Why quarantine for measles is critical…and quarantine for Ebola was not

Measles has come to the happiest place on Earth. As of this writing, a total of 32 cases of measles have been linked to Disneyland visits that took place between December 17th and 20th. About 75% of the cases identified to date were not vaccinated, either because they chose to forgo vaccines or because they were too young, and at least 6 have been hospitalized.

A measles outbreak is a public health disaster, which can cost into the millions of dollars in health resources. You can be sure that public health workers in California and beyond are working overtime trying to identify cases, educate those who were possibly exposed about how dangerous measles can be, and implement practices so that those who may have been exposed to measles don’t further put others at risk. This includes avoiding public places, and practices such as calling ahead to a doctor’s offices so possible cases can be ushered into private rooms rather than languishing in the waiting room. A clinic in La Mesa recently closed because of a potential measles exposure. An unvaccinated South Pasadena woman, Ylsa Tellez, received a quarantine order after her younger sister was diagnosed with measles. Tellez is fighting the order and “taking immune-boosting supplements” instead.

Why such extreme measures on the part of public health?

Measles is highly contagious. It’s spread by air, and so contagious that if an infected person enters a room, leaves, and an unvaccinated person enters the room hours later, they still can contract measles. Remember a few months back, when that figure was circulating showing that Ebola wasn’t particularly easy to spread? Well, measles very much is. The basic reproductive rate for Ebola is around 2, meaning on average each infected person will cause an additional 2 infections in susceptible individuals.

And what’s the reproductive number for measles?

Eighteen. Eight. Teen. I’m not exaggerating when I say that it is literally one of the most contagious diseases we know of.  On average, if you have 10 susceptible individuals exposed to a measles patient, 9 will end up getting sick.

How do we break the cycle of transmission? Vaccination is one way–if one has been vaccinated for measles, chances are very low (but not zero, because nothing is perfect) that they will contract measles. Beyond vaccination, the next-best intervention is to keep those who are infected away from everyone else. The way we do this is by quarantining them.

In public health terms, quarantine specifically refers to the separation of individuals who have been exposed to an infectious agent, *but are not yet ill themselves,* from the rest of society. That way, they’re unable to spread the infection to others. Quarantine makes the most sense when individuals can transmit the infection before they realize they’re sick, which is exactly the case with measles. Infected individuals can spread the virus fully 4 days before the characteristic rash starts to appear, and continue to spread it for another 4 or so days after the rash begins—potentially infecting a lot of people. The problem is, like Ylsa Tellez, they’ll feel fine while they’re out there in the general population. They don’t even have to be coughing or sneezing to spread it (symptoms which can appear prior to the rash)—they can just be breathing (something many of us like to do on a regular basis), and still contaminate their environment with the measles virus.

The difference in transmissibility also makes measles a very different situation from Ebola. Public health officials almost universally condemned quarantine for Ebola exposures, for two reasons: 1) Ebola wasn’t highly transmissible, and  isn’t airborne like measles is; and 2) because Ebola isn’t efficiently transmitted until late in the infection when the patient is very ill and likely bedridden. Quarantining Ebola patients was a political stunt, not a public health necessity.

This is why states have the legal authority to enforce quarantine for infectious diseases: it reduces the risk that asymptomatic, potential disease-spreaders will act as “Typhoid Marys” (another asymptomatic, deadly-disease-spreader), which is in the public interest. And while unvaccinated Tellez feels “attacked” and her mother thinks people are being “not nice” when they demand that Tellez submit to quarantine, their choice not to vaccinate has already put many others at risk of disease and, and is resulting in the quarantine of many other exposed individuals as well. In the 2011 Utah measles outbreak, 184 were quarantined and thousands of contacts traced, at an expense of approximately $300,000. The Disneyland outbreak has already spread into 4 states (California, Utah, Washington, and Colorado). Quarantine is one of our tools to stem the epidemic. In our recent outbreak among Ohio Amish, most willingly submitted to quarantine, and over 10,000 doses of the MMR vaccine were administered. Quarantine is undoubtedly a difficult prospect to face, but perhaps if Tellez and others had been vaccinated in the first place, they, and we, wouldn’t be in this situation.

Mayim Bialik is a problematic ambassador for science

Mayim Bialik is an actress. She grew up playing TV’s “Blossom,” and recently has surfaced again on television as Dr. Amy Farrah Fowler, a neurobiologist on “The Big Bang Theory.” In between, she went to college and on to grad school, receiving a PhD in neuroscience. She is a “Brand Ambassador” for Texas Instruments and is this year’s featured speaker at the National Science Teachers’ Association conference.

