have had on the incidence of a lot of these infectious diseases.

    Ear infections are much more common today than ever. Strains of menengitis and pneumonia are always evolving and virtulant stranis such as 19A have become stronger as a result of vaccinations of other strains.

    Are we really to believe that vaccines have no negative side effects? That would be foolish and I for one will always believe that money and profits will prevail over the general welfare of our children. Just look at what’s in our foods today.

    • The herd immunity only fails if the amount of people not vaccinated fall below a certain threshold. So, yes, if there were enough elderly that didn’t have boosters, the herd immunity would be compromised. I personally doubt that the elderly would pull a community below the threshold. They are the one’s who are benefiting from herd immunity.

      The sanitation argument doesn’t hold water. There was a sharp decline of incidence of varicella in the 90s and measles in the 50s after their vaccines were introduced. If you look at it on a graph, it looks like the diseases almost disappeared. Sanitation does not explain the sudden decline of incidence after the introduction of the vaccine.

      Ear infections are a non sequitur.

      Vaccines have side effects. Your argument is a straw man. The side effects are clearly stated to the parents when the child is vaccinated. There is even an index that catalogs the side effects and a vaccine court that judges whether person is harmed by vaccines. Pharmaceutical companies have a financial motive to keep vaccines safe; they don’t want to be sued.

      • Vaccine companies also make sure that they cannot be sued by making a vaccine voluntary rather than mandated. It is the school system that mandates these vaccines, but parents can bypass these school mandates for medical or religious reasons in some states. Big Pharma just has a financial motive. Until the government makes all parents vaccinate their children, then parents still must make an educated decision for themselves on whether it is safe enough to vaccinate their child based on their own child’s individuality and needs.

  5. Who said the elderly were the only ones that are not part of herd immunity. I’m 42 and i haven’t had a vaccine since I was 5. There are many middle aged people out there who have not been vaccinated against these diseases. And who gets boosters for measles and pertussis?? It’s very rare any adult follows this program.
    Look at the graphs and you’ll also notice that mortality rates for all these diseases declined by over 90% before the vaccine program. What would be your explanation for this? I’ll tell you this, if hard times ever fall on this country and urban areas stop having access to food due to an economic crisis, you’ll soon see how infectious diseases make a big comeback. Anybody who knows anything about the science of disease knows that it breeds in unsanitary condiditons and amoung the people with weakened immune systems. You best defense from all diseases is a strong functioning immune system. I’d like to hear your explanation as to why so many of our kids are suffering from neurological and autoimmune disease in much higher rates than before the big vaccine increase. I know, it’s just coincidental and nobody really knows why? It’s better diagnosis, yes? That would be the typical response from your type.

  6. Boosters only help immunity. Just because you don’t have a booster doesn’t mean you aren’t protected.

    The varicella vaccine came in the nineties. You can’t tell me that sanitation dropped the incidence by 90 percent because that is a lie.

    There are more cars now, more tvs, more factories, more cell phones, more everything. You have to have evidence before you assign blame to diseases… not just an imagined correlation.

  7. So, I’m protected but I should get a booster to get more protected.. So, were all part of a marginally protected herd. Your argument is very weak.
    The dreaded Chicken Pox disease, that one was sure a killer that we all needed protection against. 30,000 children die every year from cancer, so sorry if I don’t get excited over the big Chicken Pox decline.
    Oh, so we have more people in the world that’s why rates of Autism are up and Autoimmune disease is rising. I must say, your logic is silly to say the least.

  8. First of all, varicella did kill hundreds of people and put those who contracted it at risk of shingles. But you ignore my point that sanitation does not explain the vaccine’s success.

    I never mentioned that a multiplied population was a reason for increased rates of health problems. I was pointing out that just because there are higher rates of something doesn’t mean that it is responsible for more diseases. Why choose vaccines as a cause for increased ear infections? You have no proof of anything you are spouting in these comments.

    If you are so worried about booster shots, you should be an advocate for that. You can start off by going to get your own. As for our immunizations being sub par because they need boosters, I think maybe you should spend time talking to more infectious disease doctors. Perhaps then you would know what you’re talking about.

