[NVIC] Trashing Personal Freedom

[Guest guest]

" Perhaps that is why it's better that our public health policies require

childhood vaccination and discourage individuals from making the choice

themselves. In the final analysis, the secret truth about vaccines may be

that, sometimes, personal freedom can be a dangerous thing. "

E-NEWS FROM THE NATIONAL VACCINE INFORMATION CENTER

Vienna, Virginia http://www.nvic.org

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UNITED WAY/COMBINED FEDERAL CAMPAIGN

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" Protecting the health and informed consent rights of children since 1982. "

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NVIC Note:

Those who speak against freedom and support tyranny of any kind usually have

something to hide or protect personally and professionally. When those who

are speaking against freedom come from an elitist position in society

involving greater wealth, education or social standing, what they are

preaching should be viewed with special caution. Tyranny is tyrannny and

doctors are not exempt from the temptation to engage in it. Those who

question that fact, need only to review the transcript from the Doctor's

Trial at Nuremberg. Suggested reading: " The Nazi Doctors and the Nuremberg

Code " by s and Grodin (Oxford University Press, 1992).

http://www.boston.com/news/globe/magazine/articles/2005/12/04/the_secret_tru

th/

The Boston Globe

December 4, 2005

The Secret Truth

Parents used to accept routine vaccinations for their children without a

second thought. But as more parents weigh the benefits of vaccination

against the possible risks, some are hesitating, even resisting, those

shots, as doctors struggle to persuade them of their safety. At stake is the

health of a nation.

By Dr. Darshak Sanghavi |

Looking back, Marjorie Hansen suspected something was wrong when her toddler

started repeatedly running into the street without warning. She never

would have guessed that her family's world was about to change forever.

In 1999, Marjorie and her husband, , lived in Utah, having married

several years earlier while attending Brigham Young University. " We went to

a lot of operas, " recalls Marjorie about their dates. For several years

after graduating, worked as a research chemist - primarily on

explosives - before returning to business school. A history and political

science major, Marjorie stayed home to raise and his older sister,

ne.

As an infant, had been very social, full of smiles and responsive

cooing. But a few months after his first birthday, says Marjorie, he had a

" Dr. Jekyll-Mr. Hyde transformation. " He stopped making eye contact. He lost

his ability to say several words and was eventually left with only one:

" No. " He would scream uncontrollably in front of cupboards while Marjorie

frantically emptied them to find out what he wanted. Sometimes he didn't

want anything. She couldn't console him. " We just thought we were bad

parents, " confesses Marjorie on a recent evening when I visited their home.

Worried about her maternal skills, she even enrolled in a parenting class.

But the problems continued. In Utah, once ran out of the house, and

Marjorie anxiously looked through her neighborhood, going door to door.

She'd learned not to call his name, since that just made him run farther.

She finally found him hiding near a neighbor's garage. The pediatricians

weren't helpful, she says, since " they didn't call it anything. They always

said, 'Don't worry, just wait.' " After nine months, finally received

speech therapy, but without any formal diagnosis. In early 2000, took

a job in Framingham. Shortly after the move to Massachusetts, a new team of

doctors diagnosed . Marjorie remembers: " That's the first time we heard

the word 'autism.' "

By then the Hansens had a third child, , who was developing normally.

" You could read five books and he would sit and listen, " says Marjorie.

Then, in late 2001, suddenly stopped making eye contact. Horrified,

the Hansens watched him also lose his words and sociability. " I mean it was

scary. Cognitively, he regressed to a 9-month-old, " said Marjorie. Just shy

of 2, also was diagnosed with autism.

On the Internet, read about a possible connection between autism and a

mercury-based vaccine preservative called thimerosal. Marjorie recalls: " One

day I decided to look up their vaccination records. And I found out that

both of them had had routine vaccinations two weeks before [the symptoms

began]. And I became convinced that the vaccination is what, you know, the

final straw - the trigger in the susceptible individual. " Today, she says,

she is " 100 percent certain " that vaccines caused the autism.