She is also anti-vaccine, and a spokesperson for the “holistic mom’s network,” which eschews much that modern medicine has to offer and features several prominent anti-vaccine advocates on its advisory board.

Reactions have been mixed regarding her gig at the NSTA convention. Skeptical raptor thinks it’s OK as long as she’s just talking about her path to science (presumably, something like this article in Nature) (he clarifies here as well). Hemant Mehta (himself a math teacher) thinks not so OK, and I lean much more that way. As I noted on the Skeptical Raptor’s Facebook page, she may really like science, but the fact is that her position on vaccines undermines not only the science, but also the very *scientists* who do such work. She’s saying that some science is great, but other parts shouldn’t be believed and accepted. This is not cool or acceptable for such a big-name speaker.

That’s not to say that there are not controversial areas within science, or that everyone has to agree on every point. Certainly there are many areas which are fraught with controversy, and which we’re working to understand. But the basics of vaccines are not one of them. Certainly people would be outraged to see Michael Behe or another prominent evolution denier from the Discovery Institute or Answers in Genesis speaking at this conference, even though they may also have a PhD and, likely, a love of science. In Bialik’s case, she is *actively endangering the lives of others,* but because she’s a fellow science lover, it’s OK to give her a podium and additional notoriety? No.

Further, because she’s a PhD, many give her views on vaccines more weight than someone like Jenny McCarthy (who lacks any formal science training and is easier to write off), even though Bialik also lacks training in microbiology and immunology. In my opinion, that makes it even more important to avoid legitimizing her vaccine opinions.

Bottom line: if you love science, don’t actively undermine a part of it that actually affects the everyday lives of millions of people, and if you’re a company or organization who is promoting science, please don’t choose as a spokesperson or honored speaker someone who does this.

 

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Why I vaccinate my kids

Being a new parent is exhausting. All of a sudden, you’re out of the hospital and on your own with this amazing, tiny human, and you alone are responsible for her care. You’re given reams of paperwork about feeding and sleeping, developmental milestones, red flags to look out for. You’re inundated with information you barely have time to look at. Mom is trying to heal from childbirth while barely sleeping, while her partner is trying to pick up the slack and pitch in as much as possible. You both fumble with the car seat, thinking that NASA must have equipment that’s easier to figure out. You obsessively check your sleeping baby to make sure she’s still breathing. You worry about every sneeze and try to decipher her cries. Is the diaper too tight? Is this acne normal? What do I do about her poor dandruffy head?

Do I vaccinate?

vaccineWilliam receiving the first of  his 2-month vaccinations

I know it can be scary. You might have heard from friends or relatives, or read on the internet, that vaccines can harm your baby. You may be concerned about autism, or think that “natural immunity” is better than that which develops from injections. You may think that the diseases she’s being vaccinated against “aren’t all that bad,” or that kids today receive too many vaccines. You might feel that your physician is “bought out” by “big Pharma” and that your health care providers are writing off your concerns.

I know you just want to do what’s best for your child. I feel you. I’m the parent of a teenager, a tween, and a 2-month old. Here is why I vaccinate my children.

William vax 2William receiving his vaccinations

I’ve spent almost 20 years of my life studying infectious diseases up-close and personal, not from random websites on Google. I’ve worked with viruses and bacteria in the lab. I respect what germs are capable of. I worry about vaccine-preventable diseases coming back because of low levels of herd immunity. I cry over stories of babies lost to pertussis and other vaccine-preventable diseases. As I’ve noted before, chicken pox has played a role in the deaths of two family members, so I don’t view that as just a “harmless childhood disease.” Vaccines have eradicated or severely reduced many of the deadliest diseases from the past: smallpox, polio, measles, diptheria.