  9. Ticktock, thanks for taking the time to do this.

    Here is my analysis of the charge of “Conflict of Interest” against Offit (hint–a lie)

    http://lizditz.typepad.com/i_speak_of_dreams/2009/01/conflicts-of-interest.html

    • Wouldn’t being a co-inventor of a vaccine create a “conflict of interest” even though he may not continue to receive funds from that particular creation directly?

  10. Complications from Cold medicine kills 500 kids every year, so what’s your point. I think you should stop spreading fear to support the chicken pox vaccine.

    Proof you say. And vaccines have never been proven to be safe. All I know is that I never met a drug or medical procedure that didn’t have a negative side effect. Vaccines are not an exception to this rule. If they were, we wouldn’t need a Injury Copensation Fund to shield the Pharma industry from civil lawsuits. Vaccines are the only product in the history of mankind to receive such protection.

    • Vaccines are safe relative to the potential harm of widespread disease. The question is whether they are unsafe in regards to all the accusations of vaccine opponents, and so far they have failed to prove a link between autism (and ear infections now, I guess) and vaccines.

      I wasn’t spreading fear. I was correcting your ignorance; there is a difference. “Complications” from cold medicine do not kill 500 kids every year. What “complications” are you referring to exactly?

      Vaccines receive protection because they are extremely important to society. You wouldn’t understand.

  11. I do understand. They’re so safe that without legal protection from the government, the vaccine industry would collapse under the weight of civil lawsuits. Food is extremely important to society, why shouldn’t the food producers get the same protection? Drugs are important to socitey.. The issue here is that vaccines cause so many complications that the industry would go bankrupt without this protection. If they were as safe as you say they are, they would function like any other product on the open market.

    And what widespread diseases were occuring before 1983 when the vaccines given to kids tripled?? Exactly what epidemic disease are you referring to? I know we have an Autism epidemic. An Asthma epidemic. A food allergy epidemic. But, now we can’t treat those epidemics with vaccines. Oh yeah, we also have an AIDS epidemic. Where’s the AIDS vaccine? Kind of hard to treat an immune supression disease with somehting that depresses the immune system, I guess.

    • The vaccines may have tripled, but the antigens in them decreased.

      All the rest of what you’re saying doesn’t make sense to me. I know you won’t change your mind, so my continuing this debate will not help my sanity. Continue to believe what you want to believe, and I will continue to use the baseline of scientific knowledge to determine fact from fiction. There’s nothing more to say on the matter.

      • Ticktock, what info do you have to refute Jim’s last comment? I am wondering how the drug companies are approaching this concern.

      • I don’t speak on behalf of the drug companies. You should ask an immunologist.

  12. Jim doesn’t understand much beyond the talking points he’s memorized. That’s a sure sign that the anti-vaccine movement is in free fall.

  13. Jim, your concepts about herd immunity are flawed. You and other adults who were never immunised will have some immunitty to things like measles (for example) because you had the illness as a child. You ARE part of the “non-vulnerable” herd. There will always be those who are susceptible however. These include infants too young to have had the vaccine, those who because of medical contraindications cannot be vaccinated with live vaccines, and a few who have had a partial or no response to the vaccines.

    As long as the herd is sufficiently big in numbers, the risks of infection circulating or outbreaks occuring is very small, minimising the chance that one of those who is vulnerable may get exposed and infected.

    Regarding the impact of hygiene/safe water etc on infections, I think you will find that the incidence of those infections for which this is crucial has declined. So no cholera, hepatitis A etc. But for infections spread through airborne route the incidence has not changed much. For example, we would all get chicken pox whether we live in the third world or Beverley Hills. Similarly measles (if there were no vaccinations for it). What has declined is the MORTALITY rate associated with many of these infections, and that is because modern medicine has been able to treat the complications more effectively and therefore fewer die. But the complication rate is still the same. If 1 child in 1000 got measles encephalitis in the 1930s, the rate is still 1 in 1000 today.

    As has been pointed out to you, what has driven down the incidence of what used to be common infections to almost zero has been the introduction of vaccination. Fewer cases, so overall fewer complications, fewer deaths.

    • So maybe we don’t need the Hep A vaccine? So with the mortality rate declining due to treatment advances, then vaccines are not really helping, it is the treatment of the diseases? What study shows that the complication rate is the same? Your argument does not substantiate your concluding statement.