How an unlikely theory pushed the Hansens - and others - to reject many

routine childhood vaccinations dramatizes the biggest dilemma in public

health today. Most diseases prevented by vaccines, like polio, measles, and

whooping cough, are now pretty uncommon, and many people like the Hansens

believe the benefits of vaccines don't outweigh the risks. To increase

public acceptance of vaccines, then, should health authorities spin the

facts to make the diseases seem deadlier and the shots seem safer? The

surprising thing is that they already do. And whether we like it or not, it

may be better that way.

VACCINES HAVE LONG AROUSED resistance and suspicion. In 1901, an epidemic of

1,600 smallpox cases broke out in Boston, and the Board of Health required

that all residents get vaccinated or face a fine or jail sentence. Almost

half a million Bostonians were vaccinated, some forcibly. Protests led to a

1905 US Supreme Court case, son v. Massachusetts. The court ruled in

favor of the state, establishing the precedent for 100 years of public

health law.

Today, American toddlers receive roughly 15 separate shots against a dozen

diseases before they are 2 years old. Because the shots aren't perfect, most

require repeated doses; for example, children get four shots for tetanus and

three for polio over two years. Under certain conditions, a 15-month-old can

get as many as half a dozen shots at a single doctor's visit.

Perhaps because of the near-universal administration of vaccines, there have

been numerous, ultimately unsubstantiated, claims linking vaccines with

various diseases, including the diphtheria-tetanus-pertussis vaccine with

epilepsy and Sudden Infant Death Syndrome (SIDS), the hepatitis B vaccine

with SIDS and multiple sclerosis, the Lyme vaccine with arthritis, the

Haemophilus influenza vaccine with diabetes, and many others. Of course,

there are some proven vaccine-related injuries, mostly acute allergic

reactions. In 1986, before the thimerosal-autism debate began, the National

Vaccine Injury Compensation Program was created to protect vaccine makers,

and thus the nation's vaccine supply, from costly litigation by people who

were adversely affected by vaccinations. Since its inception, the program

has paid more than $1.5 billion on about 1,900 claims.

Fundamentally, the proposed connection between autism and thimerosal arises

from the frustrating lack of known causes for autism and Autism Spectrum

Disorders. The theory joins others blaming various exposures for baffling

diseases; consider discarded notions correlating cellphones with brain

tumors, silicone breast implants with autoimmune disorders, and water

fluoridation with bone cancer. But because of its history, the link between

vaccination and autism has acquired unusual traction.

AUTISM FRIGHTENS PARENTS more than almost any disorder, since it implies

that the child can never function independently in society and may never

fully reciprocate, or ever fully appreciate, expressions of love.

Classically, the condition consists of three problems: lack of social

interaction skills or empathy, disordered or delayed communication (such as

speech), and impaired play or imagination. Though portrayed in the public

imagination by characters such as Hoffman in Rain Man, autistic

people are like snowflakes: No two are alike, and the clinical spectrum

ranges from severe disability to near normalcy.

The vaccine-autism saga begins with a humanitarian relief mission in Iraq.

In the fall of 1971, a famine broke out in Iraq, and thousands of tons of

wheat seed were distributed in rural communities. The seeds were treated

with methyl mercury, a fungicide similar to the preservative thimerosal, and

though farmers were supposed to plant the seed to grow crops, many

mistakenly ground the wheat and baked bread. Of the estimated 50,000 people

eating the treated wheat, 6,500 were hospitalized for mercury poisoning, and

hundreds died. Many pregnant women who survived gave birth to children with

mental retardation and other birth defects.

Hoping to learn from this horrific incident, the United States Environmental

Protection Agency studied blood and hair samples from the Iraqis, and, with

many assumptions, calculated a " safe " level of mercury exposure - then

divided that allowable amount by an " uncertainty factor " of 10 to come up

with the limits we use today. (Some toxicology data from Japan and the Faroe

Islands were also used.) In 1999, Drs. and Ball at the Food

and Drug Administration realized while looking at vaccine safety that, under

certain conditions, infants getting multiple vaccines containing

mercury-based thimerosal exceeded the EPA's cumulative mercury limit, up to

threefold. (Of note, the cumulative doses did not exceed the less-strict

limits set by the World Health Organization or the FDA.)