But that’s not the only reason I vaccinate. I vaccinate because I’m all too aware of the nasty diseases out there that still don’t have an effective vaccine. My current work focuses on a germ called methicillin-resistant Staphylococcus aureus (“MRSA”), a “superbug” which kills about 11,000 people every year in the United States. We have no vaccine. I previously worked on two different types of Streptococcus: group A and group B. Group B is mainly a problem for babies, and kills about 2,000 of them every year. It leaves many others with permanent brain damage after infection. We have no vaccine. Group A kills about 1,500 people each year in the U.S. and can cause nasty (and deadly) infections like necrotizing fasciitis (the “flesh-eating disease”). We  have no vaccine. These are all despite the fact that we still have antibiotics to treat most of these infections (though untreatable infections are increasing). Infectious diseases still injure and kill, despite our nutritional status, despite appropriate vitamin D levels, despite sanitation improvements, despite breastfeeding, despite handwashing, despite everything we do to keep our kids healthy. This is why protection via vaccination is so important for the diseases where it’s available. If vaccines were available for the diseases I listed above, I’d have my kids get them in a heartbeat.

w after vax 1William with daddy, right after finishing his vaccinations

I’ve done my best to keep my kids healthy and safe. I nag about bicycle helmets and make sure they’re getting exercise. I make them eat vegetables. I don’t move the car until everyone is buckled up. My older kids were in booster seats for what felt like forever, as both were on the small size for their age. Vaccinations are just one more part of this arsenal. I’m well versed in the safety data and know that most vaccine side effects are minimal (fever, soreness at injection site). They don’t cause autism, or SIDS, or any of the other claims made by dubious sites such as Natural News or Mercola. They do save lives and prevent disease by training the body to recognize and fight germs.

My youngest recently went in for his 2-month shots. He cried a bit when he received them, but not any worse than he does when he needs to be burped, changed, or held. He slept a little extra that evening, but was back on his normal schedule the next day. At his visit, he received the oral rotavirus vaccine; his second Hepatitis B shot; his pneumococcal vaccination; and the combination shot including diptheria, pertussis, tetanus, polio, and Haemophilus influenzae (DTaP/polio/Hib). Each one I see as a small measure to support his health and safety, as well as my own peace of mind, knowing that I did what I could to protect him from infections that used to kill thousands of children every year. Some still do when vaccination isn’t available or accepted–measles killed over 120,000 people in 2012, most of them young children who hadn’t been vaccinated.

W after vax 3William at home after his vaccinations

We all try to do the best by our children. As a scientist who’s studied infectious diseases, vaccination is a no-brainer for me, and I worry for the children out there who are left undefended against these infections because of misinformation and wrongly-placed fears. I know these parents are trying to do right by their kids, but infectious diseases don’t recognize good intentions. As I sit here with my baby breathing softly beside me, I am thankful for those who came before me and dedicated their lives to protecting children like him, and grateful that he will never have to suffer from infections that were the scourge of earlier generations.

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The Pap smear is no panacea, Katie Couric

Regular readers keeping up on infectious disease issues might have seen Seth Mnookin’s post yesterday, warning of an upcoming episode of the Katie Couric show  focusing on the HPV vaccine. Even though Mnookin previously spoke with a producer at length regarding this topic, the promo for the show certainly did not look promising:

“The HPV vaccine is considered a life-saving cancer preventer … but is it a potentially deadly dose for girls? Meet a mom who claims her daughter died after getting the HPV vaccine, and hear all sides of the HPV vaccine controversy.”

And indeed, reviews thus far show that unfortunately, Couric pretty much  mangled the issue and allowed heart-wrenching anecdotes to trump science (reminiscent of Jenny McCarthy’s appearance on Oprah). I won’t cover it all (you can view it here), but basically Couric allows stories about illness and death in the weeks following administration of the vaccine to go unchallenged, and brings on Dr. Diane Harper as her HPV expert (featured prominently in the anti-vaccine documentary “The Greater Good“). Dr. Harper believes the HPV vaccine is over-hyped, and that Pap screening is “100% accurate” so no HPV vaccine is really needed. This, frankly, is hogwash. Even with emphasis on screening, here in the U.S. we have 12,000 cases and 4,000 deaths from cervical cancer alone each year. (And in Mnookin’s post and in Matthew Herper’s Forbes post, both note that head and neck cancers can also be caused by HPV as well–but have no good screening process).

Even when HPV cervical infections are caught via screening, the treatment ain’t pretty. I’ve written before mentioning one such remedy–the LEEP procedure.  I had this done several years ago, after a Pap smear came back with abnormal cells and positive for HPV DNA:

“Next, a woman with abnormal cells can expect to undergo a LEEP procedure, where portions of your cervix are removed with a burning electric wire under local anesthetic, and the foul smoking remains of your cells are sucked up into the smoke shark, “a sleek, powerful, smoke-eating machine.” [And one gets to look forward to “coffee ground-like discharge” for up to several days following the procedure, due to the materials they use to stem the bleeding cervix]. After LEEP, side effects may include infection, hemorrhage and possibly cervical incompetence.  These are rare, but if we’re talking vaccine side effects versus possible outcomes from HPV infection, these types of outcomes need to be considered as well–not just death from cervical cancer.”