  14. Every piece of writing tries to persuade you. Indeed, both doctors are trying to persuade the audience to their point of view.
    However, Dr. Offit basis his argument on a poor reading and misinformation of Dr. Sears’ book as Dr. Sears shows.
    Personally, I would prefer to be persuaded by someone who is able to come up with their own argument that is based on facts rather than poor reading and worse interpretation.

  15. An alter to science and reason has enhanced the resale value of my home. Hopefully not too many people realize I’m a fundamentalist.

    http://www.salon.com/books/int/2008/03/13/chris_hedges/index.html

  16. […] always been interested in the converse views as well.  Here’s an easier read of the debate between Offit and Sears on the subject of vaccination […]

  17. I am a pediatrician. do i vaccinate my children? absolutely. do i vaccinate them because i am secretly part of a pharmeceutical and government conspiracty to cover dangerous side effects, and bolster the drug companies pockets? no. i vaccinate my kids because vaccinates protect my children from potentially lethal infections, and are the single greatest medical intervention which reduces morbidity and mortality in history.
    it comes down to who you are willing to trust: your doctor, who like me, has probably researched this topic tirelessly (i have many patients who have unfortunately been scared by this situation) and therefore, i want to be as informed as possible.
    or are you going to trust people like jenny mcarthy, an actress, who does not truly understand the science behind the matter. She is a mother, however, and her first instinct is to protect her child. so she is looking for any answer, or solution. here is where the parasites come in: litigation lawyers who see a whole new ‘industry’ to exploit; people with ‘cures,’ such as vitamins or chelation. look at any ‘anti-vaccine’ website and you will see a host of ads for these ‘natural’ remedies. now there is some real conflict of interest.
    Jim, i’m afraid you do not truly understand herd immunity. take a look at small pox and polio, enough said.
    also, you said you haven’t had a vaccine since age 5. by age 5, you would have had basically all of the usual vaccines that any child would normally get.
    the bottom line with Dr. Sears rebuttle to Dr. Offit, is that he agrees with most of Dr Offit’s conclusions, and clarifies some of his intentions. They both endorse vaccines. i should point out that the American Academy of Pediatrics has formally recommended against Dr. Sears suggested vaccination schedule. On the other hand, as a pediatricitan, i am just glad if your child gets them done, even if in modified sequence. because i know that it poses far less risk to the child then contracting the actual disease. please do it for the sake of your children. (i have 3 kids)

    • I applaud you on being well informed and I am glad that your parents have pushed you into that direction. Another point for Dr Sears.

  18. […] on Vaccines at Babble Dr. Paul Offit, a pediatrician and vaccine expert, wrote a book called Autism’s False Prophets about the rise of the antivaccine movement.  […]

  19. Dr. Sears seemingly contradicts himself in the book or makes comments stating one thing but sowing further seeds of confusion by then telling the reader something to create doubt in what he just said. He’s very careful to really choose NO side, or rather to limit his position to staying astride the line, trying to make everybody like him. Meaning he seems to know vaccines are safe, but just in case something ever comes up, he can say ” see, I told you I was worried about this.” That way, the anti-vaccine crowd doesn’t reject him. Yet he knows that he has zero evidence to support most of his “concerns” at this time.

    (He lists Dr. Wakefield’s 1998 MMR study as one of his resources for the book. Even if he explains the study was retracted, why is it there? Do scientific authors normally use science that has been discredited?)

    I was also wondering: since he seems to tell parents they can rely on herd immunity, when more and more parents follow his schedule, (sort of, because who can keep up with and pay for all those visits?), and herd immunity is a thing of the past due to low immunization rates, what will he tell parents then?

    And his schedule that tells parents to avoid MMR and varicella and just have titers drawn at age 10…that will also contribute to the fall of immunization rates and the loss of herd immunity, not to mention increased disease outbreaks, so, hey, those titers should be positive! No doubt there will be some misery and even deaths along the way as well.

    I found it interesting that he mentions SSPE as a possible side effect of the measles vaccine. Yet the incidence of this is far greater following disease than it is following the vaccine, and rates of SSPE have dropped since measles vaccination. (see articles at end)
    I don’t recall seeing that clarified in his book, but it may have been there. It was NOT explained that way in the Vaccine Side Effects section of the book.