This finding came at a bad time for vaccines. A year earlier - in an event

unrelated to thimerosal per se -the British medical journal The Lancet

published a study suggesting that the measles-mumps-rubella (MMR) vaccine

may have caused bowel problems and autism in 12 children. In a press

conference, the lead author, Dr. Wakefield, then warned the

vaccination should be " suspended. " Shortly afterward, Prime Minister Tony

Blair refused to answer questions about whether his youngest child had

received the vaccine, and MMR vaccination rates began falling across

Britain. Last year, Wakefield's coauthors retracted the paper, since

Wakefield hadn't disclosed that most of the children were involved in

lawsuits against vaccine makers. And last month, investigative journalist

Deer alleged in The Sunday Times of London that Wakefield hoped to

profit from the panic he created, having filed to patent his own " safer "

vaccine product.

Multiple studies have now convincingly refuted Wakefield's suggestion that

the MMR vaccine causes autism. In 1999, though, just after the Lancet

article was published, the stage was set for the autism-thimerosal link. It

was then that Dr. Verstraeten, a Centers for Disease Control and

Prevention epidemiologist who now works for the vaccine maker Glaxo

Kline, produced conflicting data suggesting a possible link between

thimerosal and speech delay (though the final version of his paper,

published in 2003, concluded that " no consistent significant associations

were found " but encouraged future study; a more complete CDC study of

thimerosal will finish in 2006).

Ironically, Dr. Neal Halsey - a leading vaccine specialist based at

Baltimore's s Hopkins who pushed to eliminate thimerosal from vaccines

immediately after the FDA analysis by the Balls - believed that a quick

response would enhance public trust in vaccine safety. After all, federal

authorities called for the removal of thimerosal from vaccines in 1999 as a

precautionary measure, without conclusive proof of harm, and some states,

including Massachusetts, stopped administering childhood vaccines containing

the preservative as soon as alternatives became available.

Instead, the fear of thimerosal - amplified by Wakefield's unrelated,

misleading work on the MMR vaccine - continued to grow. In fiscal 2003, the

National Vaccine Injury Compensation Program received 2,438 claims alleging

that vaccines had caused autism, up from 18 claims in 2001. After his

grandson was diagnosed with autism, Rep. Dan Burton, an Indiana Republican,

called congressional hearings to investigate a link. This year, New York

Times contributor Kirby published Evidence of Harm, a sympathetic

portrayal of the parents who blame vaccines for their children's autism;

F. Kennedy Jr. wrote an article for Rolling Stone and Salon.com

suggesting a conspiracy to cover up a thimerosalautism connection (and later

was forced to write several clarifications and corrections). Many parents

continue to be concerned.

It's now hard to overstate the scientific evidence against the

thimerosal-autism link. Many, many chemicals seem dangerous in test tubes or

in animal studies but have no significance in the real world; thus, the most

useful safety data come from large-scale " epidemiological " studies of

people. In 2004, the prestigious Institute of Medicine, the federal

government's adviser on public health, reviewed dozens of such studies

related to vaccines and autism and concluded the " evidence favors rejection

of a causal relationship between thimerosal-containing vaccines and autism. "

Halsey sees this as a powerful statement, since " that's about as strong as

the IOM will come out. " In contrast to many massive studies from major

academic centers that found no link, the only epidemiological studies

favoring a link were one unpublished study from Mark Blaxill, a

Massachusetts-based consultant and board member of an advocacy group called

SafeMinds, and five separate published studies from the home-based

father-son team of Dr. Mark Geier and Geier - and these were all

dismissed by the IOM as " uninformative " or " uninterpretable " due to poor

methods.

As far as mainstream scientists are concerned, the vaccine-autism question

is settled.

What the movement to blame thimerosal for autism shows is a secret of the

public health authorities. Stated baldly, they blatantly exaggerate some

risks and minimize others, since for any individual, the consequences of

most unhealthy behaviors are minimal and there is little incentive to

change. (After all, for example, more than 95 percent of cigarette smokers

never get lung cancer.) But what happens when two well-intentioned parties

armed with scientific data - that is, advocates wanting to prevent autism

and health authorities wanting to ensure widespread vaccination - collide?

Who, in the end, is right?