Being currently pregnant following such a procedure, cervical incompetence was something I was carefully monitored for. Nevertheless, it’s still been a huge source of stress throughout this pregnancy, as this is a significant cause of second-trimester miscarriage and there aren’t great, foolproof ways to detect it, or remedy it if it does occur. Harper acts as if finding HPV via Pap smears is like rainbows and unicorns, but it too has a risk-benefit equation, and I’d so much rather have received a vaccination than to have gone through that. And, some women’s treatments for HPV infections and cervical abnormalities are even more extreme than mine was.

This is why I had my now-almost-14-year-old daughter vaccinated for HPV, and why my pre-teen son will soon be getting his as well. There are multiple ways to prevent HPV-induced cancers, but the vaccine (in combination with routine Pap smears) is by far the least invasive and safest route, as multiple studies have confirmed.

Finally, the show was doubly disappointing because Couric has been such an outspoken advocate of colon cancer prevention, which was the cause of her husband’s death in 1998. While realizing this is a fluff talk show and not the kind of harder journalism she’s apparently now abandoned, she still failed to ask even the most basic of questions to the supposed HPV vaccine “victims” she featured on her show, nor to note during their segments that other possibilities may exist for the girls’ illnesses and death besides the HPV vaccine. In the second segment, Rosemary Mathis even admits blatantly doctor-shopping until one would “listen to her” about her daughter–in other words, give her a new diagnosis (vaccine injury). Why isn’t this even questioned? What did her previous doctors tell her about her daughter’s condition? Couric allowed ratings and anecdotes to trump actual science, potentially causing real harm to the public health. How disappointing that this is now part of her legacy.

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Student guest post: The Fallacious Fad of Foregoing Vaccinations

It’s time for this year’s second installment of student guest posts for my class on infectious causes of chronic disease. First one this year is by Dana Lowry.

Humans have a long history of illness and death from infectious diseases. It wasn’t until the 1790s that we had a solution. Edward Jenner recognized that milkmaids never contracted smallpox but suffered from a more mild disease, cowpox. Jenner took pus from a cowpox lesion on a milkmaid’s hand and placed it in an incision he made in an eight year-old boy’s arm. He then exposed the boy to smallpox; the boy didn’t contract the disease, proving he was immune. Jenner experimented on several other children, including his own 11-month old son, and his theory of passing on immunity proved to be successful. The Latin term for cow is vacca, which is where Jenner coined the term “vaccine”. Jenner’s discovery eventually led to the eradication of smallpox from the U.S. in 1949 and from the world in 1979. For over a century, vaccines were limited to preventing smallpox but as we know today, vaccines prevent a large number of diseases.

Although many developing countries still suffer from the burden of preventable infectious diseases, the U.S. has greatly increased the life expectancy and quality of life through the use of vaccines. In the 1940s, the U.S. recommended vaccines for diphtheria, pertussis and tetanus; polio was added in the 1950s. In the 1970s, measles, mumps and rubella (MMR) were added to list. Today in the U.S., immunizations are recommended for 17 vaccine-preventable diseases during one’s lifetime and more are available for individuals traveling outside of the U.S. Many of these vaccinations are combined so they can prevent multiple diseases from one series of immunizations. The increase in life expectancy in the 20th century is largely attributable to vaccines. For each birth cohort vaccinated, 33,000 lives are saved, 14 million cases of disease are prevented, healthcare costs are reduced by $9.9 billion and $33.4 billion is saved in indirect costs. The Bill Gates Foundation believes that vaccines are one of the most cost-effective investments in global health, saving about 2.5 million lives each year. One child dies every 20 seconds from vaccine-preventable diseases while tens of thousands of other children suffer from severe illnesses and permanently disabling diseases.

Despite the facts, less and less parents are choosing to vaccinate their children today because of fears that vaccines are unsafe. Much of the controversy started with Dr. Andrew Wakefield, a former British surgeon and medical researcher. Wakefield published a paper in 1998 linking the MMR vaccine to autism and bowel disease. Wakefield’s entire study was found to be fraudulent and the infamous paper was retracted in 2010. But, what got more attention than a retracted science paper was Jenny McCarthy sharing her personal life story of how her son got autism from a vaccine on the Oprah Show. Unfortunately, more moms keep up-to-date with Oprah and popular news rather than science and still do not know the truth behind Wakefield’s falsified study; therefore, the autism myth continues.