    He just has too many wishy-washy positions for me to have any faith in him. Even his arguments against Dr. Offit are weak and confusing. Maybe he needs to read his own book.
    Here is a quote from his own article, part of his response to Dr. Offit: “My alternative schedule isn’t necessarily what I would recommend parents do.”
    Huh?
    And then there is this: “It certainly wouldn’t be a practical or reasonable vaccine schedule for our country as a whole.”
    Who does he think should be allowed to pick and choose which schedule they want to follow then?
    Oh, and then there is this:
    “Babies would fall behind on their shots, compliance would wane, and some could be susceptible to what should be a vaccine preventable disease.”

    I read his book. I was left with the impression he is trying to appear pro-vaccine while subtly and seemingly endorsing an anti-vaccine message.
    Someone should tell this guy that you can’t please everyone, and when you compromise principles in an effort to do so, everybody loses.

    1. http://ije.oxfordjournals.org/cgi/content/abstract/36/6/1334

    2. http://pediatrics.aappublications.org/cgi/content/abstract/59/4/505
    Based on estimated national measles morbidity data and national measles vaccine distribution data, the risk of SSPE following measles vaccination (0.5 to 1.1 cases/106) appears to be less than the risk following measles (5.2 to 9.7 cases/106). Because live measles vaccine is highly effective in preventing measles illness and a high proportion of children in the United States have received measles vaccine, these data are consistent with the observed downward trend in SSPE incidence since 1969.

    Submitted on May 20, 1976

    I posted one older and one newer study, but there are more available, all saying the risk of SSPE decreases in a vaccinated population.

    • It’s called presenting both sides of the argument. Not all people are as one sided and closed minded as Dr Offit or any of the anti-vaccine doctors, for that matter. Most of the evidence presented is scientifically based (with the exception Dr Wakefield). I think he is trying his best to give parents as much information as possible. Of course, he doesn’t take a side. It is not about taking sides. It is about being an informed consumer. He doesn’t want the anti-vaccine movement to reject him because he is trying to persuade them to get vaccinated whether it be on the CDC’s recommended schedule or an alternate one. Just something. And that is not compromising his principles.

      When people talk about all of those visits, it looks close to a yearly schedule which most people do for school, sports, and childcare anyways. Not a major expense, but if so, an expense the consumer chooses to make. The other schedule is for people who may not have the time. money, or education devoted to this particular subject. They are not the ones reading his book.

      If the government was so worried about these anti-vaccine people not getting shots then they should make them mandatory, but that would put the pharmaceutical companies at too much risk.

  20. Although I appreciate the effort in placing the info from these debates in one place to read, I truly believe one should read research and materials from both doctors before passing judgement. After doing that, I feel that Dr. Offit does provide some good information. But I am wary because of his connection with pharm. companies. Dr. Sears also provides a service with the vaccine book. I do NOT feel that he is anti vaccine and most people who have read his book would probably realize that. For me, following his schedule has nothing to do with autism. I do not believe taht one size fits all (nor does this work in education, btw) and as long as I get my son vaccinated, why does it matter that he is getting 2 shots at a time instead of 6? Since I have been following this alternate schedule, my son is not lethargic and in need of tyleneol following his shots. That is evidence enough for me.

  21. Dr. Offit’s attack on Dr. Sears for being a renegade was natural because he was just protecting the status quo. However, Science must be based on open debate. Shutting Dr. Sears up is not science, it is censorship. Rather than re-arranging old drug research, much like shuffling the deck chairs on the Titanic, medicine needs more data on the U.S. population as a whole. Sadly, now with cell phones being wide spread in this country no doctor has suggested using them to collect raw data from patients. Every day children are vaccinated, why not have the doctor give the parent a log in code (unique to the doctor not the patient) for an 800 number at the CDC for every parent to call and report adverse reactions, fevers, etc. for 10 days after the shot. After the data is collected and studied by the CDC and universities an actual debate based on widely collected neutral data from millions of shots can then advance this field of medical science. Then we can leave behind the tribalism attacks on other medical professionals in favor of the pure truth of science.

    • Dr Offit has every right to debunk Dr Sears and vice versa. It’s the beauty of this country, not censorship. That being said, I like your ideas with the call center. Maybe Big Pharma can pay for it.

      • How many months did it take you to think of these multiple inane responses?


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Categories

Follow

Get every new post delivered to your Inbox.

Join 63 other followers

%d bloggers like this: