When History Fades
This headline to a book review in yesterday’s NYT made me think of a sideline conversation I had with Robert Lee Hotz last week. It was after the Amy Wallace talk at NYU, which Hotz, a science columnist for the WSJ, moderated. We were chatting about the rise of the anti-vaccine movement. Hotz speculated that the phenomena may owe, in part, to people not remembering (or being cognizant of) the everyday fears and tragedies once commonly associated with childhood infectious diseases fifty years ago–which modern medicine has since largely eradicated.
I think he’s on to something, so I figured I’d take a stroll down memory lane with this doctor who was on the infectious disease frontlines in New York City, circa 1948:
Most of the patients treated were quite ill and required around-the-clock care. Children with laryngeal diphtheria needed to have membranes removed from their vocal cords by laryngoscopy two or three times a day. A half teaspoon of good whiskey on a lump of sugar in a tablespoon of warm water served as an excellent sedative for these patients and seemed to relax their respiratory distress. Some of the patients with pharyngeal diphtheria progressed to diphtheritic paralysis or myocarditis, and required special care. We treated all types of polio cases (ie, nonparalytic, paralytic, bulbar and encephalitis) using modern respirators for individuals with intercostal weakness and breathing difficulties.
Despite the anti-vaccine movement’s staying power, childhood immunization rates are currently over 90 percent in the U.S., so I don’t think we’ll be returning to those days. Still there are legitimate concerns of outbreaks, which perhaps may shake some sense into parents who buy into the anti-vaccine claptrap that emanates from people who you think would know better.
What will it take for reason to win over irrational fear? Unfortunately, I think this haunting quote from pediatrician and vaccine advocate Paul Offit (via Wallace’s terrific Wired piece) will prove prescient:
“I used to say that the tide would turn when children started to die. Well, children have started to die,” Offit says, frowning as he ticks off recent fatal cases of meningitis in unvaccinated children in Pennsylvania and Minnesota. “So now I’ve changed it to “˜when enough children start to die.’ Because obviously, we’re not there yet.”
Of course, KK, when ‘enough’ kids will start to die from infectious disease, consciousness of this will seep in slowly and vaccination rates will climb back up. Conversely, consistently high vaccination rates in an educated community in a setting of background low native immune exposure opportunities (meaning disease), in turn will expose individuals and their children to harmful effects of vaccines and these cases will then stand out in stark contrast against an otherwise disease-free background. This, will in turn morph to a ‘movement’ against ‘indiscrimate vaccination’ as the recipient community was an informed one, to begin with.
Expanding indications for vaccines will only expose populations to antigens, presented out-of-biologic-context in a sanitized, germ-free, immune system – in itself a product of a schoolmarmish mentality that does not understand the meaning or value of the ‘bad things’.
These two-and-fro swings are virtually guaranteed in social structures as ours, and anyone pretending otherwise, is only concern-mongering. What we can understand, we ought not to call ‘irrational’.
My emphasis of your statement: “…in turn will expose individuals and their children to harmful effects of vaccines…”
What harmful effects and can you cite some evidence?
Also, there already is a large movement that believes it is fighting against “indiscriminate vaccination.” It is discussed in my two recent posts on this subject.
I think that scientists need to look at the bigger picture here.
In the case of pertussis (whooping cough), deaths were Latino infants, and frequently those contracting the disease are too young to be fully immunized. It is now being realized that a major line of defense is to focus on parents, relatives, childcare workers, and other adults who come into direct contact with babies. See:
http://www.nytimes.com/2010/06/24/us/24cough.html
and
http://www.nytimes.com/2010/09/25/health/25patient.html
In the case of HiB vaccine supply has been an issue:
“Scarce supplies of the vaccine starting in 2007 prompted U.S. health authorities to recommend dropping the booster shot, which is typically given to children at 12 to 15 months who were not at high risk of infection.”
http://www.reuters.com/article/idUSTRE55O3QZ20090625
And specifically related to another example cited in the post above:
“Health officials believe the outbreaks here and elsewhere likely were triggered by a vaccine shortage that removed just enough of the protective effect of widespread immunizations to make unvaccinated children more vulnerable.”
http://www.philly.com/inquirer/health_science/daily/20090401_Hib_disease_deaths_put_focus_on_vaccine_shortage.html
Why are science journalists and science bloggers so focused on a small group of antivaxxers, when there are plenty of other issues of access and medical care that are more directly a problem in encouraging full community immunity by vaccination ?
Why there is a laundry list to go over.
1) ADEM – reported widely, but anecdotally with several vaccines
2) Guillian Barre syndrome – the original swine flu debacle in the United States
3) Narcolepsy – Being investigated in Finland currently
4) Measles vaccine induced thrombocytopenia
5) DTP induced chronic encephalopathy
6) The ever present risk of any live viral vaccine causing the disease in question: for polio, measles
I hope you don’t look at this list and lose track of my original argument , or think I am an ‘anti-vaxxer’, or denier, or some tribe member. ;’)
KK,…your linked vaccine claptrap video has Bill Maher saying….global warming is ‘settled’, but vaccines are not, and we must have a ‘debate’ on them.
Do we laugh or cry? 🙂
If you want the clap and the claptrap, check this out
http://www1.whdh.com/news/articles/bizarre/12002346324877/fla-strip-club-offers-free-flu-shots-for-elderly/
Free flu shots, free food, naked ladies and lap dances.
🙂
Gaythia ( 3):
I think it’s fair to ask why we’re not looking into the other dimensions to this story. But I would argue that the anti-vaccine movement is anything but small. They are well organized, influential, and have celebrity spokespersons.