Furthermore, parents argue “herd immunity”. If your children are effectively vaccinated then why would I have to worry about mine? First, many vaccine-preventable diseases still exist in other countries and can easily be brought into our country; second, some individuals do not build immunity to the disease even after vaccination. The more and more parents that opt out of vaccinations, the less protection their children have from the rest of the “herd”. Additionally, parents argue that their children should contract diseases “naturally” through the environment to build immunity. Parents don’t fully understand the severity of these diseases because many have been virtually eradicated through the successful use of vaccines. Though some crippling effects of polio still linger, it is rare to come across someone wearing braces or using a wheelchair as a result of a polio infection in the U.S. Many vaccine-preventable diseases can cause death during the initial acute illness and if the individual survives, he or she may be left with chronic effects that last a lifetime. Polio can lead to temporary or permanent paralysis, deformities in the hips, ankles and feet; measles, mumps and varicella can all lead to brain damage and mumps is known to cause deafness; hepatitis B can cause permanent liver damage and even liver cancer. The list of damaging effects goes on and on.

In some areas throughout the U.S., as many as 1 in 20 kindergarteners have not been vaccinated. As the antivaccination fad grows in American so do the infectious disease rates. Measles was said to be eliminated from the U.S. in 2000 but an average of about 60 cases of measles occurs each year, typically from traveling. However, in 2011, there were 17 measles outbreaks in U.S. communities and the number of cases jumped to 222. In 2012, the U.S. had one of the largest pertussis outbreaks in nearly 50 years. Nationwide, over 85,000 vaccine-preventable diseases occur each year. I am not arguing that vaccines have no potential side effects and have never caused adverse effects or even death in children. However, I do think vaccines have done considerably more good than harm. So I urge parents, before deciding to withhold your children from vaccinations, look into the facts and make a decision based on science – not popular news. Although outbreaks of disease have been conquered in the past, many vaccine-preventable diseases remain throughout the world and the U.S. is not immune to future outbreaks.

 

Temple Grandin is wrong on vaccines and autism

Temple Grandin is undoubtedly one of the most famous women with autism of our time. Trained in animal science, Dr. Grandin is a widely read author and noted speaker on autism. April is National Autism Awareness Month, and Dr. Grandin has a new book out, “The Autistic Brain.” Together, this must have seemed like a good time for the New York Times to interview her. Unfortunately, the interview is superficial and not very illuminating, and what Dr. Grandin does say is disappointing. Her take on vaccines and autism, which apparently is elaborated upon in her new book:

Q: In your new book, “The Autistic Brain,” you seriously entertain possible links between vaccines and autism in children, links that scientists have vehemently dismissed.

A: Well, there’s only one vaccine that could possibly be a problem, and that’s the measles-mumps-rubella vaccine. Now that they’ve changed the vaccine, it has fewer antigens, and that would make it a lot safer. But with the old version of the vaccine, I have not yet come across a study that looked at regressives — when a child had some speech but lost it.

Q: There has been a highly emotional battle between mothers of autistic children and the scientists who dispute their theories.

A: I have talked to maybe five or six of those mothers, and that’s the reason I don’t pooh-pooh it. Those mothers have all described the same things. They all have the vaccine, and then they talk about fevers and the weird wailing that started in just a few days. When I brought this up to an expert and asked, “Have you ever studied the regressive group separately?” I got silence.

This is the problem when scientists speak about areas where they’re not experts. I got a lot of flak for my post to my dad addressing vaccines, with people accusing me of being condescending and underestimating his intelligence, but this shows it’s not an intelligence thing at all. (Plus, my dad is plenty intelligent–otherwise why would I bother to write that for him at all?) Grandin is obviously intelligent. She’s also highly educated. She has a PhD in another field. But she’s not an expert in vaccines, as her comments show, and that’s the problem with scientists who speak outside of their area of expertise. Even the very educated amongst us can’t know everything, and it becomes problematic when we use our reputation as scientists to promote something that we don’t have the background knowledge to really understand.

So, Grandin. First, she’s simply wrong about MMR formulation. Perhaps she’s thinking of the DTP vaccine, which now includes an aceulluar pertussis component (“DTaP” or “TDaP”) and therefore has reduced the amount of antigens in the vaccine (not that “excess” antigens are a problem for our immune system, which deals with literally millions of antigens on a daily basis, but that’s another story).