" I WAS ALWAYS VERY PRO-VACCINE. I thought that parents who didn't vaccinate

were negligent, " Marjorie Hansen says. After learning about thimerosal, she

and changed their minds. was " incensed " by the presence of

thimerosal in childhood vaccines, recalling that as a student, he handled

mercury with the same care reserved for radioactive materials. Convinced

that public health authorities already took unacceptable risks with their

children, they no longer accept their pediatrician's routine vaccine

recommendations without questions. They also have filed a claim with the

National Vaccine Injury Compensation Program.

In particular, Marjorie and believe that vaccination during early

infancy, such as for hepatitis B, presents an unacceptable risk-benefit

ratio for their children. In addition to their sons' conditions, each has

several relatives who have developed seizures, high fevers, or other

problems following vaccination, and the Hansens worry that their family's

" genes " don't tolerate vaccines well. To them, the benefits of many vaccines

seem far-fetched. According to the CDC, the sources of infection for most

cases of hepatitis B are intravenous drug use, sexual contact with infected

persons, or being born to an infected mother. Since their children lack

these risk factors, wonder the Hansens, why should they be vaccinated at

birth?

The Hansens applied similar calculus to other vaccines. Inoculations that

didn't make the risk-benefit cut were shots against chicken pox, flu, and a

bacterial infection called pneumococcus. Those diseases, they said, were

rarely deadly and the risks of vaccination were too great. They did allow

their youngest girl (both daughters are developmentally normal) to be

vaccinated against polio, diphtheria-pertussis-tetanus, and MMR - the last

only " when her immune system was fully developed, " though most authorities

strongly advise against selective vaccination.

THE BREAKDOWN OF TRUST triggered by the health authorities' acceptance of

thimerosal in vaccines seemed to carry into other established medical

arenas. Because, in their opinion, the regular doctors offered few useful

treatments for their sons, Marjorie and began experimenting with

therapies outside the mainstream.

Many autistic children also experience gastro-intestinal problems, so the

Hansens had tested for food allergies. These tests were positive for

sensitivities to gluten (a component of wheat and other grains) and casein

(a milk protein). At considerable expense and inconvenience, the Hansens

eliminated wheat and dairy products from both boys' diets. They reported

tremendous improvement, and each child seemed less " hyperactive. " From being

" skinny unhealthy, " the boys seemed to bulk up. , who was already

acquiring some language and social skills in his 10 hours per week of speech

and behavior therapy, seemed to improve dramatically, Marjorie says, " He

wouldn't be diagnosed " with autism now, she says.

The Hansens also administered large doses of vitamin B6, vitamin B12, and,

after one practitioner ordered tests and concluded that one of the boys was

a " zinc waster, " zinc supplements. They also tried a drug called

glutathione, a natural detoxifying compound normally found in the liver. But

their most quantitative experiment concerned chelation.

Derived from the Greek " chele, " or claw, chelation therapy uses pincerlike

molecules to bind to and remove heavy metals like iron and lead from the

body. Used rarely for acute lead poisoning, chelation has been adopted by

numerous alternative practitioners to treat supposed lead or mercury

poisoning. It has been promoted as a cure-all by books like Dr. Hal

Huggins's It's All in Your Head (blaming mercury-based dental fillings for

many conditions) and Dr. Morton 's Everything You Should Know About

Chelation: Unclog Your Arteries and Rejuvenate Your Cardiovascular System

Without Surgery and Other Invasive Procedures.

Suspicious of any therapy lacking a " rational basis, " figured

chelation was worth a try, given 's exposure to thimerosal and

another practitioner's assertion that his son's urine had abnormal amounts

of mercury. In particular, the Hansens hoped chelation would improve

's toileting behavior (many children who are diagnosed with autism

also have problems toilet training). realized chelation was a long

shot, saying, " What helps in one child may not help in another. It's all

trial and error. " (Still, no peer-reviewed study has ever shown that

chelation helps anything other than acute lead poisoning, and could even be

dangerous. In August, a 5-year-old autistic boy, Abubakar Nadama, died in

Pennsylvania of cardiac arrest following a third round of chelation therapy

from an alternative practitioner.)

After beginning chelation, Marjorie decided to keep track of 's

toileting behavior and painstakingly plotted these points on lined and

labeled sheets. Satisfied with the outcome, she flipped through sheet after

sheet of graph paper for me and said she felt that her data showed a

correlation between improved toileting over several weeks and the chelation

treatments.

In this manner, the Hansens performed their own clinical trials with a study

population of two, or sometimes one. They made hypotheses and drew

conclusions about the role of thimerosal in causing autism, the benefits of

elimination diets, mercury chelation therapy, and various vitamins. They

applied the techniques of science, quantifying the results and even graphing

them carefully over months. They acted on the results, rejecting some

treatments as useless, like vitamin B12 therapy, and embracing others as

beneficial, like chelation and eliminations diets.

On some level, the Hansens' methods are understandable, since there are no

larger clinical trials involving, for example, elimination diets and

vitamins. Before the 20th century, all medical research resembled the

Hansens' experiments. But in spite of their intuitive appeal, personal

anecdotes are also a crucible of quackery. Even hundreds of them don't add

up to reliable data. The Hansens thus committed an ancient error by using

their personal experience to link vaccines with their sons' autism. They

transmuted a likely coincidence into truth.

LAST YEAR, MIT PROFESSOR Josh Tenenbaum told Psychology Today: " Coincidences

drive so many of the inferences our minds make. Our neural circuitry is set

up to notice these anomalies and use them to drive new learning. There is an

old saying that neurons that fire together wire together. So you could say

that coincidence operates at the level of the synapse, whenever neurons fire

at the same time. "

This " neural circuitry " explains why some parents believe the rise in autism

over the past years has been linked to the higher number of childhood

vaccines. (The same circuitry could also relate the increasing use of

cellphones, popularity of reality television, or consumption of fast food to

autism.) Consider that almost 90 percent of children receive vaccines at 15

months of age, the same time that many cases of autism are diagnosed.

Inevitably, many autistic children will be diagnosed immediately after

receiving vaccines - and, like the Hansens, parents will suspect a causal

connection.

Once scientists have a suspicion about what causes a disease, they design

experiments to prove or disprove their theory. Philosopher Karl Popper wrote

that the defining characteristic of a scientific theory is " falsifiability. "

In other words, you must clearly define what could make you change your

mind. This is the problem with some proponents of the vaccine-autism theory:

No amount of data can falsify their belief.

Consider some letters to The New England Journal of Medicine following a

2002 study of 500,000 children debunking the MMR and autism link proposed by

Wakefield. No statistically higher risk of autism was present in vaccinated

children compared with unvaccinated children. Yet, some letter writers were

upset the studies didn't address the possibility that, as one physician

wrote, " there is a vulnerability to MMR-induced disease in 10 percent of the

children with autism. " In other words, the writer accepts that vaccines

don't have a big impact on autism. But, he asks, couldn't there be a few

kids who had an unusual sensitivity to vaccination?

The study authors answered: " We cannot rule out the possibility that at

least one child would not have become autistic if he or she had not been

vaccinated, and that point alone may be sufficient for stating causality.

Unfortunately, we cannot subject this assumption to a critical test unless

it is better specified. " Thus, they may have studied half a million kids,

but there are millions of others out there, and one of them might be

different. No amount of data can refute that possibility.

What this means is that no clinical trial, no matter how well-funded or

well-designed, can ever prove a negative - it can only show that a possible

cause-effect association is very, very unlikely. That is why it will always

be impossible to eliminate the perceived link between thimerosal and autism.

THE PUBLICITY SURROUNDING the vaccine-autism hypothesis almost derailed

vaccination in America. It relied on the all-too-human tendency to make

erroneous causal connections. And it also exposed how tenuous the acceptance

of vaccination can be, once parents start balancing risk and benefit on

their own.

Today, the medical culture of developed countries relies fundamentally on

" informed consent, " where patients review the pros and cons of all

treatments and can refuse for any reason. So public health agencies try

scaring parents into vaccinating, even though actual risks of any one child

today getting polio or pertussis are extremely low.