Shub (4):
Your logic escapes me. You know, you could die in a plane crash, but airline travel is safer than car driving. You could also die of a hospital infection unrelated to the illness that lands you in a hospital. But if you need emergency care or an major operation, you’ll still go to the hospital, right? And some people get the flu or even die after getting the flu shot. Does that mean you shouldn’t get a flu shot?
So what’s the point with that laundry list you make?
Keith, I would agree with you about money and celebrity influence. But I wonder if the real negative influence of the antivaxers is more about feeding a general lack of supporting the sort of public health infrastructure that could really address issues such as those I raised above. Do our local and national public health care systems have the structure and the funding necessary to provide needed services, like vaccinations, prenatal care, pediatric care, and preventative medicine, for everyone who needs them? Are they mouthpieces for the pharmacuetical industry? Are they fully addressing product development and safety? Are the driving forces for research greatest profit or highest need? If we are doing something for the greater common good, like a polio vaccine, how are we addressing individuals who may be damaged in that process? How do we prioritize and decide to require vaccines? By the marketing prowess of pharmaceutical industries or some public mechanism? I believe that a key aspect of what destroys the credibility of the anti-vaxers, with members of the public, is that we need to be not just trying to combat propaganda,we aren’t just saying you are stupid, we are clearly offering a complete, comprehensive and science based health care plan.
Vaccines are not risk free. The risk may be small, but it isn’t zero.
As far as I can tell, the unvacinnated are mostly a risk to themselves, the vacinnated are… innoculated.
Some judge the risks differently than others. It’s called freedom. I fail to see the problem.
On the list of things-we-could-do-to-protect-children, does this make the top ten. How does the risk of not vaccinating compare with playing tackle football – 13 deaths, 13 catastrophic injuries, and 40,000 concussions per year (per Wiki) among a playing population a hair under 2.0 million. Not even counting broken bones and operations. Inquiring minds would like to know.
kk @ (6) re: Shub (4) “So what’s the point with that laundry list you make?” You asked him in (2) “What harmful effects and can you cite some evidence?” He did so, what’s your beef. He isn’t making an argument not to vaccinate, and says so. He is merely stating that vaccines have risks. The risks must be weighed against the benefits. In most cases, the benefits are overwhelming both for the individual and the population, but in a few individuals for a variety of reasons things go wrong and harm occurs. In terms of protecting the human herd, those few incidents are almost irrelevant, but if it’s you or you child that is the statistic, it’s very relevant.
For some diseases, the incidence in the population is so small that the risk of adverse reaction to vaccination is greater than the risk of contracting the disease. We have public health authorities to evaluate those risks and benefits, and make recommendations accordingly. It ain’t easy. A lot of time, effort, and research goes into it, and the science evolves.
kdk33,
“Some judge the risks differently than others. It’s called freedom.”
It is the child’s health at risk.
But the child is not “free” to “judge the risks”
Why not?
Who ‘owns’ the child?
Not the child.
Not the parents/guardians.
Not society.
Not the state.
From the article… this sound familiar?
“a product of the era of instant communication and easy access to information. The doubters and deniers are empowered by the Internet (online, nobody knows you’re not a doctor) and helped by the mainstream media, which has an interest in pumping up bad science to create a “debate” where there should be none.”
“The rejection of hard-won knowledge is by no means a new phenomenon. In 1905, French mathematician and scientist Henri Poincaré said that the willingness to embrace pseudo-science flourished because people “know how cruel the truth often is, and we wonder whether illusion is not more consoling.” Decades later, the astronomer Carl Sagan reached a similar conclusion: Science loses ground to pseudo-science because the latter seems to offer more comfort.”
“And if you need a new factoid to support your belief system, it has never been easier to find one. The Internet offers a treasure trove of undifferentiated information, data, research, speculation, half-truths, anecdotes, and conjecture about health and medicine. It is also a democratizing force that tends to undermine authority, cut out the middleman, and empower individuals. In a world where anyone can attend what McCarthy calls the “University of Google,” boning up on immunology before getting your child vaccinated seems like good, responsible parenting. Thanks to the Internet, everyone can be their own medical investigator.
There are anti-vaccine Web sites, Facebook groups, email alerts, and lobbying organizations. Politicians ignore the movement at their peril, and, unlike in the debates over creationism and global warming, Democrats have proved just as likely as Republicans to share misinformation and fuel anxiety.”
“the risks must be weighed against the benefits”
From the perspective of the individual this can lead to freeloading… the higher the percentage of society whom are vaccinated, the lower the risk of not vaccinating yourself or ‘your’ child… reap the benefits of vaccination and avoid the risks. ‘course if you or your child catch the disease you endanger not only others who are freeloading, but all who have yet to take the vaccine.
Lazar
Your argument above, about freeloading etc,…makes good sense only in the context of a disease that is virtually never subclinical, produces reasonably severe symptoms uniformly in those infected and has a high secondary attack rate.
For all other kinds of infectious diseases, the lines are not so clear.
Every parents dilemma:
If I vaccinate my child may die (or be harmed by) potential side effects of the vaccine. If I don’t, he may contract and die from the disease.
The more parents who chose not to vaccinate, the higher the risk that the disease will enter or persist in the population, and he greater the risk that their children will be exposed. In a cohesive society, we have an obligation to others and to others’ children as well as to our own. Tough choices, but free exchange of information promotes better choices. An educational system that teaches people to think critically instead of accepting what is popular or conventional is essential but sadly lacking in much of America. Religious claptrap has a lot to do with our state of ignorance as a nation, but we can’t have freedom without freedom to believe (or not).