She’s also wrong about studies on regressives. As a scientist, why doesn’t she do her own literature search, rather than “asking experts” and supposedly getting silence? Because she could find several such studies, like this study in the journal Pediatrics or this one in PLoS ONE, if she simply searched.

Her biggest problem, though, isn’t just failure to represent the scientific literature or to understand the MMR vaccine. It’s her over-reliance on anecdote. Simply by the numbers, this correlation between regression and MMR vaccination (or any vaccination) is completely expected. There are currently about 75 million children in the United States. It’s estimated that anywhere from about 1 in 90 to 1 in 50 kids have some kind of autism spectrum diagnosis. Using the higher numbers for the sake of argument and easier math, that’s about 1.5 million kids, and most are diagnosed between the ages of 1 and 5. The first dose of the MMR vaccine is at ~12-15 months of age–when many parents of children with autism are starting to realize that their kids perhaps aren’t communicating like their peers or showing other characteristics of autism, and may think about getting them evaluated. That’s a window of about 1500 days, in which the majority of those 1.5 million kids receive their diagnosis–so averaging a thousand kids a day. Some of those kids will have just gotten shots, and some will have the reactions Grandin mentions–fevers, crying–by chance alone. Some will also wear mismatched socks that day. Some will eat Cheerios for breakfast. But because these aren’t in the news, moms don’t remember the socks, Cheerios, or a thousand other things that their kid did that day that are just as relevant to developing autism as the vaccines they received.

Correlation does not equal causation, and in this case, many, many studies have *disproven* such a link. Talking to “five or six mothers” does not trump years of scientific data looking at many thousands of kids diagnosed with autism, and it’s unfortunate both that Grandin has promoted this type of thinking, and that the New York Times interviewer considered that newsworthy enough to ask Grandin, out of everything else in her book.

An open letter to my dad on the occasion of his recent anti-vax Facebook postings

Pa and I 3Dear Pa,

I know you care deeply about many issues, especially social justice. You’re tired of wars, you’re ashamed of the attempts to destroy social programs in this country, you hate seeing the unions that helped you as a worker provide for our family get dismantled by wealthy CEOs whose only goal is to make themselves and their cronies more wealthy. These are noble things to believe in, and values that you’ve instilled in your children.

But you probably don’t often consider how you select and digest (and frequently, share on Facebook) the stories that you’ll accept as true. This is called cognitive bias–sorry, that’s a terrible article for a layman, but I’d be happy to discuss next time I’m home. Anyway, the bottom line is that the beliefs you already hold prime you to accept certain types of information, and reject others–and it’s something everyone should be aware of when reading anything on the Internet, especially. You don’t investigate how the authors of articles and videos you read and view came to their conclusions, or what data they may have overlooked (I’m being generous here–in most of the things you post, it’s not a matter of “overlooking” contradictory evidence on the case of the authors, it’s flat-out denial that it even exists). And you’re not an expert on health issues like fluoride or vaccines, so I don’t expect you to go back to the journal articles and try to figure out if these people you’re listening to are telling the truth. That’s what I do, but it took years of training to get me to this point, as you probably remember.

You repeatedly caution, “follow the money.” Often this is the case, and no one disagrees that many times people or companies do some nasty shit in the name of profit. However, you have to look at this on a case-by-case basis. Let’s look at vaccines, for instance. Sure, pharmaceutical companies make money off of vaccines. However, this money is a fraction of what they make for drugs that treat chronic conditions or “lifestyle” medicines, like cholesterol meds and Viagra. Indeed, many pharmaceutical companies have gotten out of the vaccine game altogether because it’s not particularly profitable, and because of lawsuits directed against them (which, in most cases, aren’t based in science but on fear and misunderstanding of cause and effect). This leaves us with fewer and fewer options when we need new vaccines quickly, like for the H1N1 pandemic in 2009.

So, we’re agreed that vaccines are potential money-makers for pharmaceutical companies (though, comparatively, not a lot). Let’s look now at those who started the most recent iteration of vaccine panic, including Andrew Wakefield. Wakefield is the British doctor whose study first drew an association between the measles/mumps/rubella (“MMR”) vaccine and autism. Except, first of all, it really didn’t if you look at the original article. And, you might note that article has a big “RETRACTED” notice at the top. This means that the journal took away its support of the paper–it shows that it never should have been published. That’s because, for that study and several others, Wakefield lied about data, unethically recruited test subjects, and/or just outright made shit up. Why might he do this? Well, a British lawyer had paid him to find evidence of this connection between MMR and autism, so that the lawyer could sue on behalf of the parents. Oh, and did I mention that Wakefield stood to make money for a replacement for the MMR vaccine as well? Follow the money indeed–though in this case, it didn’t lead to the pharmaceutical companies. Wakefield was tried in England and stripped of his medical license, but has since moved to the United States and still spreads misinformation about vaccines.