On its website, the Massachusetts Department of Public Health reports, " In 1

out of 4 men, mumps causes swollen testicles. " Promoting pertussis (whooping

cough) vaccine, the Centers for Disease Control explains, " In infants,

[pertussis] can also cause pneumonia and lead to brain damage, seizures, and

mental retardation. " Chicken pox, the CDC reports, " can lead to severe skin

infection, scars, pneumonia, brain damage, or death. "

While public health authorities hype the benefits of immunization, parents

try to determine if the risks of side effects, even highly unlikely ones,

are worth it. And the presence of a convincing group of people who believe

that vaccines can cause autism - like the Hansens - scares parents about

vaccines.

If given the choice, many parents vote with their feet. In Britain, for

example, vaccination is optional, and MMR immunization rates fell to 80

percent overall after the Wakefield report, and 62 percent in parts of

London. According to the journal Science, measles began to spread twice as

efficiently as before. In 1987, Japan allowed parents to decide whether

their children should be vaccinated against several diseases, including

measles. Many opted out, and now more than 100,000 cases of measles occur

each year, with an estimated 50 to 100 deaths.

The secret truth about vaccines is that they don't have much of a benefit

for the individual child who receives them. They're mostly for the good of

the community. My sons got multiple polio shots, for example, for little

personal benefit. The same goes for flu, measles, whooping cough, chicken

pox, and almost every other immunization. The reason they'd be fine without

the shots is that most everybody else gets them. This concept is called

" herd immunity, " and it is the foundation for disease control. Essentially,

it means that once a critical " tipping point " for vaccination coverage

occurs - say, about 90 percent of the population - the probability of

getting a disease suddenly falls, since it can't spread.

Following a 1957 influenza pandemic, the Japanese government began

vaccinating all schoolchildren, since they spread flu efficiently. After

mandatory vaccination ceased in 1994, a report in The New England Journal of

Medicine found that the vaccination campaign had prevented as many as 49,000

deaths annually among the Japanese population. That is, one older person's

life was saved for every 420 children vaccinated.

In the United States, getting your kids vaccinated is like paying your

taxes: Cheating a little doesn't really hurt anyone as long as everyone else

pays up. But left to their own devices, parents may balk at subjecting their

children to the needle when there's no significant risk of disease. So the

United States decided in the favor of greater good and not individual

rights, making certain vaccinations compulsory for admission to public

schools and day-care centers. As a result, despite well-publicized small

outbreaks of whooping cough and even polio recently, vaccination rates in

the United States are higher than ever. Today, about 90 percent of

Massachusetts children and 80 percent nationwide are fully immunized - and

millions of people enjoy some of the world's lowest rates of devastating but

preventable infections.

THE HANSENS ARE LOVING, devoted parents. When we spoke in their dining room

a few weeks ago, poured me a glass of lemonade and popped into the

room repeatedly to make contact by smiling. When their daughter spilled milk

in the kitchen, Marjorie patiently cleaned it up and reasoned with her about

being more careful. They brought the same consideration to our conversation,

knowing that I was probably skeptical of their theory.

I now better understand how the Hansens came to believe that vaccines cause

autism, even though I still do not share their belief.

Like the Hansens, many of us have a hard time being truly scientific and

objective when our loved ones are involved. It's terribly hard to accept

that the universe operates in random ways and that innocents may be harmed.

What we choose to do with that sorrow is not always rational. We seek

explanations, no matter how unlikely they may be. And who knows: If my sons

were autistic, perhaps I, too, would have believed that something, maybe

even vaccines, could have caused it.

The Hansens, like most people, want the best health for children. " Vaccines

are one of the great successes of medicine, " says. He doesn't want to

stop vaccination, but rather allow parents to weigh the pros and cons. When

I explain that leaving the choice to parents can harm herd immunity, as in

Japan and Britain, he expresses genuine concern. " That's a very good point, "

he says.

Perhaps that is why it's better that our public health policies require

childhood vaccination and discourage individuals from making the choice

themselves. In the final analysis, the secret truth about vaccines may be

that, sometimes, personal freedom can be a dangerous thing.

Dr. Darshak Sanghavi, an assistant professor of pediatric cardiology at the

University of Massachusetts Medical School, is a Globe columnist and the

author of A Map of the Child: A Pediatrician's Tour of the Body. E-mail him

at sanghavi@....

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