What about other anti-vaccine players? Jenny McCarthy has made millions selling books about how she “cured” her son Evan of his autism. Joseph Mercola makes millions selling dietary supplements (untested and largely unregulated, by the way), and lives in a two million dollar mansion. I know you’ve criticized creationists; well, these people are the creationists of the medical field. They distort, they cherry-pick their evidence, and they cause the public to lose confidence in credentialed scientists because of their writings. Credentialed scientists like myself, who carry out the vast majority of this research but certainly don’t live in million-dollar homes.

And you’re helping the Mercolas of the world–every time you post something like your “Italian court rules MMR vaccine causes autism” picture. Guess what “evidence” that court used? Andrew Wakefield’s discredited study. In science, this is an error even a first-year PhD student would be embarrassed to make. Not surprisingly, the decision is being appealed. But in the meantime, every parent who (wrongly and unscientifically) believes that vaccines caused their child’s autism is being buoyed by this court, whose decision is being trumpeted by people like Mercola and Mike Adams at Natural News (another supplement-pusher like Mercola, with no medical expertise or training). Every time someone buys into their anti-vaccine line and chooses to buy their supplements instead of vaccinating their child, it puts other children in danger. And you’re helping them.

Know the results of this vaccine backlash? Research dollars are diverted away from real causes of autism and other conditions. And kids are dying. Just in the U.S., there have been more than 1000 vaccine-preventable deaths in the last 6 years, and over 100,000 vaccine-preventable illnesses. Freaking whooping cough has made a huge comeback in the U.S. A big reason for the resurgence of these diseases is because anti-vaccine myths and scares spread so easily between acquaintances–in person, and on social media; scares that you’re now perpetuating with your own posts. Sure, it’s a free country and you have every right to share these pictures and memes, but have you thought about the possible harm it might do to others when you click “share”?

I know how crazy it drives you when Republican politicians (and friends and relatives) post pictures and stories that are flat-out wrong, about the deficit, the economy, “Obamacare,” and more. It makes you nuts how uncritically they quote Fox News. They don’t examine their own biases; they don’t stop and think why they accept that Obama is the anti-Christ and that everything associated with him is evil, even if the facts clearly contradict their belief. Sure, they may know a lot, but it’s all from the same sources and it reinforces their pre-existing belief that Obama is Satan. Here’s the kicker: you’re doing the same thing. Yes, I know you’ve watched a lot of YouTube videos on vaccines, and fluoride, and other health issues, but the ones you watch–and accept–are the ones that already appeal to the beliefs you’ve accepted. This isn’t how science works, or how evidence is fairly weighed. I know this can get messy, because again, you’re not one of those trained scientists and you don’t know how to navigate the literature and determine which studies are well-conducted and which ones are crap. So sometimes, you have to accept that there are people out there who have taken the time to do this in an unbiased fashion, and decide to trust them (y’know, people like your daughter, perhaps? Or thousands of other scientists and journalists who have studied these fields for many, many years?), and look skeptically upon people like Mercola et. al. (Follow the money!)

I will be sending along some books I hope you’ll read with an open mind: The Panic Virus by Seth Mnookin, and Deadly Choices by Paul Offit. Both come into this from different backgrounds–Mnookin is a journalist and new parent who was investigating vaccines, while Offit is a research scientist like myself who has worked in vaccines and infectious diseases his whole life. Both come to the same conclusions: vaccines are safe, and critical for public health. And before you google Offit and find that he holds a vaccine patent, ask yourself–if I were to work on a vaccine at some point in my career, would you dismiss my authority and expertise for that reason? Or would you be willing to look at the science behind it before making a judgement?

Next discussion: the Illuminati. Baby steps.

Love,

Tara

 

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“Rabid” by Bill Wasik and Monica Murphy

Rabies is a disease without a public relations firm. In developed countries, human disease is incredibly rare–we see typically one or two deaths from rabies each year. In contrast, lightning is responsible for about 60 deaths each year. However, worldwide, rabies is another matter. Today is World Rabies Day, a reminder that 55,000 people still succumb to this virus every year–most of them in impoverished regions of Africa and Asia. While cases in the U.S. are typically due to wildlife exposure (rabid bats or even beavers or rabid kitten), infected dogs remain the main vector of infection in most rabies-endemic countries.

In a new book, “Rabid”, Bill Wasik and Monica Murphy have penned an ambitious history of rabies. It’s subtitled, “A cultural history of the world’s most diabolical virus,” and this emphasis makes Rabid unique. Indeed, while the recognition of the rabies virus is just a bit over a hundred years old, Wasik and Murphy trace the infection back to antiquity. The first half of the book is, as promised, a cultural history–4,000 years of literature references to rabies, hydrophobia, “rage” disease, and dog- and bat-borne contagion in places as far-flung as various mythologies (Greco-Roman, Christian, and Egyptian, to name a few); medical literature from Aristotle to Pasteur; and even the vampire myths from medieval times up to Sesame Street’s Count. Wasik and Murphy explore the animal metaphors used for millenia and examine them through the lens of rabies infection, as well as colorfully explain the various (mis)understandings of the virus and rabies epidemiology in ancient texts. Though Rabid is certainly a pop-science book, many portions of the book wouldn’t be out of place in various literature, history, and even religion classes, which again lends to the book’s eclectic flavor.

The latter half of the tale, then, focuses more narrowly on the science of rabies, covering Pasteur’s work toward a vaccine; the (rather late) discovery of bats as the ultimate reservoir of the virus; the challenge to mount vaccination campaigns in resource-poor areas, and the lingering fear of rabies to this day, which is sometimes justified and sometimes not. They also cover the controversy over the Milwaukee protocol as a treatment for symptomatic rabies, and the problem of rabies control.

Finally, Wasik and Murphy note that even today, almost 130 years after the development of the rabies vaccine, control of rabies among the biggest human source of disease–infected dogs–is almost as poor in some places as it was during pre-vaccine England. The methods to control it are, in some cases, also equally barbaric. The introduction of rabies into Bali in 2008 led to a mass cull of dogs, shooting many in the street. Eventually, a science-based vaccination strategy was adopted and seems to be helping, but not before well over 100,000 dogs were culled and several hundred people had been killed by the virus. Rabies may be an ancient disease, but it is a scourge that is still threatening us where government lacks the will and the funding to beat back “the world’s most diabolical virus.”

CBS airs anti-vaccine Jumbotron ad

Via Skepchick, CBS will be airing ads from the National Vaccine Information Center and Mercola on the CBS Jumbotron in Time’s Square (NVIC announcement here). This, while there’s a measles outbreak in Minnesota (and another one being investigated in Utah), and we’re on the heels of the worst pertussis outbreak in generations in California. Shameful.

Hello,

I recently learned that CBS will be playing ads featuring misinformation by the National Center for Vaccine information Vaccine Information Center. These ads are misleading and potentially dangerous. Vaccine-preventable illnesses have had a resurgence in the past decade, and there currently is an ongoing measles epidemic in Minnesota. Pertussis cases (and deaths) hit a record high in California in 2010. Much of this increase in disease is due to unfounded fears about vaccination, pushed by NCVI, Mercola, and even your own Sharyl Attkisson.

Recently AMC theaters did not run similar anti-vaccine ads (http://getsatisfaction.com/amc_theatres/topics/remove_the_unfounded_anti_vaccine_message_from_your_ads). Until a similar solution is reached by CBS, I will boycott CBS TV shows and sponsors, and ask others to do the same. I am an infectious disease epidemiologist and have seen the dangers that can result from vaccine misinformation. Please do not be complicit in spreading these dangerous lies to your consumers.

Thank you,

Tara C. Smith, PhD

(Some other template language can be found here).

You can also sign the petition at Change.org, email CBS (jeremy.murphy@cbs.com, info@cbsoutdoors.com) and tweet @CBSoutdoors to let them know your thoughts on this development.

“Pox” by Michael Willrich

Next to Ebola, my favorite virus would probably be smallpox (Variola virus). I mean, now that it’s eradicated in nature, what’s not to love about the mysteries it’s left us–where it came from, why it was so deadly (or, not so deadly, as in the emergence of the “mild” form, variola minor), and will a new poxvirus emerge to take its place? The topic is particularly germane since the debate still rages on about the fate of the world’s smallpox stocks. Smallpox has killed untold millions and influenced the destiny of societies; and as Michael Willrich details in his new book, Pox: An American History, the legacy smallpox has left us is still alive and well today.
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